Regions Emergency Medicine Residency October 29, 2009 Felix Ankel, MD

History n Accreditation 1995, 1999, 2003, 2009 n 90 graduates 1999-present n 118 residents 1996-present

Mission:PAPEEMCE Provide and promote excellence in emergency medicine care and education n Patient centered n Resident focused n Team oriented n Transparency n Professionalism n Knowledge n Skills n Attitudes n Core competencies n Contribution to specialty

90 graduates 1999-present n 59 Minnesota: 13 Regions, 10 EPPA, 7 Fairview-U, 6 North, 5 Abbott, 4 Duluth, 4 HealthEast, 3 United, 2 Waconia, Shakopee, Brainerd, Rochester, New Ulm, Princeton n 29 out of state: SD 4, NE 3, IA 3, CO 2, IN 2, WI 2, ND 2, NY 2, WA 2, CA, MS, MT, NH, OR, UT, VA, n 15 Academic: 13 Regions, Wishard, Mayo n 14 Hybrid: 7 Fairview-U, 6 North, Mercy-Iowa City n 60 Community n 7 Fellows (2 toxicology, faculty development, critical care, simulation, informatics, ultrasound)

118 residents ( present) 34 medical schools n 41 U of M n 8 UND n 7 MCW, Iowa, USD n 6 Mayo n 5 Creighton n 4 UW n 2 Nebraska, Loyola, Indiana, Kansas, Chicago Med School, Colorado, Loma Linda n SUNY-Buffalo, SLU, Des Moines, Nevada, Vermont, Penn, Hawaii, East Carolina, Arizona, Utah, Michigan State, SUNY-Syracuse, VA-COM, UCSF, Dartmouth, Yale, Tufts, Cincinnati, Morehouse

26 Faculty (12 Different EM Residencies) n Regions x 12 n Henry Ford x 2 n Harvard Affiliated x 2 n Illinois x 2 n HCMC n Brooke Army n St Vincent’s n Christ n Indiana n Boston Medical Center n Grand Rapids n Michigan

Rotations (4 weeks blocks) n Year 1: ED-I 5.7, SICU 1.3, Ortho 1, MICU 1, Cards/Hosp 1, OB 1, Mpls Kids 1, Plastics 1 n Year 2: ED 7.3, SICU 1.3, Community ED 1, MICU 1, St Paul Kids 1.3, Tox/Adm 1 n Year 3: ED/ St Paul kids 9.7, SICU 1.3, Elective 1, Community ED 1

Residency Strategic Plan /28/05 n SWOT analysis n Conferences n Simulation n Mentorship n Administrative curriculum n Scholarly activity n Individualization of educational experience n Integration with U of M n Integration with twin city hospitals n National presence

n Conference changes –Move to Thursdays –Increase critical case to 90 minutes –Increase simulation time during conf –Pre-conference sim sessions n Structured ultrasound workshops n Schedule change from teams to sides, 10-hr shifts n Doctors Dahms, Morgan and Taft assume roles as Asst. PDs n Incorporation of Peds-EM faculty (Ortega & Reid) into Residency n Hosting of Ecuadorian EM residents n EM/FM combined residency discussions n E-portfolio application submission to ACGME n Specialized interview days n Resident self-eval on shift cards n Nurse mentorship program

2008 Retreat Minutes n Strengths: critical care experience, procedural experience, collegiality/camaraderie n Area of focus : ultrasound machines, documentation, EKG training, evening food availability

n Community ED rotations EM-2 & EM-3 n Clarification of back-up & pull residents n Ultrasound afternoons during anesthesia rotation n Melding of cardiology & hospitalist rotation

Program review 2009 n Residency coordination n Toxicology rotation n Resident support n Residency leadership n Independence n Progressive responsibility n Cardiology rotation n Admin rotation n ED Conference rooms n ED Exam rooms n HCMC rotation n Plastics rotation

n ED-I rotation (EM, Anes, EMS) n 3 new ultrasound machines n EM-3 Peds anesthesia n New ED n Cards/Hospitalist rotation n Fellowship development (EMS, International)

Future Directions n Less resources for GME n More resources for quality movement n Quality movement based on sustained change in behavior n Education = sustained change in behavior n Change residency from knowledge-based residency to quality residency n Quality matrix (Bingham, Quinn)

SAEM Annual Meeting May 22, 2005 New York City, NY

The Matrix

Thoughts n Caring for patients vs. treating patients n Complex vs. complicated system n Wisdom of Crowds, James Surowiecki n The Culture Code, Clotaire Rapaille n The Foucault Reader, Paul Rabinow (Ed.) –Enlightenment vs. obedience –Knowledge, power, ethics

Questions to Consider n How do we build on our strengths? n How do we address our weaknesses? n How do we integrate quality and education? (conferences, clinical practice/rotations, projects…) n What 9 quality service lines should we begin with? (e.g., cardiovascular, neurosciences, trauma, behavioral health…)

Regions Emergency Medicine Residency October 29, 2009 Felix Ankel, MD