University of Medicine and Dentistry of New Jersey

University of Medicine and Dentistry of New Jersey-

Robert Wood Johnson Medical School

Graduate Medical Education

Annual Report

for

Academic Year

2010-2011

9

Marie C. Trontell, MD

Associate Dean for Graduate Medical Education

Chair, Graduate Medical Education Committee

Designated Institutional Official

University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School

Reviewed and approved by the UMDNJ- RWJMS Graduate Medical Education Committee at its November 8, 2011 meeting.

University of Medicine and Dentistry of New Jersey - Robert Wood Johnson Medical School (RWJMS)

Graduate Medical Education Annual Report

Academic Year July 1st, 2010-June 30th, 2011

I. INTRODUCTION AND OVERVIEW

Graduate Medical Education (GME) is required training of medical school graduates which results in competence in a specialty/subspecialty of medicine and board eligibility in that field. The number of years required to complete training in a given specialty/subspecialty is determined by the respective Residency Review Committee of the Accreditation Council for Graduate Medical Education (ACGME) or Board of Medical Specialties. The ACGME is responsible for the accreditation of allopathic graduate medical education programs; it has five member organizations: the American Board of Medical Specialties, the American Hospital Association, the American Medical Association, the Association of American Medical Colleges, and the Council of Medical Specialty Societies.

In 2010-2011, UMDNJ-Robert Wood Johnson Medical School (RWJMS) sponsored forty-eight residency and fellowship programs and has a close relationship with the Physical Medicine and Rehabilitation Residency program at John F Kennedy. Forty-five of the RWJMS programs are under the auspices of the ACGME, two are under the auspices of the American Board of Obstetrics-Gynecology and one is accredited by the Society of Surgical Oncology.

RWJMS has affiliation agreements with hospitals participating in required rotations for its GME programs: Atlantic Health System (Overlook), Capital Health Regional Medical Center, CentraState, Children’s Specialized Hospitals, Cooper University Medical Center, Deborah Heart and Lung Hospital, Jersey Shore University Medical Center, John F Kennedy Hospital, Raritan Bay Medical Center, Robert Wood Johnson University Hospital, Robert Wood Johnson University Hospital at Hamilton, Saint Peters University Hospital, University Behavioral Health Care, University Medical Center at Princeton, the Veterans Affairs New Jersey Health System, and the Philadelphia Veterans Affairs System. RWJMS is also affiliated with residency programs not sponsored by RWJMS at some hospital sites.

RWJMS, through its Graduate Medical Education Committee (GMEC) and the Office of Graduate Medical Education (GME), has the ultimate responsibility for all of the GME programs sponsored by the school. The school’s responsibility for GME includes demonstrating an overall commitment to graduate medical education, maintaining affiliation agreements with institutions participating in GME, monitoring the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) status of participating institutions, ensuring that formal quality assurance programs are conducted at participating institutions, monitoring eligibility and selection of residents, monitoring all aspects of resident appointment, monitoring resident participation in educational and professional activities, monitoring the residents’ work environment, and monitoring the institution and all programs’ compliance with Accreditation Council for Graduate Medical Education (ACGME) requirements. The school examines program outcome measures, conducts extensive internal reviews of each GME program, and monitors program compliance with the ACGME standards, especially limitations on duty hours. The school ensures that each program teaches and assesses the ACGME general competencies: Patient Care, Medical Knowledge, Practice-Based Learning, Interpersonal and Communication Skills, Professionalism, and Systems–Based Practice. The Office of Graduate Medical Education facilitates the registration and permit process required of all unlicensed physicians in New Jersey and provides support for each residency and fellowship program and for the Graduate Medical Education Committee (GMEC).

The Associate Dean for Graduate Medical Education, Marie Trontell, MD, is the Designated Institutional Official (DIO), whom the ACGME defines as having “the authority and responsibility for all the ACGME-accredited GME programs”. The Associate Dean reports to the Senior Associate Dean for Education, Carol Terregino, MD.

The GMEC, whose existence and activities are prescribed by the RWJMS Bylaws and by the Accreditation Council for Graduate Medical Education (ACGME), met ten times during academic year 2010-11. There were 199 members, including program directors, chief residents, peer-elected residents, the Associate Dean for Graduate Medical Education (the Designated Institutional Official), and administrative representatives from each participating affiliated hospital. The membership of the GMEC elected the Associate Dean for GME to be the committee chair. The GMEC advises the Dean on all aspects of graduate medical education, conducts internal reviews of all residency and fellowship programs, oversees the accreditation status of all programs and all programmatic interactions with accrediting bodies, and discusses ACGME and Residency Review Committee (RRC) requirements, JCAHO regulations, patient care issues, hospital and resident issues, and state and federal legislation affecting GME.

