1. The GME Committee Lois L. Bready, M.D. Associate Dean for GME and DIO Chair, GME Committee, UTHSC San Antonio John D. Rybock, M.D. Assistant Dean and Compliance Officer for GME, The Johns Hopkins University School of Medicine

2. The GMEC Why have a GMEC? Why have a GMEC? Requirements, Responsibilities Requirements, Responsibilities ACGME IRC Citations involving the GMEC ACGME IRC Citations involving the GMEC Structure & Function Structure & Function Membership Membership Organizational Chart Organizational Chart Meetings and Documentation Meetings and Documentation Minutes Minutes Increasing Effectiveness Increasing Effectiveness

3. The GMEC Why have a GMEC? ACGME Institutional Requirements (7/07) III ACGME Institutional Requirements (7/07) III Contains 26 separate references to GMEC! Contains 26 separate references to GMEC! Coordination of GME resources Coordination of GME resources Ensure compliance with lots of other entities (JCAHO, NRMP, state medical boards, state health depts, United Federation of Planets, etc.) Ensure compliance with lots of other entities (JCAHO, NRMP, state medical boards, state health depts, United Federation of Planets, etc.) Educational role – members, institution Educational role – members, institution Vehicle to achieve the work of GME

4. The GMEC Why have a GMEC? ACGME Institutional Requirements III “The Sponsoring Institution must have a GMEC.” “The Sponsoring Institution must have a GMEC.” Group - 13 specific areas of responsibility Group - 13 specific areas of responsibility Look at the IRD; keep it on your desktop Look at the IRD; keep it on your desktop Other tasks – we’ll get to these... Other tasks – we’ll get to these...

5. The GMEC “GMEC must establish & implement policies and procedures regarding the quality of education & the quality of education & the work environment the work environment for the residents in all programs” for the residents in all programs”

6. The GMEC 1. Resident funding/ benefits 2. Communication - PDs 3. Duty Hours 4. Resident supervision 5. Communication - OMS 6. Curriculum, evals: General Competencies 7. Resident selection, evaluation, promotion, transfer, discipline & dismissal 8. Program accreditation 9. Institutional accreditation 10. ACGME correspondence 11. Experimentation & innovation 12. Reductions & closures 13. Vendor interactions The 13 Specific Areas of Responsibility

7. The GMEC The 13 Specific Areas of Responsibility 1. Resident stipends, benefits, position allocation* 2. Communication – a) GMEC with PDs b) PDs with Site Directors at each participating site 3. Resident duty hours a) Written policies & procedures b) Consider requests for exceptions to 80 hour limit * At least annually

8. The GMEC 4. Resident supervision – monitor programs: a) Patient care safe & effective b) Educational needs of residents c) Progressive responsibility d) Compliance with CPRs, specialty-specific PRs 5. Communication with Medical Staff a) Annual report to OMS b) Education – Pt Safety & Quality of care c) Accreditation status and patient care citations

9. The GMEC 6. Curriculum & Evaluation 7. Resident status a) Selection b) Evaluation c) Promotion d) Transfer e) Discipline f) Dismissal

10. The GMEC 8. Oversight of program accreditation (Letters of Notification and Action Plans for Correction) 9. Institutional accreditation 10. Oversight of program changes (11 items) – essentially everything 11. Oversight of educational experiments & innovations 12. Oversight of reductions & closures 13. Vendor interactions

11. The GMEC Other GMEC responsibilities – IR IV. Internal Review process, approved protocol GMEC minutes document Int Rev ‘in process at midpoint’ Internal Review process, approved protocol GMEC minutes document Int Rev ‘in process at midpoint’ Monitor program responses to Int Rev recommendations Monitor program responses to Int Rev recommendations

