Perspectives of a Designated Institutional Official DIO

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Perspectives of a Designated Institutional
Official (DIO)

• Building effective relationships between the
  DIO, GME Office, Program Directors, Program
  Coordinators, and Residents Fellows

Graduate Medical Education
Robert B. Baron, MD, MS Associate Dean,
GME Designated Institutional Official
ARCOS Meeting March 6, 2008
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What is the DIO (at UCSF)?

• Oversee all ACGME programs
• Oversee all ABMS and non-standard programs
• Chair GMEC and conduct all Internal Reviews
• Provide annual reports to Medical Staffs and
  Governing Body
• Serve on key committees of School, Campus,
  Medical Centers, State and National Organizations
  (Eighty percent of success is showing up. Woody
  Allen)
• Advocate for residents and fellows to the Medical
  Centers and School of Medicine
• Support and provide expertise to Program
  Directors and Program Coordinators

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My personal mission

• Make sure the E in GME is not only present, but
  robust and innovative

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Definition of Dio(Dizionario Italiano-Inglese)

• Principal translation
• the All-knowing
• Additional Translations
• Prime mover
• God
• The all-wise

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On the other hand

• Dean is awfully close to dead.

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About UCSF
Facts and Figures

• Built in 1897
• The only UC campus dedicated exclusively to the
  health sciences
• School of Dentistry
• School of Medicine
• School of Nursing
• School of Pharmacy
• Graduate Division for Pre-doctoral and
  Postdoctoral Scientists
• Mission advancing health worldwide

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About UCSF
Facts and Figures (cont.)

• Campus locations
• The 107-acre Parnassus campus is home to
• UCSF Medical Center 600 beds
• UCSF Childrens Hospital 150 beds
• Langley Porter Psychiatric Institute 22 beds
• 43-acre Mission Bay campus
• Home of basic science expansion and future
  womens, children, and cancer hospital
• UCSF Mount Zion campus
• Site of ambulatory expansion
• 50-bed inpatient unit

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About UCSF
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Facts and Figures (cont.)

• Key partnerships with affiliated institutions
• San Francisco General Hospital (SFGH)
• A general acute care hospital, owned and operated
  by the City and County of San Francisco,
  Department of Public Health
• 340 beds, with 18,000 patients admitted annually
• Veterans Affairs Medical Center (VAMC)
• Established in 1934, the VAMC serves the health
  care needs of more than 310,000 veterans living
  in an 8-county area of Northern California. VAMC
  has 280 beds.

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About the School of Medicine
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• Mission
• The UCSF School of Medicine strives to advance
  human health through a fourfold mission of
  education, research, patient care and public
  service
• History
• 1864 Founded as Toland Medical College
• 1873 Became part of University of California
• 1898 School moved to present Parnassus campus
• 1907 First UC hospital opened, growing into
  Moffitt-Long Hospitals and UCSF Childrens
  Hospital

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About the School of Medicine
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• Highlights
• 26 academic departments, 9 organized research
  units, and 8 interdisciplinary research centers
• Ranked by U.S. News and World Report fifth
  overall in quality of research training and
  eighth nationally in quality of primary care
  training
• Ranked third among U.S. medical schools by NIH
  dollars awarded
• Ranked among the top 10 in seven of eight medical
  school specialty programs, including first in
  AIDS medicine, second in womens health, and
  third in internal medicine

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SOM Medical Education
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About Graduate Medical Education
Highlights

• 73 ACGME accredited residency and fellowship
  programs
• 21 residency programs
• 52 fellowship programs
• Over 50 non-standard programs
• Over 1,300 residents and clinical fellows
• Institution received Continued Accreditation for
  5 years

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Office of Graduate Medical Education
GME Faculty

• Robert B. Baron, MD, MSAssociate Dean for
  GMEDesignated Institutional Official
• Claire Brett, MDDirector, Internal Reviews
• Lee Learman, MD, PhDDirector, Curricular Affairs
• Mary McGrath, MDDirector, Resident Fellow
  Affairs
• Rene Salazar, MDDirector, Diversity Affairs
• Arpana Vidyarthi, MDDirector, Quality Patient
  Safety

