Program Directors’ Caucus Update

TDW 2013

Art DeCross MD AGAFAssociate Professor

Gastroenterology and Hepatology DivisionUniversity of Rochester Medical Center

Who are we?

Rafiki: The question is, who... are you?

For the new guys…The question might be:

We are this nation’s 156 GI Fellowship Training Programs#

SMALL MEDIUM BIG

3 fellows/year1-2 fellows/year > 4 /year*

*median 4 Range 4-10

30% 50% 20%

# Data from 2009 GI Fellowship Training environment survey

Mission Environment

ALL

SMALL

MEDIU

M BIG0

102030405060708090

100

TotalClinicalResearch

CLINICAL n=63

RESEARCH n=36

0

5

10

15

20

25

30

35

SMALLMEDIUMBIG

Why are we here?(Why create a Caucus?)

One good reason: Programs self-identified* with INADEQUATE OR MARGINAL RESOURCES

0

10

20

30

40

50

60

70

80

90

100

ALL SMALL MEDIUM BIG

TotalAT RISK

37%42%60%

46%

# of programs

* Data from 2009 GI Fellowship Training environment survey

Another good reason:Because this is what training used to look like

Apprenticeship model: Spend 3 years as my GI fellow, & you are a gastroenterologist.

GI FELLOWJuly 1, every year

And this is what someone wants it to look like…

Yes, the “M” word.

And it is usually at this point you New guys realize you need Indispensable Program Director Tools

How do we control our training environment?

Ideally…

GI Training Environment

AGA Training

Committee

ACG Training

Committee

Our profession would shape and guide the training environment, robustly responsive and adaptive to changing needs.

AASLD Training

Committee

ASGE Training

Committee

In Reality…

GI Fellowship Training Programs

AGA

ACG

ACGME dictates rules and defines the training environment. Programs are isolated. Input from the profession is well intentioned

but was prone to being slow, sporadic, unilateral and uncoordinated.

AASLD

ASGE

ACGME

ACGME(“we’re here to help”)

Program Director(“please stop helping”)

Why have a GI PD Caucus…

GI Training program environment

- GI PD Caucus -

AGAACGAASLD ASGE

ACGME

Isolated training programs

– lonely GI PDs -

Provide a more uniform training environment through sharing.

Coordinate a more responsive and deliberate support from the profession.

Caucus Mission Statement1. To serve the professional administrative

needs of all GI Fellowship Training Directors.

2. To more effectively promote the educational and training goals of our Profession, as advocated through all of our professional colleges, societies and associations.

3. To create a more effective interaction between our training programs and the agencies of GME which regulate them.

Functional objectives• Create a forum for rapid response to identifying and

addressing issues affecting training programs.

• Provide access to Training program directors’ perspective on agenda items advanced through our Education and Training committees, and on ACGME issues.

• Create a mechanism to more effectively communicate and implement shared educational and training goals of the Profession.

• Create standardized, validated tools and identify resources for program administration.

Functional Objectives- simplified -

• Identify the issues

• Facilitate communication

• Create the tools

Updated activities• Communication:– Match timeline shift finalized.– Chris Bowlus MD, PD UC Davis, represented GI– PD Caucus committed to measuring impact:• 2011 Match PDs and 1st year fellows surveyed

• Same survey will be conducted following Dec 2012 Match for the entering class of July 2013.

• Major concern remains the potential impact of the shortened interview season.

Just how healthyis the Match?

(after timeline shift?)

GI Fellowship Match Participation

*The NRMP lists this column as certified programs, counting all of the participating tracks in gastroenterology, as many as four for any single program. Excluding military programs, there are approximately 156 GI fellowship programs that are eligible to participate in the NRMP/SMS giving GI programs a 92% participation rate for positions starting in July 2013. NRMP and AGA Statistics (2013)

DATA from 2007-2012: courtesy of Deborah D. Proctor MD

Start Date Tracks* Programs Positions Total Matched

Offered Applicants Applicants

2007 134 112 285 585 276

2008 150 123 325 622 313

2009 153 126 339 608 328

2010 153 127 361 627 345

2011 157 130 383 642 362

2012 162 134 399 664 387

2013 171 144 433 695 418

Match survey (pre-timeline shift)• Existing first year fellows surveyed on Match

kinetics

• 72 respondents of 362 matched first year applicants (~20%)

• Recall: “old” Match completed application due mid-R2 year, required rotations, research, career plans, mentoring etc. to solidify as an intern

(pre-timeline shift)

Did you feel rushed in making your decision to enter the GI

Match process?

Yes No

80%

20%

(pre-timeline shift)Do you feel you had enough

time to build a solid CV for the GI Match process?

Yes No28%

72%

(pre-timeline shift)

0 - 10 11 ~ 25 26 - 50 51 - 75 76 - 100 > 1000

5

10

15

20

25

30

35

40

Column2

How many programs did you apply to in the Match?