12. The GMEC Adult Cardiothoracic Anesthesia Adult Cardiothoracic Anesthesia II.B: “There should be an institutional policy governing the educational resources committed to the adult cardiothoracic anesthesiology program.” Anesthesiology Critical Care Anesthesiology Critical Care II.B: “There should be an institutional policy governing the educational resources committed to critical care programs assuring cooperation of all involved disciplines.” Surgery Critical Care 1.A.2: Surgery Critical Care 1.A.2: “There should be an institutional policy governing the educational resources committed to critical care programs and ensuring cooperation of all involved disciplines.” Pediatric Critical Care VIII: “ Pediatric Critical Care VIII: “If there is more than one ACGME program in critical care medicine in the sponsoring institution, there should be an institutional policy governing the educational resources committed to these programs and ensuring cooperation of all disciplines involved.” Internal Medicine Critical Care Internal Medicine Critical Care – no longer addresses this

13. The GMEC Anesthesiology Pain Management Anesthesiology Pain Management I.B.4: “There must be an institutional policy governing the educational resources committed to pain medicine that ensures cooperation of all the involved disciplines.” Physical Medicine & Rehab Pain Mgmt Physical Medicine & Rehab Pain Mgmt: Same as above Neurology Pain Mgmt Neurology Pain Mgmt: Same as above Psychiatry Pain Mgmt Psychiatry Pain Mgmt: Same as above

14. The GMEC A major benefit of GMEC: Committee structure enhances effectiveness of the DIO “I think/need/have decided...” vs. “The GMEC says/requests/decided...”

15. The GMEC Structure & Function – Membership (Inst Reqs III.A.2) Voting membership Voting membership DIO DIO residents nominated by their peers residents nominated by their peers representative program directors representative program directors administrators administrators may include other members of the faculty or others may include other members of the faculty or others

16. The GMEC Structure & Function – Membership Residents nominated by their peers Mechanism(s) for peer-selection Mechanism(s) for peer-selection election election resident organization’s (elected) officers resident organization’s (elected) officers others others Roles in GMEC Roles in GMEC involvement in GMEC, subcommittees, etc. involvement in GMEC, subcommittees, etc. internal reviews – essential! internal reviews – essential! How to ensure meeting attendance How to ensure meeting attendance

17. The GMEC Structure & Function – Membership Representative program directors Which ones? Which ones? All vs. core programs vs. other All vs. core programs vs. other Mechanisms for rotating other PDs? Mechanisms for rotating other PDs? Other meetings with all PDs? (IR III.B.2.a) Other meetings with all PDs? (IR III.B.2.a) Roles in GMEC Roles in GMEC internal reviews internal reviews subcommittee work subcommittee work How to ensure meeting attendance How to ensure meeting attendance

18. The GMEC Structure & Function – Membership Administrators Which ones? Which ones? All participating institutions vs. primary All participating institutions vs. primary Who can add value to the process? Who can add value to the process? Reporting lines matter – incoming and outgoing Reporting lines matter – incoming and outgoing Roles in GMEC Roles in GMEC internal reviews internal reviews subcommittee work subcommittee work How to ensure meeting attendance How to ensure meeting attendance

19. The GMEC* Structure & Function – Membership Program Coordinators Which ones? Which ones? How selected? How selected? Roles in GMEC Roles in GMEC internal reviews internal reviews subcommittee work subcommittee work How to ensure meeting attendance How to ensure meeting attendance

20. The GMEC Structure & Function – Membership Anyone else who will add value to your GMEC*? Legal staff Legal staff Compliance officer Compliance officer Quality, risk management Quality, risk management Public member Public member CME, UME, Clinical deans CME, UME, Clinical deans Others Others Appointment vs. periodic reporting Appointment vs. periodic reporting *likely to evolve over time

21. The GMEC Structure & Function – Membership Voting vs. Non-voting members Implications Implications What will you be voting on? What will you be voting on?

