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UCF

UCF. Jay L. Falk, MD, FACEP, FCCM Chief Academic Medical Officer Medical Education Orlando Health. Professor of Medicine and Emergency Medicine University of Central Florida College of Medicine Assistant Dean for Clinical UME @ OH, UCF COM

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UCF

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  1. UCF

  2. Jay L. Falk, MD, FACEP, FCCMChief Academic Medical Officer Medical EducationOrlando Health Professor of Medicine and Emergency Medicine University of Central Florida College of Medicine Assistant Dean for Clinical UME @ OH, UCF COM Professor of Medicine and Emergency Medicine, FSU COM, UF COM and USF COM

  3. Lisette & Whitman

  4. Jay Falk, MD John Hillenmeyer, President/CEO “I’m looking for a position where I can slowly lose sight of what I originally set out to do with my life, with benefits.”

  5. John Hillenmeyer, President/CEO Jay Falk, MD “You’ll be a perfect addition to our expendable workforce.”

  6. MEDICAL EDUCATION • Pre-med – BS / BA • Medical school – MD / DO • GME (Graduate Medical Education) • Residency training • 3 – 7 years • Diplomat status • CME (Continuing Medical Education)

  7. ACCREDITATION, CERTIFICATION, LICENSURE • Medical Student Education • 125 US med schools • LCME – AMA, AAMC • GME • ACGME • 26 RRC’s Certification (voluntary) Licensure (mandatory) • ABMS • 24 specialty boards • Recertification • USMLE 3 part exam • NBME • Fed State Med Boards

  8. Corporate Sponsor Corporate Sponsor DIO Designated Institutional Officer Graduate Medical Education IRC RRC Program Directors ACGME Faculty Residents 1º Specialties Fellows Subspecialties JF ORMC 2011

  9. MEDICAL EDUCATION & HEALTHCARE • Societal contract • History • Current challenges • Opportunities

  10. MEDICAL EDUCATION & HEALTHCARE “It’s important to recognize that the caliber of doctors we have represents a negotiation between medical education and society. Our physicians reflect the type of people and society we are, not just the efforts of academic health centers. It would not be an exaggeration to say that as a nation we ultimately get the doctors we deserve. Kenneth Ludmerer Time to Heal 1999

  11. MEDICAL EDUCATION IN AMERICA • Civil War – 1920 – Medical Education in US worst – best in industrialized world. • 1893 – Johns Hopkins Medical School opens – becomes model • 1910 – “Flexner report” – Medical Education in the US and Canada Carnegie Foundation for the Advancement of Teaching • 1920’s – Flexnerian Revolution • Proprietary schools – University Schools • Public/Private Funding • State licensing laws • Proprietary schools loose accreditation • 1920’s – 1970’s Progressive education – Golden Era • Hands on – Academic medical centers (teaching hospitals) • GME develops • Medicare/Medicaid (1965) • 1980’s – Managed Care – Wall Street • 1990’s – present “Second Revolution”

  12. THE FIRST REVOLUTION • William Welch, 1st Dean, Johns Hopkins • “The advancement and development of medicine in itself required an improvement in the methods of teaching medicine” • Johns Hopkins University Press 1920

  13. FUNDRAISING • “keep in mind that we are a public service institution and see to it that you do not fail to help the public” • President Nicholas Butler, Columbia University…address to the medical faculty 1919

  14. UNIVERSITY AND “TEACHING HOSPITAL” • “There are few influences that exert as elevating an effect on the standard of professional work in a hospital as the presence in it of medical teaching” • “This is so true that the phrase ‘teaching hospital’ is almost synonymous with a good hospital” • Francis W. Peabody…..1923

  15. RESTORING THE SOCIAL CONTRACT • “The first step toward getting an endowment was to deserve one” • Charles Eliot, The Success of the Harvard Medical School. Boston Medical and Surgical Journal 1873;88:632

  16. MEDICAL SCHOOL CURRICULA • Flexner report 1910 • 2 years basic sciences • Anatomy • Biochemistry • Physiology • Microbiology • 2 years Clinical Clerkships • Internal Medicine • Surgery • OB-GYN • Pediatrics • Psychiatry • Electives (home/away) • Pharmacology • Pathology • Introduction to Clinical Medicine

  17. RECENT INOVATIONS IN MEDICAL SCHOOL CURRICULA • Content • Geriatrics / end of life care • Cultural competence / nutrition / family violence • Genetics / molecular biology • Medical decision making • Medical ethics • Teaching/Learning Methods • Organ system approach • Problem based learning • Small groups • Interactive • Earlier patient contact • Information Technologies • Using databases • Multimedia • Simulation

  18. MEDICAL STUDENT ASSESSMENT • OSCE’s • Objective structured clinical exams • Trained actors • Standardized patients • Direct (remote) faculty observers • Communication skills • Professionalism • NBME – Clinical Skills Component 2004 • National Board of Medical Examiners • 3 part exam • 12 interactions – standardized patients

  19. MEDICAL STUDENT CLINICAL EDUCATION • Inpatient services challenges • Narrower scope of illnesses in hospital • Complex, specialized problems in hospital • Short length of stay • Outpatient pre and post stay • Early stages not seen in-hospital • Outpatient teaching challenges • Clinics / offices away from campus • Decreased efficiency (throughput) • Consistency • Faculty models (private practice)