# of program applications per applicant

(pre-timeline shift)

1~3 4~6 7~9 10~12 13-15 >150

5

10

15

20

25

30

Column2

How many programs did you get to interview at?

# of interviews per applicant

(pre-timeline shift)

Do you wish you had applied to:

More programs Less programs

I applied to just the right number

69%

24%

7%

(pre-timeline shift)

0 1 2 3 4 5 >50

10

20

30

40

50

60

70

Series 3

How many interviews did you decline due to unavoidable conflicts or lack of duty coverage?

# of interviews declined, per applicant, due to conflicts

(pre-timeline shift)• How many weeks were between your first

interview date and your last interview date?

– MEAN: 10.3 weeks (pre-timeline shift)

– MEDIAN: 10 weeks (pre-timeline shift)

Reminder: pre-timeline shift: Interview season technically Jan 1 thru May 21 (20 weeks max)practically Feb 1 thru May 1 (13 weeks)

(pre-timeline shift)

Did you feel rushed in for-mulating your match list after you interviewed?

Yes No

98.6%

1.4%

(pre-timeline shift)

1 2 3 4~5 >50.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

Series 3

Which ranked program on your list did you match?

What choice was your program (that you matched) on your rank-order list?

Match survey (pre-timeline shift)• GI Program Directors surveyed• 16/158 respondents = ~ 10%• 1. How many positions were offered in the

clinical track? Mean: 2.6

• 2. How many applicants were interviewed for your clinical track? Mean 37 (14.2 : 1)

• 3. How many applicants were ranked for your clinical track? Mean 25 (9.6 : 1)

Match survey (pre-timeline shift)• 8. What was the lowest rank # of the last

applicant to match at your program on your rank order list? (i.e. how far down the list did you go to fill the clinical positions at your program)

rank 1-7 rank 8-15 rank 16-25 rank >250

1

2

3

4

5

6

Series 3

Updated activities• Creating the tools:

– Focusing on curriculum modules for niche areas of the curriculum:

– Nutrition module: Completed!

– In various stages of progress:• Practice Management (Ryan Madanick MD)• Women’s Health Issues in GI (Kathryn Peterson MD)• Geriatrics (Charlene Prather MD)• Motility (TBD)

We need you to volunteer!Join a committee and share your expertise!

Early Challenges for the Caucus

Isolated training programs

Early Challenges for the Caucus…

GI Training program environment

AGAACGAASLD ASGE

ACGME

Provide a more uniform training environment through sharing.

Coordinate a more responsive and deliberate support from the profession.

Challenges

Program Director(“please stop helping”)

How do we go from this….

To this…everyone on the same team?

Governance Redesign of the GI Program Directors’ Caucus

Existing structureGI Training

program environment

From the 156 GI programs, a demographically representative steering committee body, selected based on program size and

training mission (clinical vs research)

PD Steering Committee

AGA training committeeACG training

committee

AASLD training committee ASGE training

committee

AGA governing boardASGE

governing boardACG governing

board

AASLD governing board

G8

Existing structure

• Problems:– Not nimble– Not timely– Competing agendas– 5th wheel - most of the training committees not

consulting with us, not sure where we fit in.

Proposed Structure

Governance Redesign of the GI Program Directors’ Caucus

AASLD

2012-2014ACG

2012-2014AGA

2012-2013ASGE

2012-2013

AASLD

2012-2013ACG

2012-2013AGA

2012-2014ASGE

2012-2014

Steering Committee

Big Research

2012- 2013

Medium

Clinical

2012-2014

Small

Clinical

2012-2014

Big Research

2012-2014

Medium

Clinical

2012-2013

Medium

Clinical

2012-2013

Small

Clinical

2012-2013

Medium

Research

2012-2013

Medium

Clinical

2012-2014

Small

Clinical

2012-2014

Advisory Board

Advisory Board

Steering Committee

AGA training cmt

ACG training cmt

AASLD training cmt

ASGE training cmt

AGA GB

ASGE GB

ACG GBAASLD GB

Incoming chair for the GI Program Directors’ Caucus

Thomas J. Savides MD• Professor, UC SanDiego• Executive Vice Chairman, UCSD Dept of Medicine • GI Program Director – June 2004 to present• Advanced Endo Training Director – 2001 - present• Clinical Services Chief, UCSD Gastroenterology• ASGE Training Committee 2005-07• ASGE Governing Board 2007-2010

Acknowledgements

• Course directors Walter Coyle and Jane Onken• Robert Sandler MD, AGA president supportive of

initiating the GI PD Caucus• AGA Education and Training committee which

nutured the development of the caucus• AGA staff, most particularly Ms. Tamara Jones of

the AGA, principle administrator for the Caucus • Countless volunteers among the GI Program

Directors