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H e i d i K r o m r e i , P h DC l i n i c a l F a c u l t y , M i c h i g a n S t a t e U n i v e r s i t y C o l l e g e o f O s t e o p a t h i c M e d i c i n e

A s s i s t a n t D e a n , W a y n e S t a t e U n i v e r s i t y S c h o o l o f M e d i c i n e

Proven Practical Approaches to

Increasing Scholarly Activity for Residents

and FacultyWebinar for the Statewide Campus System

College of Osteopathic Medicine at Michigan State University

February 5, 2019

1. Understand the evolving ACGME requirements and expectations for scholarly activity in residency programs

2. Recall strategies to increase program scholarly activity

Session Goals

2018 ACGME REQUIREMENT:FACULTY SCHOLARLY ACTIVITY

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Participation in Professional Activities/Committees Publications Presentations Chapters/TextbooksGrant Leadership Leadership or Peer-

Reviewed Role Teaching Formal Courses Participation in Quality

Improvement Projects

How is Scholarly Activity Currently Measured by ACGME?

ACGME FACULTY SCHOLARLY ACTIVITY DEFINITIONS

Source: ACGME Web ADS

Professional Activities/Committees

Bibliography

Review Articles, Chapters, Textbooks

Presentations, Abstracts, Grants

ACGME CURRENT FACULTY SCHOLARLY ACTIVITY

REPORTING (INITIAL TO CONTINUED)

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2018 ACGME REQUIREMENTS: RESIDENT SCHOLARLY ACTIVITY

RESIDENT SCHOLARLY ACTIVITY DEFINITIONS

Source: ACGME Web ADS

ACGME CITATION: INITIAL APPLICATION

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2019 ACGME COMMON PROGRAM

REQUIREMENTS: SCHOLARLY ACTIVITY

CHANGES

Current (2018-2019) ACGME requirements for faculty members to demonstrate scholarship will not be a part of the 2019 ACGME Common Program Requirements

2019 ACGME REQUIREMENT CHANGES

2019 ACGME SCHOLARSHIP DEFINED

This seems like a very big shift in a good direction

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Among their scholarly activity, programs must demonstrate accomplishments in at least three of the following domains:1. Research in basic science, education, translational science,

patient care or population health2. Peer-reviewed grants3. Quality improvement and/or patient safety initiatives4. Systematic reviews, meta-analyses, review articles, chapters

in medical textbooks, or case reports5. Creating of curricula, evaluation tools, didactic educational

activities, or electronic education materials6. Contribution to professional committees, educational

organizations, or editorial boards7. Innovations in education

2019 ACGME CPR: PROGRAM SCHOLARSHIP REQUIREMENTS

ACGME Review Committees will choose to require

# 1 OR BOTH #1 AND #2

1. Faculty participation in grand rounds, posters, workshops, quality improvement presentations, podium presentations, grant leadership, non-peer-reviewed print/electronic resources, articles or publication, book chapters, textbooks, webinars, service on professional committees, or serving as journal reviewer, journal editorial board member of editor

2. Peer-reviewed publication

ACGME REVIEW COMMITTEE SCHOLARSHIP REQUIREMENTS

Residents must participate in scholarship

The ACGME review committee may further specify

2019 ACGME RESIDENT SCHOLARSHIP

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Practical Strategies for Program Requirements for Scholarship

Strategies

Engage in system-level projects (posters)

Build on IRB-approved protocols (amendments)

Collaborations with academic affiliates and departments (tenure-track faculty)

Challenges

Time Burden Research expertise and

experience required Level of rigor Longitudinal project

management Lack of research

support

RESEARCH IN BASIC SCIENCE, EDUCATION, TRANSLATIONAL SCIENCE, PATIENT CARE OR POPULATION HEALTH

Strategies

Begin small (pilot projects)

Apply for internal grants

If not funded, seek other resources (hospital, department)

Try, try again (If you don’t apply you WILL NOT get it)

Challenges

Highly-competitive Knowledge/Skills Grant writing support

access varies Time Burden Resources

PEER REVIEWED GRANTS

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Strategies

Review articles require less capital and resources

Consider editing a book on educational topic and engage your faculty to write chapters (control)

Double down on case reports (faculty, residents) and submit often

Challenges

Significant writing time

Statistical skills (meta analyses)

