Internal Medicine Residency Training Program Update

1
Internal Medicine Residency Training Program
Update

• DOIM Faculty Meeting
• March 31, 2008

2
Update

• 2008 match
• ABIM Board Pass Rate 94
• National average 93
• Duty hours issues

3
Match 2008

• National data
• 4,858 IM categorical positions offered in match
• 372 programs
• 2.2 positions unfilled (107/4858)
• 4.9 positions unfilled in Southern region
• 54.8 positions filled by US seniors

4
VCU 2008 recruitment
70
15
Numbers inflated and do not sum due to
applicants applying to multiple tracks Planned
for additional intern taken outside the match
(transfer from VCU program)
5
VCU 2008 Match
6
VCU 2008 Intern Class
7
Work hours

• Monitoring
• Program
• Institution
• Resident reporting
• ACGME
• Resident survey
• Program reporting
• Site visit

8
Work hours

• 80-hour rule
• Duty hours must be limited to 80 hours per week,
  averaged over a four-week period, inclusive of
  all in-house call activities.
• 30-hour rule (24 plus 6)
• Continuous on-site duty, including in-house call,
  must not exceed 24 consecutive hours. Residents
  may remain on duty for up to six additional hours
  to participate in didactic activities, transfer
  care of patients, conduct outpatient clinics, and
  maintain continuity of medical and surgical care.
  

9
Work hours

• 10-hour rule (adequate rest)
• Adequate time for rest and personal activities
  must be provided. This should consist of a
  10-hour time period provided between all daily
  duty periods and after in-house call.
• Note that 8-hours is acceptable in some call
  schedules IF program informs ACGME (VCU)
• 1 day in 7 rule
• Residents must be provided with one day in seven
  free from all educational and clinical
  responsibilities, averaged over a four-week
  period, inclusive of call.

10
Distribution of 80-hour violations by rotation
(07-08)
332 HOUSESTAFF REPORTING DUTY HOURS
11
80-hour violations due to rotation (07-08)
12
Distribution of 30-hour violations by rotation
(07-08)
332 HOUSESTAFF REPORTING DUTY HOURS
13
30-hour violations due to rotation
14
MRICU plans

• Long-term
• Rotation structure change
• 4-weeks of MRICU over 8-week block
• 2-wk MRICU / 2-wk ambulatory / 2-wk MRICU / 2-wk
  ambulatory
• Goal decrease 80-hour violations
• Additional staffing
• Physician/resident extenders
• Goal decrease 30-hour violations

15
MRICU plans

• Immediate changes (continue long-term)
• Change in MRICU conference structure
• Decrease number of 8am conferences (now daily)
• Goal decrease 30-hour violations and impact
  80-hour
• Change in rounding time to 8am
• Goal decrease 30-hour violations and impact
  80-hour
• Monitoring and reminders on unit daily reports
• Additional staffing
• Resident extender for post-call team
• Will pull from current bridge system
• Specific duties to be outlined
• Goal decrease 30-hour violations

16
Program duty hour plans

• MCV Wards
• Revisit structure
• Monitor 80-hour with removal of bridge system
  (necessary given MRICU issues)
• Consider no overnight calls
• Continued monitoring
• Increase compliance