  20. GME – TEACHING /ASSESSING THE “NEW” COMPETENCIES • Patient care • Medical knowledge • Practice-based learning and improvement • Interpersonal and communication skills • Professionalism • Systems based practice

  21. RESIDENT SUPERVISION • Graded responsibility • Meaningful responsibility • Patient safety • ED • Trauma • CCM • OR • Resident credentialing

  22. GME SPONSORSHIP, OVERSIGHT, ACCOUNTABILITY • Decentralized system • 2003; 713 institutions, 7954 specialty programs • Over 100,000 residents • Sponsoring institution responsibility • Must have a DIO (designated institutional official) • Associate dean for GME • VP med-ed, DME, CAMO • Governing board ultimately responsible

  23. TEACHING HOSPITALS • 1100 Hospitals involved in Med Ed • 400 AAMC COTH Hospitals • Council of Teaching Hospitals • 281 Non-federal acute care • 19 Children’s hospitals • 12 Specialty hospitals • 64/116 VA medical centers • COTH Categories • Integrated Academic Medical Center Hospital n = 118; 43 shared ownership + 19 were shared – now split • Independent Academic Medical Center Hospitals n = 163

  24. COTH Members Provide Specialized Services… Short-Term, Nonfederal Hospitals Admissions Surgical Transplant Services COTH Members 21% 44% Other Hospitals 6% 79% 56% Burn Intensive Care Units Level 1 Regional Trauma Centers Arthritis Treatment Centers Source: AAMC Analysis of 2002 AHA Survey Data 69% 54% 42% 31% 46% 58%

  25. ……and Contribute a Disproportionate Share of Charity Care and Services to the Medicaid Population Short-Term, Nonfederal Hospitals Charity Care Medicaid Discharges 46% 26% 6% 94% 54% 74% COTH Members Source: AAMC Analysis of 2002 and 2003 AHA Survey Data Other Hospitals

  26. Hospital Total Margins by Teaching Status, 1996 - 2001 Major Teaching Hospitals 7.3% Other Teaching Hospitals 7.0% Other Hospitals 4.9% 3.4% 3.5% 1.1% 1996 1997 1998 1999 2000 2001 Source: MedPAC June 204 Data Book

  27. PHYSICIAN MANPOWER SHORTAGE • National problem • 85,000 MD’s short by 2020 • Drivers • Aging population (boomers) • Increasing demand-specialty services • Earlier MD retirement • Younger docs work fewer hours • Worse in Florida • Managed penetration • Liability crisis • Population growth

  28. FLORIDA LAGS BEHIND OTHER STATES • 41st in medical school graduates • 26th in physicians per 100,000 population • 24% fewer physicians per 100,000 population compared to 10 highest income states • Imports 80-90% of its new physicians • 3rd highest importer of international medical graduates

  29. FLORIDA NEEDS MORE RESIDENCY POSITIONS • Florida ranks 45th in slots/population • 3000 slots needed in 5 years to = national average

  30. HISTORY OF GME AT OH • First Interns – 1926 • Orange General Hospital • Designated teaching hospital – 1951 • Programs based on service needs • All voluntary faculty

  31. HISTORYOF GME AT OH • Accreditation Council for Graduate Medical Education (ACGME) 1960’s – present • Teaching not service • Increasing regulation/documentation • Due Process • Duty Hour Restrictions • “Competencies” • Full time program directors/faculty • Service/Teaching balance • “Town-Gown” collaboration • Programs “unburden” private Docs • Stimulating environment • Proud tradition

  32. GME at OH • Large full time faculty…nearly 300 • Olando Health Physician’s Group • 100 in med-ed • 65 MD Anderson • Pediatric specialists (APH) • “Geographic” full time..EM, Path, Colorectal • 248 Trainees (residents/ fellows) • 110 over the “cap” • Continuing to expand core program size • Developing new programs (fellowships) • Annual budget exceeds $100 M

  33. OH BOD Commitment • Service excellence (patient satisfaction) • Patient Safety • Physician communication • Physician behavior • Outcomes (measurable) • Medical Education

  34. Patient First Strategy • Transformational • Long Journey • Needs all of us • Working together

  35. 15

  36. It is all about Quality! Quality of Medical Staff/Teachers Quality of Resident Education Quality of Patient Care Quality of Research Culture of Quality

  37. Strategic Vision: Patient-First Orlando Health will create a Patient-First clinically integrated new model of care in collaboration with our medical staff to pursue seamless, quality outcome-driven extraordinary care.

  38. Patient safety service quality What Patients Want 1. Don’t Hurt Me 2. Help Me 3. Be Nice to Me

  39. Educational Challenge • Service versus Teaching • Economic Impact to Institution • Impact on Patient Care • Patient satisfaction • Patient Safety • Simulation • Supervision • Resident credentialing • competencies

  40. ACGME • Quality management is the newest “competency” • Didactic and experiential curriculum needed • Required • Part of “pay for performance” • OH GME committed

  41. Role of GME in Quality Improvement Residents on the Front Line Residents as Team Members Residents as Teachers Residents as Students of Quality and Safety Learning

  42. GME and Quality at OH AIAMC National initiative participant Resident participation on medical staff committees Resident initiated QI projects Research fair 5/23/2011

  43. ACTUAL SENTENCES FOUND IN PATIENTS’ HOSPITAL CHARTS

  44. On the second day the knee was better, and on the third day it disappeared.

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