The GME CommitteeThe GME Committee
Lois L. Bready, M.D.Lois L. Bready, M.D.Associate Dean for GME and DIO Associate Dean for GME and DIO
Chair, GME Committee, UTHSC San AntonioChair, GME Committee, UTHSC San Antonio
John D. Rybock, M.D. John D. Rybock, M.D. Assistant Dean and Compliance Officer for GME, Assistant Dean and Compliance Officer for GME,
The Johns Hopkins University School of MedicineThe Johns Hopkins University School of Medicine
The GMECThe GMEC
Why have a GMEC?Why have a GMEC? Requirements, ResponsibilitiesRequirements, Responsibilities ACGME IRC Citations involving the GMECACGME IRC Citations involving the GMEC Structure & FunctionStructure & Function
MembershipMembership Organizational ChartOrganizational Chart
Meetings and DocumentationMeetings and Documentation MinutesMinutes
Increasing Effectiveness Increasing Effectiveness
The GMECThe GMEC
Why have a GMEC?Why have a GMEC? ACGME Institutional Requirements (7/07) IIIACGME Institutional Requirements (7/07) III
Contains Contains 2626 separate references to GMEC! separate references to GMEC! Coordination of GME resourcesCoordination of GME resources Ensure compliance with lots of other entities Ensure compliance with lots of other entities
(JCAHO, NRMP, state medical boards, state (JCAHO, NRMP, state medical boards, state health depts, United Federation of Planets, etc.)health depts, United Federation of Planets, etc.)
Educational role – members, institutionEducational role – members, institution
Vehicle to achieve the work of GMEVehicle to achieve the work of GME
The GMECThe GMEC
Why have a GMEC?Why have a GMEC?ACGME Institutional Requirements IIIACGME Institutional Requirements III “ “The Sponsoring Institution must The Sponsoring Institution must
have a GMEC.” have a GMEC.” Group - 13 specific areas of responsibilityGroup - 13 specific areas of responsibility Look at the IRD; keep it on your desktopLook at the IRD; keep it on your desktop
Other tasks – we’ll get to these . . . Other tasks – we’ll get to these . . .
The GMECThe GMEC
““GMEC must establish & GMEC must establish & implement policies and implement policies and procedures regarding procedures regarding
the quality of education &the quality of education & the work environment the work environment for the residents in all programs”for the residents in all programs”
The GMECThe GMEC
1.1. Resident funding/ Resident funding/ benefitsbenefits
2.2. Communication - PDsCommunication - PDs3.3. Duty HoursDuty Hours4.4. Resident supervisionResident supervision5.5. Communication - OMSCommunication - OMS6.6. Curriculum, evals: Curriculum, evals:
General CompetenciesGeneral Competencies7.7. Resident selection, Resident selection,
evaluation, promotion, evaluation, promotion, transfer, discipline & transfer, discipline & dismissaldismissal
8.8. Program Program accreditationaccreditation
9.9. Institutional Institutional accreditationaccreditation
10.10. ACGME ACGME correspondencecorrespondence
11.11. Experimentation & Experimentation & innovationinnovation
12.12. Reductions & Reductions & closuresclosures
13.13. Vendor interactionsVendor interactions
The 13 Specific Areas of ResponsibilityThe 13 Specific Areas of Responsibility
The GMECThe GMEC
The 13 Specific Areas of ResponsibilityThe 13 Specific Areas of Responsibility1.1. Resident stipends, benefits, position Resident stipends, benefits, position
allocationallocation**
2.2. Communication – Communication – a)a) GMEC with PDsGMEC with PDs
b)b) PDs with Site Directors PDs with Site Directors at each participating siteat each participating site
3.3. Resident duty hoursResident duty hoursa)a) Written policies & proceduresWritten policies & procedures
b)b) Consider requests for exceptions to 80 hour limitConsider requests for exceptions to 80 hour limit
* At least annually
The GMECThe GMEC
4.4. Resident supervision – monitor programs:Resident supervision – monitor programs:a)a) Patient care safe & effectivePatient care safe & effective
b)b) Educational needs of residentsEducational needs of residents
c)c) Progressive responsibilityProgressive responsibility
d)d) Compliance with CPRs, specialty-specific PRsCompliance with CPRs, specialty-specific PRs
5.5. Communication with Medical StaffCommunication with Medical Staffa)a) Annual report to OMSAnnual report to OMS
b)b) Education – Pt Safety & Quality of careEducation – Pt Safety & Quality of care
c)c) Accreditation status and patient care citationsAccreditation status and patient care citations
The GMECThe GMEC
6.6. Curriculum & EvaluationCurriculum & Evaluation7.7. Resident status Resident status
a)a) SelectionSelectionb)b) EvaluationEvaluationc)c) PromotionPromotiond)d) TransferTransfere)e) DisciplineDisciplinef)f) DismissalDismissal
The GMECThe GMEC
8.8. Oversight of program accreditation (Letters Oversight of program accreditation (Letters of Notification and Action Plans for of Notification and Action Plans for Correction)Correction)
9.9. Institutional accreditationInstitutional accreditation10.10. Oversight of program changes (11 items) – Oversight of program changes (11 items) –
essentially everythingessentially everything11.11. Oversight of educational experiments & Oversight of educational experiments &
innovationsinnovations12.12. Oversight of reductions & closuresOversight of reductions & closures13.13. Vendor interactionsVendor interactions
The GMECThe GMEC
Other GMEC responsibilities – IR IV.Other GMEC responsibilities – IR IV. Internal Review process, approved Internal Review process, approved
protocol GMEC minutes document Int Rev protocol GMEC minutes document Int Rev ‘in process at midpoint’‘in process at midpoint’
Monitor program responses to Int Rev Monitor program responses to Int Rev recommendationsrecommendations
The GMECThe GMEC Adult Cardiothoracic AnesthesiaAdult Cardiothoracic Anesthesia II.B: “There should be an institutional policy governing the
educational resources committed to the adult cardiothoracic anesthesiology program.”
