The GME Committee

1. The GME Committee Lois L. Bready, M.D. Associate Dean for GME and DIO Chair, GME Committee, UTHSC San Antonio John D. Rybock, M.D. Assistant Dean and Compliance Officer for GME, The Johns Hopkins University School of Medicine

2. The GMEC • Why have a GMEC? • Requirements, Responsibilities • ACGME IRC Citations involving the GMEC • Structure & Function • Membership • Organizational Chart • Meetings and Documentation • Minutes • Increasing Effectiveness

3. The GMEC Why have a GMEC? • ACGME Institutional Requirements (7/07) III • Contains 26 separate references to GMEC! • Coordination of GME resources • Ensure compliance with lots of other entities (JCAHO, NRMP, state medical boards, state health depts, United Federation of Planets, etc.) • Educational role – members, institution Vehicle to achieve the work of GME

4. The GMEC Why have a GMEC? ACGME Institutional Requirements III • “The Sponsoring Institution must have a GMEC.” • Group - 13 specific areas of responsibility • Look at the IRD; keep it on your desktop • Other tasks – we’ll get to these . . .

5. The GMEC “GMEC must establish & implement policies and procedures regarding • the quality of education & • the work environment • for the residents in all programs”

6. Resident funding/ benefits Communication - PDs Duty Hours Resident supervision Communication - OMS Curriculum, evals: General Competencies Resident selection, evaluation, promotion, transfer, discipline & dismissal Program accreditation Institutional accreditation ACGME correspondence Experimentation & innovation Reductions & closures Vendor interactions The GMEC The 13 Specific Areas of Responsibility

7. The GMEC The 13 Specific Areas of Responsibility • Resident stipends, benefits, position allocation* • Communication – • GMEC with PDs • PDs with Site Directors at each participating site • Resident duty hours • Written policies & procedures • Consider requests for exceptions to 80 hour limit * At least annually

8. The GMEC • Resident supervision – monitor programs: • Patient care safe & effective • Educational needs of residents • Progressive responsibility • Compliance with CPRs, specialty-specific PRs • Communication with Medical Staff • Annual report to OMS • Education – Pt Safety & Quality of care • Accreditation status and patient care citations

9. The GMEC • Curriculum & Evaluation • Resident status • Selection • Evaluation • Promotion • Transfer • Discipline • Dismissal

10. The GMEC • Oversight of program accreditation (Letters of Notification and Action Plans for Correction) • Institutional accreditation • Oversight of program changes (11 items) – essentially everything • Oversight of educational experiments & innovations • Oversight of reductions & closures • Vendor interactions

11. The GMEC Other GMEC responsibilities – IR IV. • Internal Review process, approved protocol GMEC minutes document Int Rev ‘in process at midpoint’ • Monitor program responses to Int Rev recommendations

12. The GMEC • Adult Cardiothoracic Anesthesia II.B: • “There should be an institutional policy governing the educational resources committed to the adult cardiothoracic anesthesiology program.” • Anesthesiology Critical Care II.B: “There should be an institutional policy governing the educational resources committed to critical care programs assuring cooperation of all involved disciplines.” • Surgery Critical Care 1.A.2: “There should be an institutional policy governing the educational resources committed to critical care programs and ensuring cooperation of all involved disciplines.” • Pediatric Critical Care VIII: “If there is more than one ACGME program in critical care medicine in the sponsoring institution, there should be an institutional policy governing the educational resources committed to these programs and ensuring cooperation of all disciplines involved.” • Internal Medicine Critical Care – no longer addresses this

13. The GMEC • Anesthesiology Pain Management I.B.4: “There must be an institutional policy governing the educational resources committed to pain medicine that ensures cooperation of all the involved disciplines.” • Physical Medicine & Rehab Pain Mgmt: Same as above • Neurology Pain Mgmt: Same as above • Psychiatry Pain Mgmt: Same as above

14. The GMEC A major benefit of GMEC: • Committee structure enhances effectiveness of the DIO “I think/need/have decided . . .” vs. “The GMEC says/requests/decided . . .”