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Office of Graduate Medical Education
GME Staff

• Lorenzo WooDirector
• Liza AsatoFinance Analyst
• Amy DayManager of Resident Fellow Affairs
• Sharon FreemanAnalyst for Associate Dean

• Heidy GarciaAccreditation Manager
• Gitanjali KapurEducation Technology Analyst
• Helen ShuiGME Administrative Analyst

Former Program Coordinator or other key
residency administrator
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Orthopaedic Surgery ACGME Programs
SECTION HEADING

• Orthopaedic Surgery Residency (PC Delphine Quan)
• Five-year program
• 30 residents (6 per year)
• Hand Surgery Fellowship (PC Delphine Quan)
• One-year program
• 1 fellow
• Sports Medicine Fellowship (PC Layne Sanders)
• One-year program
• 1 fellow

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Orthopaedic Surgery Non-Standard Programs
SECTION HEADING

• Arthroplasty
• Oncology
• Surgery of the Spine
• Orthopaedic Trauma

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Reaching Out to Residents and Fellows

• GME Grand Rounds
• The Residents Report
• Associate Dean Lunch with the Residents
• Chief Residents Dinner
• Residents Council
• New Resident Clinical Fellow Orientation
• Chief Resident Workshop
• Diversity Events
• Annual License Fair

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Reaching out to Residents and Fellows

• GME Grand Rounds
• This GME-sponsored conference is held monthly for
  residents and clinical fellows
• Available on DVD at the GME Office, video on the
  GME website, and Podcast

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Reaching out to Residents and Fellows

• The Residents Report
• Published quarterly by the Office of Graduate
  Medical Education
• Provides current updates, events, and information
  for the resident and clinical fellow.
• Issues are distributed to all residents and
  fellows in all Departments.

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Reaching out to Residents and Fellows

• Lunch with the Residents
• Held annually for each program.
• An opportunity for residents to confidentially
  discuss any issues or concerns, and talk about
  how things are going with their program.
• Led by the Associate Dean and Dr. Mary McGrath,
  Director of Resident Fellow Affairs for GME.

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Reaching out to Residents and Fellows

• Chief Residents Dinner
• Held monthly
• Chief Residents have dinner with the Associate
  Dean, CEO, CMO, and other hospital leadership and
  discuss issues and ideas related to residents and
  fellows in the Medical Center
• Led by the Associate Dean and the CEO of the UCSF
  Medical Center

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Reaching out to Residents and Fellows

• Residents Council
• Formed by residents to represent the more than
  1,300 UCSF Residents and Clinical Fellows (ACGME
  or non-ACGME) in academic and administrative
  forums.
• The Residents Council works toward developing
  and advocating alternative guidelines that will
  ultimately increase the educational value at
  UCSF.

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Reaching out to Residents and Fellows

• Resident Fellow Orientation
• Sponsored by the GME Office
• One day event held twice in June for incoming
  residents and fellows
• Includes
• Lectures on hospital and University required
  material
• Skills Lab Blood-borne and Airborne Pathogen
  Safety Training
• Vendor Fair

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Reaching out to Residents and Fellows

• Chief Resident Workshop
• Leadership development program held twice
  annually
• Topics include
• Leadership and Management
• Conflict Management
• Patient Safety
• Building a Chief Resident Community
• Time Management
• Career Mentoring
• Financial Planning

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Reaching out to Residents and Fellows

• Diversity Events
• Second Look visits for prospective residents
• Student National Medical Association (SNMA)
  Conference
• National Hispanic Medical Association (NHMA)
  Conference
• Diversity Dinners
• UME/GME Mentoring Program

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Reaching out to Residents and Fellows

• Annual License Fair
• Sponsored by the GME Office
• One-stop processing includes
• Notary
• Photographer
• Live Scan Fingerprinting
• Representative from the California Medical Board

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Resident Support and Enhancement Programs

