Preparing Residents

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					      University of Toronto
   Pre-Accreditation Workshop
       September 8, 2006


  Preparing Residents
    for Accreditation


Joseph Mikhael, MD, MEd, FRCPC
 Adam Natsheh, MD, BSc (Pharm)   1
Outline
 Introduction and Objectives
 Remembering Life as a Resident
 CAIR Accreditation Manual/Survey
 Top 7 things that residents should know
  going into accreditation
 Continuous Quality Improvement




                                        2
Introduction
   Our experience with accreditation:
     National RC Accreditation Committee
     Full University Reviews
     Special Surveys of other programs
     UofT Internal reviews
     UofT Internal Review Committee (IRC)




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Objectives
   After this discussion, you should be able
    to:
     Appreciate  accreditation from residents’
      point of view
     Feel comfortable discussing accreditation
      with your residents
     Explore difficult situations about
      accreditation with your residents
     Ensure that your program is making
      changes on an ongoing basis
     Believe that our daughters are cute…
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Life as a resident




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I’m not really a resident...




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…I just play one on TV




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If I only knew then…
 Think Back…..Way Back:
 Before life as a Program Director…
 Before life as a Staff person…
 To…life as a Resident…
     What  did you know then about
      accreditation?
     What questions or misconceptions did you
      have?
     Did you go through an accreditation visit? -
      What was it like?
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So many questions???
 What is
  accreditation?
 How will it affect us?
 How do we “pass”?
 How is this different
  from the internal
  review we just did?




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So Many Myths…




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FEAR OF THE UNKNOWN!
   What happens if we don’t get full approval
    (“pass”)?
       Will we be able to finish residency?
       Can we write the boards?
       Can we get a license/job?
   Will we be punished for bringing up major
    issues that haven’t been resolved?
       By chief/senior residents?
       By Program Director?
       By Chief?
       Will there be retribution (e.g. OR time)?

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CAIR Pre-accreditation
Manual/Survey
   CAIR Manual distributed to all residents
     Briefdescription of accreditation purpose
      and process

   CAIR Pre-Accreditation Survey
     Confidentialsurvey of all residents
      regarding accreditation standards
     Compiled and given to CAIR resident reps
      attending accreditation visit

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Residents Want to Know!
   Therefore - teach them about:
       Process
       Standards
       Categories of accreditation - less than full
        approval is not a bad thing
       Actual survey visit - what happens
 Opportunity to reinforce CanMEDS/Four
  Principles
 ? At academic 1/2 day or other teaching
  session
       Ask for help if needed - e.g. through Internal
        Review Committee
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Top 7 things residents need to
know about accreditation:
1)   Resident Input is Critical
2)   Accreditation is an impetus for a better
     program
3)   Less than full accreditation  bad
     residents
4)   Balance strengths and weaknesses
5)   All levels of residents must be heard
6)   This is your chance! (with caveats)
7)   Intimidation and Harassment
                                                18
1) Resident Input is Critical
 Resident input is highly valued by the surveyors!
 Are changes to the program having their
  intended effect?
 Residents should be:
     Open
     Honest
     Interactive and forthcoming with surveyors
   Residents should feel valued as a key
    stakeholder in the process
       Without residents there would be no program

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2) Accreditation is an impetus
for a better program
   Which residency program is perfect?
     None   - all have some room for improvement
   Accreditation is an opportunity to:
     Showcase     strengths and positive changes
      that have been made to program
     Critically reflect on how to make your
      program even better
     (Constructive feedback is a good thing!)
   Therefore residents should be open and
    honest
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3) Less than full accreditation
     bad residents
   Dispel myths of less than full approval
     Often  a temporary status
     Renovations: “we apologize for the
      inconvenience….”
     Doesn’t mean that residents are doing a poor
      job or are failing
     Often an impetus for systemic issues to be
      corrected - e.g. hospital safety concerns or
      political issues

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4) Balance strengths and
weaknesses (+ and -)
   Colleges want to hear and see
     All   strengths:
        Allows   for dissemination of best practices
     All   weaknesses:
        To    offer constructive feedback on how to make
            your program the best in the country




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5) All levels of residents must
be heard
 Ensure all levels of training are heard from
 Issues are often VERY different
 Can be intimidating for juniors to speak with
  chiefs and seniors present:
       Split by PGY level
       Small group - split into juniors and seniors - e.g.
        PGY1/2 and PGY-3 upwards
   Surveyors find time with residents extremely
    valuable – arguably most important
       You should feel that discussion is relevant to all levels
        of training
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 6) This is your chance (with
     caveats)
    This is your opportunity to optimize the
     process
    Caveats:
1.   Generally, there should be no huge surprises
        PD should communicate with resident group
         regularly, and be responsive to major concerns
         (e.g. “fix-it rounds”)
        Are changes at RTC having their intended effect?
2.   Beware of focusing on minutia
3.   The process should avoid letter writing
     campaigns – BUT if you do not think it was an
     open process, you can pursue further
     communication…
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7) Intimidation and Harassment
   Be sensitive to I and H
   Be aware that the CFPC and RC have a
    zero tolerance, and want to know about it
       If it exists (and it is a reality of training in all fields),
        hopefully it has already been exposed and it is
        being dealt with
   Do NOT try to cover it up
       This will only compound the problem
       It is “better” if it occurs, but has a process that
        works to correct it, than pretending it does not
        exist
   Occasionally, Accreditation is the only
    process that can uncover it
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7) Intimidation and Harassment

   Surveyors will look for due process
    through proper channels:
     University procedure
     Hospital procedure
     Was complaint taken seriously?
     Is system working?
     Are we confident that if a complaint arises
      in 2 months time, it will be handled
      appropriately and resolved?

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Quality Improvement
   Accreditation - only q 6 year snapshot

   Ongoing/Continuous Quality
    Improvement (CQI) preferred:
     Through     Residency Training committee
     You want to know about issues early
     Talk to residents
     “fix it” rounds


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Which daughter belongs to
whom #1?




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Which daughter belongs to
whom #2?




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Questions and Discussion




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