15. The GMEC Structure & Function – Membership (Inst Reqs III.A.2) • Voting membership • DIO • residents nominated by their peers • representative program directors • administrators • may include other members of the faculty or others

16. The GMEC Structure & Function – Membership Residents nominated by their peers • Mechanism(s) for peer-selection • election • resident organization’s (elected) officers • others • Roles in GMEC • involvement in GMEC, subcommittees, etc. • internal reviews – essential! • How to ensure meeting attendance

17. The GMEC Structure & Function – Membership Representative program directors • Which ones? • All vs. core programs vs. other • Mechanisms for rotating other PDs? • Other meetings with all PDs? (IR III.B.2.a) • Roles in GMEC • internal reviews • subcommittee work • How to ensure meeting attendance

18. The GMEC Structure & Function – Membership Administrators • Which ones? • All participating institutions vs. primary • Who can add value to the process? • Reporting lines matter – incoming and outgoing • Roles in GMEC • internal reviews • subcommittee work • How to ensure meeting attendance

19. The GMEC* Structure & Function – Membership Program Coordinators • Which ones? • How selected? • Roles in GMEC • internal reviews • subcommittee work • How to ensure meeting attendance

20. The GMEC Structure & Function – Membership Anyone else who will add value to your GMEC*? • Legal staff • Compliance officer • Quality, risk management • Public member • CME, UME, Clinical deans • Others • Appointment vs. periodic reporting *likely to evolve over time

21. The GMEC Structure & Function – Membership Voting vs. Non-voting members • Implications • What will you be voting on?

22. The GMEC Structure & Function – Membership Documentation of attendance • Institutional Site Visit – past 12 mo’ GMEC minutes • attendance – have back-ups • residents’ attendance

23. Chairs The GMEC Structure of the GMEC & its components • Distributed Labor (Texas Style) • Subcommittees • Quality & Accreditation • Resident Duty Hours • Education & Evaluation • Resident Funding & Allocation • Working Environment • Resident Supervision • House Staff Council • Program Coordinators • Steering/Executive committee

24. The GMEC* Structure of the GMEC & its components • Centralized Labor (Baltimore Style) • Subcommittees • Only for internal review • Executive Committee • DIO, vice chair of GMEC, assistant dean for compliance, VPMA of primary hospital, registrar

25. The GMEC Structure of the GMEC & its components • Lean and Mean GMEC • Small group that does it all

26. The GMEC Structure & Function of the GMEC • Frequency of meetings “must meet at least quarterly” • common model = monthly meetings • Duration of meetings • Location of meetings • Format – round table, theater-style • Videoconference? • Food and drink? • CME credit? minimize barriers

27. The GMEC Structure & Function of the GMEC • Calendar • Reminders • Agenda - email vs. hardcopy vs. both • Projection vs. paper • Standing agenda items • Best practices from your programs • GME Visiting Professors • share with program-level speakers who do GME

28. Approval of Minutes Reports from: DIO/Executive Comm Consent agenda* Best Practice(s) Reports from Subcommittees Quality/Accred All others Autopsiestracking ACGME RRC correspondence Each hospital – news & QI information Announcements Next meeting Closed session Residents in adverse status The GMEC Standing Agenda Items - GMEC *action plans without controversy

29. Consent Agenda • Part of the regular agenda - one of the first items • Items for information only, and do not require a decision or action (e.g., committee reports) • Allows all reports to be received with 1 motion & 1 vote • Members can ask questions - once dealt with, the vote on the single motion addresses all the consent agenda reports.  • Removing an item from the CA - if needs action or a decision, or if significant further discussion is needed. • Any member can request that an item be removed from the consent agenda, but the majority should decide.

30. The GMEC GMEC Minutes • Must maintain written minutes (III.A.3) • Format of minutes • Paper vs. electronic vs. both vs. email & link to website • Distribution list – facilitate communication/QI issues • Institutional site visit: need past 1 year’s GMEC minutes • “If it isn’t documented, it didn’t happen*” *every organization whose rules you have to comply with

32. The GMEC Common ACGME Citations  - GMEC • IV.A.1 - GMEC composition & meetings • IV.B.4.a.1 – duty hours & call schedules monitored & adjusted • IV.B.4.b – procedures to monitor duty hours • IV.B.6 – curriculum/eval – gen’l competencies • IV.B.8 – review accred letters and monitor action plans

33. The GMEC In your sponsoring institution: • How is the GMEC appointed? • By whom? • To whom does it report?

34. The GMEC For your sponsoring institution: • How do your GMEC minutes document that it fulfills its responsibilities?

36. The GMEC For your sponsoring institution: • Where is the GMEC on the organizational chart?

37. The GMEC

38. The GMEC Challenge to you: • Review & revise: • GMEC membership list • GMEC organizational chart • GMEC minutes

39. After this meeting I plan to make the following GMEC changes: 1. 2. 3.