22. The GMEC Structure & Function – Membership Documentation of attendance Institutional Site Visit – past 12 mo’ GMEC minutes Institutional Site Visit – past 12 mo’ GMEC minutes attendance – have back-ups attendance – have back-ups residents’ attendance residents’ attendance

23. The GMEC Structure of the GMEC & its components Distributed Labor (Texas Style) Distributed Labor (Texas Style) Subcommittees Subcommittees Quality & Accreditation Quality & Accreditation Resident Duty Hours Resident Duty Hours Education & Evaluation Education & Evaluation Resident Funding & Allocation Resident Funding & Allocation Working Environment Working Environment Resident Supervision Resident Supervision House Staff Council House Staff Council Program Coordinators Program Coordinators Steering/Executive committee Steering/Executive committee Chairs

24. Structure of the GMEC & its components  Centralized Labor (Baltimore Style)  Subcommittees  Only for internal review  Executive Committee  DIO, vice chair of GMEC, assistant dean for compliance, VPMA of primary hospital, registrar The GMEC*

25. The GMEC Structure of the GMEC & its components Lean and Mean GMEC Lean and Mean GMEC Small group that does it all Small group that does it all

26. The GMEC Structure & Function of the GMEC Frequency of meetings “ must meet at least quarterly” Frequency of meetings “ must meet at least quarterly” common model = monthly meetings common model = monthly meetings Duration of meetings Duration of meetings Location of meetings Location of meetings Format – round table, theater-style Format – round table, theater-style Videoconference? Videoconference? Food and drink? Food and drink? CME credit? CME credit? minimize barriers

27. The GMEC Structure & Function of the GMEC Calendar Calendar Reminders Reminders Agenda - email vs. hardcopy vs. both Agenda - email vs. hardcopy vs. both Projection vs. paper Projection vs. paper Standing agenda items Standing agenda items Best practices from your programs Best practices from your programs GME Visiting Professors GME Visiting Professors share with program-level speakers who do GME share with program-level speakers who do GME

28. The GMEC Approval of Minutes Reports from: DIO/Executive Comm Consent agenda* Best Practice(s) Reports from Subcommittees Quality/Accred All others Autopsies tracking ACGME RRC correspondence Each hospital – news & QI information Announcements Next meeting Closed session Residents in adverse status Standing Agenda Items - GMEC *action plans without controversy

29. Consent Agenda Part of the regular agenda - one of the first items Part of the regular agenda - one of the first items Items for information only, and do not require a decision or action (e.g., committee reports) Items for information only, and do not require a decision or action (e.g., committee reports) Allows all reports to be received with 1 motion & 1 vote Allows all reports to be received with 1 motion & 1 vote Members can ask questions - once dealt with, the vote on the single motion addresses all the consent agenda reports. Members can ask questions - once dealt with, the vote on the single motion addresses all the consent agenda reports. Removing an item from the CA - if needs action or a decision, or if significant further discussion is needed. Removing an item from the CA - if needs action or a decision, or if significant further discussion is needed. Any member can request that an item be removed from the consent agenda, but the majority should decide. Any member can request that an item be removed from the consent agenda, but the majority should decide.

30. The GMEC GMEC Minutes Must maintain written minutes (III.A.3) Must maintain written minutes (III.A.3) Format of minutes Format of minutes Paper vs. electronic vs. both vs. email & link to website Paper vs. electronic vs. both vs. email & link to website Distribution list – facilitate communication/QI issues Distribution list – facilitate communication/QI issues Institutional site visit: need past 1 year’s GMEC minutes Institutional site visit: need past 1 year’s GMEC minutes “If it isn’t documented, it didn’t happen*” *every organization whose rules you have to comply with

32. The GMEC Common ACGME Citations  - GMEC 1. IV.A.1 - GMEC composition & meetings 2. IV.B.4.a.1 – duty hours & call schedules monitored & adjusted 3. IV.B.4.b – procedures to monitor duty hours 4. IV.B.6 – curriculum/eval – gen’l competencies 5. IV.B.8 – review accred letters and monitor action plans

33. The GMEC In your sponsoring institution: How is the GMEC appointed? By whom? To whom does it report?

34. The GMEC For your sponsoring institution: How do your GMEC minutes document that it fulfills its responsibilities?

36. The GMEC For your sponsoring institution: Where is the GMEC on the organizational chart?

37. The GMEC

38. Challenge to you: Review & revise: GMEC membership list GMEC organizational chart GMEC minutes

39. After this meeting I plan to make the following GMEC changes: 1.2.3.