Time

Sustained interest

SYSTEMATIC REVIEWS, META ANALYSES, REVIEW ARTICLES, CHAPTERS IN MEDICAL TEXTBOOKS, CASE REPORTS

Strategies

Program Director Specialty Groups

Knowledge/resource sharing – work distribution

IRB not always required Residents tech savvy

and interestedMedical Ed Journals, QI

poster days

Challenges

Tool reliability/validation

Lack of technology skills/access to tools

Lack of knowledge of electronic resources and publishers

CREATE CURRICULA, EVALUATION TOOLS, DIDACTIC EDUCATIONAL ACTIVITIES, ELECTRONIC EDUCATION

MATERIALS

Strategies

Engage both residents & faculty

Consider meeting frequency

Serve as judge or reviewer for conference submissions, research day

SCS, PD, Faculty Development Committees

Network, Invite yourself

Challenges

Time Burden Networking ability Opportunities lost due to

being unaware of opportunities

Longitudinal commitment

CONTRIBUTION TO PROFESSIONAL COMMITTEES, EDUCATIONAL ORGANIZATION, OR EDITORIAL BOARDS

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Strategies

Seek resident and junior faculty participation & guidance

Start small, think big Technology used in

different ways Look to other fields (non-

health care) for ideas and support

Think out of the box

Challenges

Time Burden Networking ability Lack of resources

INNOVATIONS IN EDUCATION

PRACTICAL STRATEGIES TO INCREASE

SCHOLARLY ACTIVITY

1. Scholarly Activity Strategic Plan 2. Develop QI projects to address reported non-compliance in

ACGME Resident Survey 3. Think low hanging fruit4. Identify areas of interest to faculty and residents in the clinical

setting (carrots!)5. Identify and uti l ize institutional resources6. Create a template for managing QI and research projects and

use it routinely (Coordinator collect)7. Increase your knowledge about QI and research (volunteer!) 8. Create or join a team of other GME folks and spread the work

and wealth (Specialty PDs, Faculty Group, Inter-Professional Team, SCS group, Coordinator Group, etc.)

9. Develop useful, practical QI projects that wil l help in future practice

10. Double, triple, quadruple dip

PLANNING FOR PROGRAM SCHOLARSHIP

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2019 SCHOLARLY PROJECT STRATEGIC PLANNING

Project Description Team Members

Start Date

End Date

Presentation/Publication

IHI Training Resident/Faculty Open School Online Training in QI

PD, APD, Coordinator

2/5/19 Local ConfTier 3 publication

Barriers to effective clinic scheduling

Understand the barriers to effective clinic scheduling in ambulatory clinic

CSR, F-3, R-7, PCA, CC

2/1/19 4/1/19 Local ConfRegional ConfNational ConfJournal XJournal Y

Sign Out Implement the IPASS sign out process

Hospital Admin, R-1, F-1, PD, Nurse 1

3/1/19 5/1/19 Local ConfRegional ConfNational ConfJournal XJournal Y

Set goals and timelines

Develop a management plan for each project

Delegate and distribute tasks

Nothing fancy required for tracking

Project Task

Assigned to:

Deadline:

PDSA Outline

Resident X, Faculty A

02/28/19

Finalize Project Plan

Resident C, Faculty A

03/15/19

Implement Survey

Resident D 03/30/19

Survey Analysis

Faculty B, Resident D

04/15/19

SCHOLARLY ACTIVITY PLANNING

Strategy: Develop QI Projects to address areas of reported non-compliance with ACGME Resident Survey Results

Include all relevant GME stakeholders (Hospital Admin, Nursing, CSR, Technicians, Faculty, Residents, Med Students)

Use the Plan, Do, Study, Act Model Develop and Implement Project Plan Report results at program meetings (Faculty, Resident, PEC) If you have a citation for it, report the results of your PDSA and

note the increased compliance in your next ACGME Resident Survey in your program’s response to ACGME RC

If no citation yet, tell the ACGME RC about it in your Major Changes Section to avoid citations and let them know you are on task

Continue to report results/findings to stakeholders until resolved Triple Dip: Resolve citation, improve survey, increase

resident/faculty engagement in scholarship

ACGME SURVEY NON-COMPLIANCE: EDUCATIONAL/EVALUATION QI PROJECTS

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ACGME SURVEY NON-COMPLIANCE CITATION RESPONSE EXAMPLE

Analyze call schedule frequency and complexity by site (service) Identify drivers for patient wait times and recommend solutions

(then implement them and evaluate – multiple projects) (service) Develop a new evaluation form and survey residents and faculty

to determine util ity and ef ficacy (faculty feedback, evaluation) Conduct a root cause analysis to determine cause of duty hour

violations on a rotation (CLE and Work Environment) Develop a Residency Operations Committee to address problems

with abil ity to raise issues and concerns and evaluate its outcomes/effectiveness (# projects initiated and completed, resident satisfaction) (abil ity to raise issues concerns)

Develop a resident wellness program and assess resident/faculty satisfaction (new wellness section)

Develop and implement a strategic plan for program scholarship and measure its ef fectiveness by productivity (scholarly activity)

Chart Audit Activity (provided data about practice habits)

IDEAS FOR QI PROJECTS TO ADDRESS SURVEY NONCOMPLIANCE

Projects that are interesting and motivating

Projects that can be used in multiple places

Projects that GME folks want to do

Start small, build big (PDSA, case report, review article, expand existing project, etc.)