Anesthesiology Critical CareAnesthesiology 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 CareSurgery Critical Care 1.A.2: 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 CarePediatric Critical Care VIII: “ 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 CareInternal Medicine Critical Care – no longer addresses this
The GMECThe GMEC Anesthesiology Pain ManagementAnesthesiology 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 MgmtPhysical Medicine & Rehab Pain Mgmt: Same as above
Neurology Pain MgmtNeurology Pain Mgmt: Same as above Psychiatry Pain MgmtPsychiatry Pain Mgmt: Same as above
The GMECThe GMEC
A major benefit of GMEC:Committee structure enhances effectiveness of the DIO
“I think/need/have decided . . .”vs.
“The GMEC says/requests/decided . . .”
The GMECThe GMEC
Structure & Function – MembershipStructure & Function – Membership(Inst Reqs III.A.2) (Inst Reqs III.A.2) Voting membershipVoting membership
DIODIO residents nominated by their peersresidents nominated by their peers representative program directors representative program directors administratorsadministrators may include other members of the faculty or othersmay include other members of the faculty or others
The GMECThe GMEC
Structure & Function – MembershipStructure & Function – MembershipResidents nominated by their peersResidents nominated by their peers
Mechanism(s) for peer-selectionMechanism(s) for peer-selection electionelection resident organization’s (elected) officersresident organization’s (elected) officers othersothers
Roles in GMECRoles in GMEC involvement in GMEC, subcommittees, etc.involvement in GMEC, subcommittees, etc. internal reviews – internal reviews – essential!essential!
How to ensure meeting attendanceHow to ensure meeting attendance
The GMECThe GMEC
Structure & Function – MembershipStructure & Function – MembershipRepresentative program directorsRepresentative program directors
Which ones?Which ones? All vs. core programs vs. otherAll vs. core programs vs. other Mechanisms for rotating other PDs?Mechanisms for rotating other PDs? Other meetings with Other meetings with allall PDs? (IR III.B.2.a) PDs? (IR III.B.2.a)
Roles in GMECRoles in GMEC internal reviews internal reviews subcommittee worksubcommittee work
How to ensure meeting attendanceHow to ensure meeting attendance
The GMECThe GMEC
Structure & Function – MembershipStructure & Function – MembershipAdministratorsAdministrators
Which ones?Which ones? All participating institutions vs. primaryAll participating institutions vs. primary Who can add value to the process?Who can add value to the process? Reporting lines matter – incoming and outgoingReporting lines matter – incoming and outgoing
Roles in GMECRoles in GMEC internal reviews internal reviews subcommittee worksubcommittee work
How to ensure meeting attendanceHow to ensure meeting attendance
The GMEC*The GMEC*
Structure & Function – MembershipStructure & Function – MembershipProgram CoordinatorsProgram Coordinators
Which ones?Which ones? How selected?How selected?
Roles in GMECRoles in GMEC internal reviewsinternal reviews subcommittee worksubcommittee work
How to ensure meeting attendanceHow to ensure meeting attendance
The GMECThe GMEC
Structure & Function – MembershipStructure & Function – MembershipAnyone else who will add value to your GMEC*?Anyone else who will add value to your GMEC*?
Legal staffLegal staff Compliance officerCompliance officer Quality, risk managementQuality, risk management Public memberPublic member CME, UME, Clinical deansCME, UME, Clinical deans OthersOthers
Appointment vs. periodic reportingAppointment vs. periodic reporting
*likely to evolve over time
The GMECThe GMEC
Structure & Function – MembershipStructure & Function – MembershipVoting vs. Non-voting membersVoting vs. Non-voting members
ImplicationsImplications What will you be voting on?What will you be voting on?