• 24-Hour GME Confidential Hotline
• Resident Well-Being Program
• Housing Allowance
• Patient Care Fund
• Blumberg Loan
• License and USMLE Step 3 Fee Reimbursement
• Everyday Errands Program

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Resident Support and Enhancement Programs

• UCSF Medical Center Incentive Program
• Program Description
• Program provides direct financial bonuses to
  residents and fellows based on achieving quality
  and operational goals which are linked to
  achieving excellence in patient care.
• Goals for FY2007-08
• Patient Satisfaction
• Patient Safety and Compliance
• Pain Management

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Resident Support and Enhancement Programs

• UCSF Medical Center Incentive Program (cont.)
• Eligibility
• All residents and clinical fellows at UCSF
  Medical Center sites for at least 12 weeks (84
  days)
• Payment
• For Fiscal Year 2007-2008, payment will be based
  on achievement of 3 quality and operational
  goals, at a rate of 400 each for a maximum
  possible incentive payment of 1,200.

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Educational Innovations

• Learning Portfolios
• Curriculum Committee
• Evaluation Task Force
• Innovations in Medical Education Funding
• Research Courses
• Resident Teaching Program
• Teaching Workshop

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Educational Innovations

• Pathways to Discovery Program
• To foster the pursuit of discovery, inquiry, and
  innovation for every physician trained at UCSF,
  by providing medical students, residents, and
  fellows with opportunities for in-depth training
  in one of several areas of inquiry that go beyond
  the routine practice of medicine.

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Educational Innovations

• Pathways to Discovery Program (cont.)
• The Pathways include
• Molecular Medicine
• Clinical and Translational Research
• Community Health and Health Policy
• Global Health
• Health Professionals Education

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Program Director Development

• Faculty Development Workshops
• Sponsored by the Office of Medical Education, in
  conjunction with Office of GME and the Academy of
  Medical Educators.
• Monthly topics include
• Developing Skills in the Art of Effective
  Feedback and Remediation
• The Educators Portfolio
• Competency-Based Education and Evaluation
• Preparing and Conducting Site Visits

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Program Director Development

• New Program Director Orientation
• The Associate Dean conducts one-on-one
  orientation sessions with new Program Directors

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Program Director Development

• The Haile T. Debas Academy of Medical Educators
  is dedicated to creating an environment that
  enhances the status of teachers of medical
  students at UCSF, promotes and rewards teaching
  excellence, fosters curricular innovation, and
  encourages scholarship in medical education.
• Increasingly inclusive of GME.

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Innovations Funding of Academy

• Examples 6 of 9 related to GME 25-30K each
• Cross-pathways Core Writing Courses Scientific
  Writing, Reflective Writing, Advocacy Journalism
• Health Policy Training Program
• Curriculum to Train Health Care Leaders in UME
  and GME
• Shared Outpatient Clinic for Medicine Residents
• Procedural Skills Training for UME and GME
• Competencies in Community Engagement for UME and
  GME

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Program Coordinator Development

• Program Coordinator Quarterly Meeting (PCQM)
• Representation on Graduate Medical Education
  Committee (GMEC)
• GME Program Coordinator Workshops
• GME Management System EValue and Egme

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Program Coordinator Development

• Program Coordinator Quarterly Meeting (PCQM)
• 80 Program Coordinators meet quarterly for
  professional development training and to get the
  latest updates on GME-related topics and issues.
• Cited as best practice by ACGME
• Associate Deans Update begins each meeting

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Program Coordinator Development

• Program Coordinator Quarterly Meeting (PCQM)
• Recent topics include
• Streamlining the Interview Scheduling
  Process Cathy Ratti, Program Manager,
  Pediatrics
• Taking the Stress Out of Interviews Carol
  Piunti, Program Coordinator, Neurology
• Annual Program Coordinator Awards
  Presentation Amy Day, Manager of
  Resident/Fellow Affairs, GME
• Professionalism and Re-defining the Role of the
  Program Coordinator Ruth Nawotniak, MS, C-TAGME
• Dealing with Difficult People, Stress and Anger
  Management Andrew Parker, Faculty/Staff
  Assistance Program

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Program Coordinator Development

• Representation on Graduate Medical Education
  Committee (GMEC)
• Program Coordinator representatives sit on the
  Graduate Medical Education Committee.
• Program Coordinators provide valuable input and
  play a role in the decision-making process in
  GME.