LOW HANGING FRUIT

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Clinical Practice Fellowship Enrollment Process Improvement Private Practice Business of Medicine Technology in Medicine Communication Academics Leadership Innovations in Medicine Hospital Administration

WHAT ARE THE INTERESTS OF THE RESIDENTS & FACULTY?

MSU COM Statewide Campus System Research Support

MSU COM SCS Online Journal for GME

Statistical Support

Local Delivery of Research Methods Seminar

MSU COM SCS Statewide Research Day (Judges, Residents/Fellow/Faculty Participants)

Hospital Research Days

Consortium Resident and Faculty Training

Online Courses

Local Subject Matter Experts and Mentors

UTILIZE INSTITUTIONAL RESOURCES

GO TO IHI SCHOOL!

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Specialty Program Director Group – develop an evaluation or curriculum or multi-institutional survey/QI project

Regional or national committee (joint projects, shared ideas)

AAMC GME Leadership Academy (national networking, poster, joint projects, mentorship)

Specialty conference faculty development and resident training – QI and Research, Evaluation and Teaching

National Committees (AAMC, AOA, GRA, ACOS, etc.)

JOIN SOMETHING!

Every project should have at least one resident and faculty member participating

QI project to poster(s) to presentation(s) publication(s)

Multiple settings in which to publish work

Look for the helpers (who need publications?)

PRACTICE THE ART OF THE DOUBLE, TRIPLE, QUADRUPLE DIP

Susan Seman, DO, Program Director for Sinai Grace General Surgery Program at DMC

Initial Application citation for lack of Program Director Scholarly Activity, Continued Pre-Accreditation

Action Plan: IHI Open School QI training PD QI projects with residents and faculty Volunteer judge at DMC QI Research Day, MSU Research Day,

Michigan Summit QI Statewide competition SCS QI Boot Camp Attendee Attends other Training/Seminars QI Posters at regional and statewide research days

Outcome: Citation removed, ACGME Initial Accreditation with Commendations

ROLE MODEL FOR SCHOLARSHIP

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GOT SCHOLARSHIP PROJECTS, NOW WHAT?

Program Scholarship…It’s important!

Source: ACGME Webinar @ http://acgme.org/acgmeweb/Portals/0/PFAssets/Dec12Ophthalmology.pdf

Track your projects and outcomes

Program DirectorFacultyResident Planned, completed,

in processTell the ACGME and

remind your residents and faculty!

Present and publish your work

DOCUMENT

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Academic Medic ine Journal o f Graduate Medical Educat ion Medica l Educat ion Medica l Educat ion Onl ine Medica l Sc ience Educator Medica l Teacher Teaching and Learn ing in Medic ine Journal o f Cont inuing Education in the Heal th Professions Advances in Heal th Sc iences Educat ion Best Ev idence in Medic ine Journal of the Internat ional Assoc iat ion of Medical Sc ience Educators BioMed Centra l Medica l Educat ion Educat ion for Heal th Journal o f the Scholarsh ip of Teaching and Learn ing The C l in ica l Teacher Journal of Medica l Educat ion and Curr icular Deve lopment MedEd Por ta l Spec ia l ty Journals

MEDICAL EDUCATION JOURNALS

PUBLICATION RESOURCE GUIDES

https://www.ohsu.edu/xd/education/schools/school-of-medicine/education/educators-collaborative/resources/journals.cfm

Impact Factor of Medical Education Journals and recently developed indices: Can any of them support academic promotion criteria? J Postgrad Med. 2016 Jan-March; 62(1): 32-39 PMID: 2673194

Medical Education Journals, McGill Faculty Development Office: Accessed online on February 4, 2019 at: https://www.mcgill.ca/medicinefacdev/links/journals

ACGME Common Program Requirements (2019 Tracked Changes Version). Accessed online on February 4, 2019 at: https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/CPRResidency2019-TCC.pdf

REFERENCES

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hkromrei@med.wayne.edu