Working with the Office of Graduate Medical Education, the GMEC has developed and approved policies which govern all programs. These policies are gathered and filed in the GME Policy Manual, which is maintained on the RWJMS GME web site (http://rwjms.umdnj.edu/education/GME)

II. OUTCOME MEASURES

A. Accreditation Status of Programs at UMDNJ-RWJMS

UMDNJ-Robert Wood Johnson Medical School is the sponsoring institution for forty-nine active Graduate Medical Education Programs, forty-five of which are eligible for ACGME accreditation and are fully accredited by the ACGME. The following programs underwent ACGME site visits in the 2010-11 academic year:

1.  Family Medicine Residency RWJ-New Brunswick – July 13, 2010 - Continued Accreditation

2.  Pathology Residency– September 29, 2010 – Continued Accreditation

3.  Adult Cardiothoracic Anesthesia Fellowship – September 30, 2010 – Continued Accreditation

4.  Surgery Critical Care Fellowship – December 10, 2010 – Initial Accreditation

5.  Forensic Psychiatry Fellowship April 14, 2011 – Continued Accreditation

6.  Anesthesia – May 24, 2011 – Report pending

7.  Pediatric Developmental –Behavioral – May 25, 2011 – Report pending

8.  Family Medicine Sports Medicine – May 26, 2011 – Continued Accreditation

9.  RWJMS as an institution and 25 of its programs eligible for ACGME accreditation currently have received the maximum possible number of years of continued accreditation after their most recent site visits. No programs received any citations concerning patient care or safety issues. The following table shows the current Accreditation Status of all residency and fellowship programs.

ACGME Accreditation Status Report as of June 30, 2011

* sponsored by JFK

OTHER PROGRAMS SPONSORED BY RWJMS

B. Performance on Certifying Examinations

Performance on board certification examinations is carefully reviewed each year. During 2010, 132 graduates of 34 RWJMS programs took certifying board examinations; 110 passed on their first attempt (83.3%). The board passage rate was 100% for first time takers from 24 of the 34 programs. The average program percent passage rate on board examinations for first time takers in 2010 was 87.7%. The average percent passing rate for all RWJMS programs in 2004 was 90.2%, in 2005 was 91.3%, in 2006 was 95.90%, in 2007 was 93.40%, in 2008 was 88.1%, and in 2009 was 93%.

C. National Resident Matching Program

UMDNJ-RWJMS programs matched 95.8% of sought positions via the 2011 National Resident Matching Program (NRMP); 92.3% of the matched positions were filled by US senior students. In the 2011 NRMP, the following programs filled all matched positions with US seniors: Anesthesia, Dermatology, Internal Medicine Preliminary, Internal Medicine Categorical, Neurology, Obstetrics-Gynecology, Orthopedic Surgery, Pathology, Psychiatry, Radiology, Radiation Oncology, Surgery Preliminary, and Surgery Categorical.

III. ACTIVITIES OF THE GMEC DURING 2010-11

A. Resident Supervision

The GMEC made certain that all programs would be fully compliant with new ACGME policies on resident supervision, which became effective July 1, 2011. The new regulations require that each sponsored residency program develop a policy and procedure on resident supervision which specifies that residents are provided with progressively increasing responsibility for patient care according to their level of education, ability, and experience. These policies must specify the extent to which residents may undertake patient care without direct supervision. The classifications of supervision include: (1) Direct Supervision, in which the supervising physician is physically present with the resident and patient; (2) Indirect Supervision with direct supervision immediately available, in which the supervising physician is physically within the hospital or other site of patient care, and is immediately available to provide direct supervision; (3) Indirect supervision with direct supervision available, in which the supervising physician is not physically present within the hospital or other site of patient care, but is immediately available by means of telephone and/or electronic modalities, and is available to provide direct supervision; and (4) Oversight, in which the supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered. The new regulations also stipulate that PGY-1 residents should be supervised either directly or indirectly with direct supervision immediately available until the resident has demonstrated sufficient competence to progress to being supervised indirectly with direct supervision available. The new regulations also stipulate that each sponsored program must establish schedules which show the supervising physicians and guidelines for circumstances and events in which residents must communicate with appropriate supervising faculty members.

The GMEC reviews a yearly status report, collected by the GME Office, on each program’s policies governing resident and fellow supervision to ensure that each program monitors the supervision of its trainees at all participating sites. Each trainee is assigned to a designated service and back-up is available at all times through more senior house officers and attending physicians. Each program director is responsible for establishing detailed written policies describing resident supervision at each level for each site involved in the residency program. A copy of each program’s supervision policy is kept on file in the GME Office. Resident supervision is also monitored through the GMEC Internal Review process and annual “focus group” meetings held by the Associate Dean for GME with the trainees in each program.

B. Resident Responsibility

The GME office maintains a copy of each program’s descriptions of the roles for each year of residency training, which are required to be affixed to the resident’s contract. The contract is signed by the resident, the Program Director, the Department Chair, and the Associate Dean for GME.

The GMEC reviewed each program’s process for assessing their residents’ competence in specific procedures and documenting that competence for participating hospitals.