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Program Coordinator Development

• GME Program Coordinator Workshops
• Program Coordinator workshops are conducted by
  the GME Office throughout the year. These
  include
• How To Prepare for a Site Visit
• Resident and Fellow Appointment Process
• Licensing Process
• GME Management System Training

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Program Coordinator Development

• The GME Management System EValue and Egme
• The system is currently being implemented at UCSF
  and will be launched on July 1, 2008.
• The system will manage and streamline
• Appointments
• Rotation Scheduling
• Duty Hours Tracking and Monitoring
• Evaluations
• Procedure Tracking
• Portfolios
• Medicare Cost Reporting

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Program Coordinator Development

• The GME Management System EValue and Egme

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OLPPS
Manage Employee Data Create Paychecks
Rotation Schedule Resident Reports Actual
TimeACGME Rules Duty Hour Violations Evaluations
Medicare Reporting Affiliate Billing
GME Management System
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RFS
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Cost Center (DPA/Fund) Tracking Common
Paymaster/Reporting
HBS
Medicare Cost Report
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Program Coordinator Development

• In the Works
• Program Coordinator Job Description
• Program Coordinator Training Manual and Online
  Training Modules

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Questions and Comments
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GME Programs Residency (21)
SECTION HEADING

• Residency Programs
• Anesthesiology
• Dermatology
• Emergency Medicine
• Family Medicine
• Internal Medicine
• Neurology
• Neurological Surgery
• Nuclear Medicine
• Obstetrics Gynecology
• Ophthalmology
• Orthopaedic Surgery

• Otolaryngology
• PathologyAnatomic Clinical
• Pediatrics
• Plastic Surgery
• Psychiatry
• Radiation Oncology
• Radiology-Diagnostic
• Surgery
• Surgery-East Bay
• Urology

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GME Programs ACGME Fellowships (52)
SECTION HEADING

• Forensic Psychiatry
• Gastroenterology
• Geriatric Medicine
• Geriatric Psychiatry
• Hand Surgery
• Hematology
• Hematology and Oncology
• Infectious Disease
• Interventional Cardiology
• Medical Toxicology
• Molecular Genetic Pathology
• Neonatal-Perinatal Medicine

• Fellowship Programs
• Adolescent Medicine
• Cardiovascular Disease
• Child and Adolescent Psychiatry
• Child Neurology
• Clinical Cardiac Electrophysiology
• Clinical Neurophysiology
• Colon and Rectal Surgery
• Critical Care Medicine (AN)
• Critical Care Medicine (IM)
• Cytopathology
• Dermatopathology
• Endocrinology, Diabetes, and Metabolism

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GME Programs ACGME Fellowships (52)
SECTION HEADING

• Fellowship Programs (cont.)
• Nephrology
• Neuropathology
• Neuroradiology
• Orthopaedic Sports Medicine
• Pain Medicine
• Pediatric Anesthesiology
• Pediatric Cardiology
• Pediatric Critical Care Medicine
• Pediatric Endocrinology
• Pediatric Gastroenterology
• Pediatric Hematology/Oncology
• Pediatric Infectious Diseases

• Pediatric Nephrology
• Pediatric Pulmonology
• Pediatric Radiology
• Pediatric Rheumatology
• Pediatric Urology
• Preventive Medicine (General)
• Preventive Medicine (Occupational Medicine)
• Procedural Dermatology
• Pulmonary Disease and Critical Care Medicine
• Rheumatology

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GME Programs ACGME Fellowships (52)
SECTION HEADING

• Fellowship Programs (cont.)
• Surgical Critical Care
• Thoracic Surgery
• Transplant Hepatology
• Vascular and Interventional Radiology
• Vascular Neurology
• Vascular Surgery

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