The GMECThe GMEC
Structure & Function – MembershipStructure & Function – MembershipDocumentationDocumentation of attendance of attendance Institutional Site Visit – past 12 mo’ GMEC Institutional Site Visit – past 12 mo’ GMEC minutesminutes
attendance – have back-upsattendance – have back-ups residents’ attendance residents’ attendance
The GMECThe GMECStructure of the GMEC & its components Distributed Labor (Texas Style)Distributed Labor (Texas Style)
Subcommittees Subcommittees Quality & AccreditationQuality & AccreditationResident Duty HoursResident Duty HoursEducation & EvaluationEducation & EvaluationResident Funding & AllocationResident Funding & AllocationWorking EnvironmentWorking EnvironmentResident SupervisionResident SupervisionHouse Staff CouncilHouse Staff CouncilProgram CoordinatorsProgram Coordinators
Steering/Executive committeeSteering/Executive committee
Chairs
Structure of the GMEC & its components
Centralized Labor (Baltimore Style)Centralized Labor (Baltimore Style) SubcommitteesSubcommittees
Only for internal reviewOnly for internal review Executive CommitteeExecutive Committee
DIO, vice chair of GMEC, assistant dean for DIO, vice chair of GMEC, assistant dean for compliance, VPMA of primary hospital, compliance, VPMA of primary hospital, registrarregistrar
The GMEC*The GMEC*
The GMECThe GMEC
Structure of the GMEC & its components Lean and Mean GMECLean and Mean GMEC
Small group that does it allSmall group that does it all
The GMECThe GMEC
Structure & Function of the GMEC Frequency of meetings Frequency of meetings ““must meet at least quarterlymust meet at least quarterly” ”
common model = monthly meetingscommon model = monthly meetings Duration of meetingsDuration of meetings Location of meetings Location of meetings Format – round table, theater-styleFormat – round table, theater-style Videoconference?Videoconference? Food and drink?Food and drink? CME credit?CME credit?
minimize minimize barriersbarriers
The GMECThe GMEC
Structure & Function of the GMEC CalendarCalendar RemindersReminders Agenda - email vs. hardcopy vs. bothAgenda - email vs. hardcopy vs. both Projection vs. paper Projection vs. paper Standing agenda items Standing agenda items Best practices from your programsBest practices from your programs GME Visiting Professors GME Visiting Professors
share with program-level speakers who do GMEshare with program-level speakers who do GME
The GMECThe GMEC
Approval of Minutes Reports from:
DIO/Executive Comm
Consent agenda* Best Practice(s) Reports from
Subcommittees Quality/Accred All others
Autopsies tracking
ACGME RRC correspondence
Each hospital – news & QI information
Announcements Next meeting Closed session
Residents in adverse status
Standing Agenda Items - GMEC
*action plans without controversy
Consent AgendaConsent Agenda
Part of the regular agenda - one of the first itemsPart of the regular agenda - one of the first items Items for Items for information onlyinformation only, and do not require a , and do not require a
decision or action (e.g., committee reports)decision or action (e.g., committee reports) Allows all reports to be received with 1 motion & 1 Allows all reports to be received with 1 motion & 1
votevote Members can ask questions - once dealt with, the Members can ask questions - once dealt with, the
vote on the single motion addresses all the consent vote on the single motion addresses all the consent agenda reports. agenda reports.
Removing an item from the CA - if needs Removing an item from the CA - if needs actionaction or a or a decisiondecision, or if , or if significant further discussionsignificant further discussion is needed. is needed.
Any member can request that an item be removed Any member can request that an item be removed from the consent agenda, but the majority should from the consent agenda, but the majority should decide.decide.
The GMECThe GMEC
GMEC Minutes Must maintain written minutes (III.A.3)Must maintain written minutes (III.A.3) Format of minutesFormat of minutes Paper vs. electronic vs. both vs. email & link to Paper vs. electronic vs. both vs. email & link to websitewebsite Distribution list – facilitate communication/QI issuesDistribution list – facilitate communication/QI issues Institutional site visit: Institutional site visit: need past 1 year’s GMEC need past 1 year’s GMEC minutesminutes“If it isn’t documented, it didn’t happen*”*every organization whose rules you have to comply with
The GMECThe GMECCommon ACGME Citations - GMEC
1.1. IV.A.1 - GMEC composition & meetingsIV.A.1 - GMEC composition & meetings2.2. IV.B.4.a.1 – duty hours & call schedules IV.B.4.a.1 – duty hours & call schedules
monitored & adjustedmonitored & adjusted3.3. IV.B.4.b – procedures to monitor duty IV.B.4.b – procedures to monitor duty
hourshours4.4. IV.B.6 – curriculum/eval – gen’l IV.B.6 – curriculum/eval – gen’l
competenciescompetencies5.5. IV.B.8 – review accred letters and IV.B.8 – review accred letters and
monitor action plansmonitor action plans
The GMECThe GMEC
In your sponsoring institution: How is the GMEC appointed? By whom? To whom does it report?
The GMECThe GMEC
For your sponsoring institution: How do your GMEC minutes document that it fulfills its responsibilities?
The GMECThe GMEC
For your sponsoring institution: Where is the GMEC on the organizational chart?
The GMECThe GMEC
The GMECThe GMEC
Challenge to you: Review & revise:
GMEC membership list GMEC organizational chart GMEC minutes
After this meeting I plan to After this meeting I plan to make the following GMEC make the following GMEC
changes:changes:1.1.
2.2.
3.3.
Top Related