In 2005, we were notified that we had passed our recent site visit with flying colors—receiving the maximum accreditation cycle of five years. We simultaneously became eligible to submit a proposal to participate in the Educational Innovations Project (EIP)—a demonstration project sponsored by the Internal Medicine Residency Review Committee (RRC) of the Accreditation Council of Graduate Medical Education (ACGME). This program offered selected programs with a history of accreditation excellence the opportunity to use a more streamlined set of regulations in exchange for agreeing to develop innovative educational programs and to provide data on both resident and patient outcomes under this innovation. Additionally, the RRC agreed that programs participating in this project would have their accreditation cycle extended to 10 years.
Never fear: Work hours restrictions and patient caps are the same for EIP programs as they are for all other residency programs.
Our residents and faculty wanted to lead the way in shaping the residency of the future.
Our residency program has a long tradition of educational innovations. For example, our strategy for teaching residents to analyze medical error through a novel morbidity and mortality conference has received national recognition and has been adopted by other medical centers across the country. Historically, the ACGME regulations, unlike the EIP, discouraged innovations. Our residents and faculty wanted to have the freedom to innovate and address some of the most difficult issues in residency education today.
We believe that physicians must willingly take on the responsibility of assessing and improving the quality of care they and their colleagues deliver. To do so requires education about strategies that enable physicians to identify care delivery problems and to lead the redesign of critical processes. Our residents and faculty believe that the best way to learn is by doing. The EIP provided a perfect opportunity to use data for the betterment of both patient care and resident education.
In the ACGME's Next Accredidation System (NAS), lessons learned from Internal Medicine EIP's provided the basis for much of the newly restructured system that began nationwide July, 2013.
The attached poster summarizes our EIP Strategy. All innovations are under the guidance and supervision of three resident-faculty design teams: the inpatient team, the outpatient team and the critical care team.
Quality Improvement: We believe that physicians of tomorrow must be comfortable analyzing data and initiating strategies to improve both their performance and the performance of their colleagues and institutions.
Demonstrable Competency: We believe that physicians of tomorrow must be capable of demonstrating competency through outcomes, not simply through the presence of a graduation certificate. Milestone-based evaluations are the natural next step for our program.
Effective Teamwork: We believe that health care of tomorrow will be delivered by a set of diverse multidisciplinary teams and that physicians must be capable of effectively leading and monitoring these teams.
Inpatient Wards: Patient satisfaction and infection control measures; safe and efficient transitions at discharge
Critical Care Units: Communication Training, Procedural training; Mock code initiatives
Outpatient: Resident and Patient Satisfaction with Access and Continuity; Clinical performance metrics
Redesign of Continuity Clinic into Blocks rather than weekly clinics
Procedural Competency through Simulation and Formal Assessment
Resident and Faculty driven assessment of interpretive skills
EKG and CXR reading training and assessment
Resident Clinic Dr. Friedman Assessments
Transitions of Care
Day team to night team
ICU to ward team
Inpatient to outpatient
Fundamentals of Critical Care coursework: Simulation based skills training
Optimizing response to the critically ill patient
Effective communication under crisis
METI® Anesthesia mannequin allows us the opportunity to run complex simulations of real-life critical care situations. These mannequins respond physiologically to physical (i.e. synchronized cardioversion) and chemical (i.e. medications) interventions and can be programmed to mimic many different physiologic conditions. This allows residents to test their diagnostic and therapeutic strategies in realistic but low stakes environments.
Central Line Simulators: with and without ultrasound. These simulators are used by residents to practice their procedural skills and to allow for faculty to ‘sign off’ on core techniques prior to practice on patients.
IV, endoscopic, arthrocentesis, and other simulators
The information warehouse is a central data repository that brings together clinical data, resource utilization data and financial data so that they can be easily searched. This can allow us to tie interventions in residency education to patient outcomes.
“As one of the 17 original EIP Programs, we feel challenged to continuously make our best better, for the sake of our trainees and the patients they serve.”