Anesthesiology Training Program Accreditation Challenges

Anesthesiology Training Program Accreditation Challenges AAPD/SAAC November 2005 Why the Question • A large portion of our training programs are on probation or on short review cycles • Are there lessons learned from our successes and shortfalls? • Are there some things we can do or should be doing? • Can the RRC review/report provide leverage in Med School/Hospital negotiations? Survey • Relationship with Institution – Private vs Public; Non-Profit vs For-Profit – Other GME programs in your hospital • Department Make-Up – Faculty mix (generalist; specialist) – Administrative help (non-billing staff) – Size of residency (Is larger or smaller better) – Use of mid level providers (CRNA; AA) – Estimate of clinical workload deterrents Survey… • Teaching Environment – Work hours; Work hour violations – Lectures; Mentoring for underperformance – Faculty to Resident ratios – Training Tests; Mock Oral Exams – Outside meetings (Dept Support) • Academic Enhancement – Fellowships Offered – Funding (NIH; Industry) – School of Medicine and Hospital Support Survey… • Citations (Number; Type) • Relationship to Evaluation, Review Cycle and ?? Probation?? N=36 Progs 28 % Resp 16 By Region / Public or Private N/A Private Public Number of Programs 14 12 10 8 6 4 2 0 CE 10 NE 15 SO 5 WE 6 Region (#) Non-Profit / For-Profit 100% 90% 80% 70% None/Both For-Profit Non-Rofit Percent 60% 50% 40% 30% 20% 10% 0% CE 10 NE 15 SO 5 WE 6 Region NONE ON Probation 16 Current Accreditation Pending Full Number of Programs 14 12 10 8 6 4 2 0 CE NE SO WE Region N=36 Progs 28 % Resp 18 Review Cycle 16 16 Number of Programs 14 12 10 8 6 6 4 2 0 1 3 1 9 6 5 4 3 2 PEND Years Between Reviews N=36 Progs Review Cycle 16 18 16 Number of Programs 14 12 10 8 6 6 4 2 0 1 3 1 9 6 5 4 3 2 PEND Years Between Reviews Department Make-Up • • • • • Faculty mix (generalist; specialist) Administrative help (non-billing staff) Size of residency (Is larger or smaller better) Use of mid level providers (CRNA; AA) Estimate of clinical workload deterrents Faculty By Specialty 25 Number Per Program 20 15 10 5 0 Crit Care OB Ped Specialty Card Neur Pain Gen Faculty:Resident Ratio 3 2 1 0 2 year 3 Year 4 Year 5 Year Review Cycle Admin Staff Per Program 25.0 20.0 15.0 10.0 5.0 0.0 2 3 4 Review Cycle 5 Resident Number in Program 50 45 40 35 30 25 20 15 10 5 0 2 year 3 Year 4 Year 5 Year Review Cycle Mid Level Providers (MLPs) 35 30 25 20 1 5 1 0 5 0 Yes No CRNA AA AVG 10,760 Resident Work Hours P er Week 64 62 60 58 56 54 2 3 4 5 Review Cycle Teaching Aides • • • • 35 of 36 33 of 36 35 of 36 36 of 36 Sent residents to meetings $$ from Dept, 2 shared, 1 resident Provide Mock Oral Exams Use In-Service Training Exam Daily Lectures 1.2 1.0 0.8 0.6 0.4 0.2 0.0 2 3 4 5 Review Cycle AKT Test Series 4 3 2 1 0 2 3 4 5 Review Cycle Academic Exposure • • • • 35 of 36 28 of 36 19 of 36 30 of 36 Advanced Clinical Track Advanced Scientist Track NIH Funding Industry Funding 2 Year Cycle Programs 4 3 2 1 0 Crit Care OB Ped Card Neur Pain Y-2 N 4 2 0 1 8 6 4 Year Cycle Programs Y N 2 3 4 5 6 3 Year Cycle Programs 7 6 5 4 3 2 1 0 Crit Care OB Ped Card Neur Pain Y N 5 Year Cycle Programs 15 10 5 0 Crit Care OB Ped Card Neur Pain Y N Faculty vs Fellowship 14 12 10 8 6 4 2 0 Crit Care OB Ped Card Neur Pain 2 Year Review Cycle 14 12 10 8 6 4 2 0 Crit Care OB Faculty vs Fellowship Faculty Program Faculty Program Ped Card Neur Pain N=3 4 Year Review Cycle N=9 Faculty vs Fellowship 14 12 10 8 6 4 2 0 Crit Care OB Ped Card Neur Pain 3 Year Review Cycle 14 12 10 8 6 4 2 0 Crit Care OB Faculty vs Fellowship Faculty Programs Faculty Program Ped Card Neur Pain N=6 5 Year Review Cycle N=17 Med School and Hospital Support 30 25 M D Sch Hosp Percent of Revenue 20 15 10 5 0 2 3 4 5 Review Cycle NIH Funding 80 Percent of Programs 70 60 50 40 30 20 10 0 2 3 4 5 Years Review Cycle Industry Funding 120 Percent of Programs 100 80 60 40 20 0 2 3 4 5 Year of Review Cycle Citations by Year of Review Cycle 12.0 10.0 8.0 6.0 4.0 2.0 0.0 2 3 4 5 6 R eview C ycle Citations by Review Cycle 10 Number of Citations 9 8 7 6 5 4 3 2 1 0 2 2 2 3 3 3 3 3 3 4 4 4 4 4 4 4 4 45 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 6 Review Cycle in Years Citations 2 Year Review Programs • • • • • • Inadeq scholarly act (3) Too many residents (2) No res/post op notes (2) Low ABA cert rate (2) No QA involvement (2) ICU exper inadequate (2) • • • • • • • Low blocks for Ca pain Low case diversity More 1:2 res coverage Prog Dir qualifications No neuroanesth fac Inadequate library Core competencies not incorporated • Affil sites not registered Citations 3 Year Review Programs • • • • Low scholarly act (3) Low ABA cert rate (3) Too many residents (2) Poor specialty experience – Poor ICU involv (2) – Poor pain curriculum – Low Nerve blocks # – Low trauma # – Poor PACU (in OR) – Poor evoked potent. # – low ACLS cert rate • • • • • • Low fac non-clin time 66% Fac ABA cert rate Low Inst support MLPs Acting chair CBY curric violation Low res/post op notes Citations 4 Year Review Programs Too many residents (2) • CBY curric violation Excess service demands • Acting chairperson Low ABA cert pass rate • Core competency not documented Poor Specialty Experience • Confusion about G&Os – low block numbers • Res:Fellow designation – pain/OB only in CA3 – limited ICU rotations • Inadequate off space – NO chronic pain program • Inadequate locker room • Little research • • • • Citations 5 Year Review Programs • • • • Affiliate program form clarification (2) Low post op notes Poor case lot entries Poor Specialty experience – – – – low specialty cases low OB minimums low pain procedures low Crit Care teaching – low FOB experience Conclusions • Small sample size; conclusions limited Further information Apparent association - Short Review Cycle • Lower resident number • Lower admin staff number • Reduced fellowship offering • Reduced specialty faculty • Reduced specialty experience