1. Regions Emergency Medicine Residency October 23, 2008 Felix Ankel, MD

2. History n Accreditation 1995, 1999, 2003 n 81 graduates 1999-present n 108 residents 1996-present

3. 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

4. 81 graduates 1999-present n 50 Minnesota: 11 Regions, 7 Fairview-U, 6 North, 5 EPPA, 5 Abbott, 4 Duluth, 4 United, 3 HealthEast, 2 Waconia, Shakopee, Brainerd, Mayo n 26 out of state (15): SD 4, NE 3, IA 3, CO 2, IN 2, WI 2 ND 2, MS, OR, NH, MT, WA, UT, VA, NY n 12 Academic: 10 Regions, Wishard, Mayo n 15 Hybrid: 7 Fairview-U, 7 North, Mercy-Iowa City n 50 Community n 7 Fellows (2 toxicology, faculty development, critical care, simulation, informatics, ultrasound)

5. 108 residents (1996 - present) 25 medical schools n 37 U of M, n 8 UND n 6 USD, Mayo, MCW, Iowa n 4 Creighton, UW n 2 Nebraska, Loyola, Indiana, Kansas, Chicago Med School, Colorado n SUNY-Buffalo, SLU, Des Moines, Nevada, Vermont, Penn, Hawaii, East Carolina, Arizona, Utah, Michigan State, Albany, VA-COM, UCSF, Dartmouth, Yale, Tufts, Cincinnati

6. 31 Faculty (14 Different EM Residencies) n Regions x 10 n Henry Ford x 2 n Harvard Affiliated x 2 n Illinois x 2 n Pittsburgh n HCMC n Brooke Army n St Vincent’s n UCSF/Fresno n Christ n New Mexico n Indiana n Boston Medical Center n Grand Rapids n Michigan

7. Rotations (4 weeks blocks) n Year 1: ED 3.7, SICU 1.3, Ortho 1, MICU 1, Cards 1, OB 1, Mpls Kids 1, Anesthesia 1, Plastics 1, EMS 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

8. Residency Strategic Plan 2005-2010 4/28/05 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

9. 2006-2007 n Ultrasound workshops, EPIC, Relationship with hospitalists, Admin education, Pt based scheduling n Micro to macro: Integration with U of M, twin cites hospitals n EM education to EM delivery education: EMR, flow, quality, pt satisfaction n Rotation CQI throughout year n Leadership experiences: residents on national committees, society and editorial boards n Mentorship n Anatomy lab, procedure lab n 3 chief residents, off-service residents n Combined conferences, guest speakers, alumni engagement n Increased selective site, formalized Ecuador elective n Focus on ED teaching and feedback

10. 2007-2008 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

11. Program review 2008 n Residency coordination n HealthEast rotation (1) n MICU rotation n Resident responsibility and independence n EMS rotation n Residency leadership n Cardiology rotation n Orthopedics Rotation n ED Call Room n Admin rotation n Ultrasound n Research

12. 2008-2009 n Community ED rotations EM-2 & EM-3 n Clarification of back-up & pull residents n Ultrasound afternoons during anesthesia rotation n Improvement of cardiology rotation

13. Themes n Bedside teaching/microskills faculty assessment cards n Merging residency & quality movement n Merging residency & patient satisfaction movement

15. 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 More resources for residency

18. Questions to consider