GME and Health Care ReformGME and Health Care Reform

St H R M DSteven H. Rose, M.D.Professor of AnesthesiologyVice Dean and DIOMayo School of Graduate Medical EducationMayo School of Graduate Medical Education

Sponsoring InstitutionsSponsoring InstitutionsACGME Residents ACGME Programs

New York Presbyterian 1,636 119

Mount Sinai SOM 1,391 91

U TX-SW 1,382 94

UPMC (Pittsburgh) 1,381 107

COM, Mayo Clinic 1,247 129

Source: ACGME Data Book

MSGMEMSGME

90 programs 24 programs 25 programs90 programs1,176 trainees

24 programs157 trainees

25 programs146 trainees

GME FinancesGME Finances

GME and Health Care ReformGME and Health Care Reform

• Value of GME

• Train physician workforce of the future• Projected physician shortageProjected physician shortage• Primary care/specialty mix

• Preparing physicians for future practice• Preparing physicians for future practice

GME Value: Inpatient PracticeGME Value: Inpatient Practice

• Work/Residents

• Duty hours

• Shift to outpatient environment• Shift to outpatient environment

• Prescriptive time requirements

• Administrative burden

• Hospitalistsp

• PA/NP

“Probably in the not too distant future we will ycrawl out of our old methods of education, as a snake sheds it skin, and reorganize a new plan ”plan.

Charles H. Mayo

KnowledgeKnowledge

Photo credit: Mikael Damkier

SkillsSkills

BehaviorsBehaviors

GME and Health Care ReformGME and Health Care Reform

• Inter-professional learning p g• Team training• Experiential learningp g

• Quality improvement

• Education technology• Education technology

• Science of health care delivery

• Professionalism

Relationship BuildingWork in partnership with all

colleagues for the genuine concern and well being of our patients

and othersEffective Assertion

ReflectiveListening PEARLS

TeamworkCommunications

Listen for understandingto the diverse opinions

of others

Assertion

Empowered to voicemy opinion and trust that

it will be heard

Leading withMutual Respect

Treat one another with respect and courtesyAcknowledge and value the contributionsSBAR PositiveAcknowledge and value the contributions

of others

Tools

Assertion

Tools

Simulation CentersSimulation Centers

Quality AcademyQuality Academy

• Quality trainingy g

• Quality projects

OfferingsOfferings

• Individual LevelQA: Applied StatisticsLevel Courses• 27 Face-to-

QA: Applied Statistics

Face• 3 Online

QA: Quality Concepts & Philosophies

QA: Selecting QI Methods

The Deteriorating Patient and Simulation

VTE Prophylaxis Best Practice

C i ti A C T itiCommunication Across Care Transitions

30 Day Readmissions30 Day Readmissions

Catheter-Associated UTICatheter Associated UTI

Hospital Discharge Medicationp g

Quality Fellows ProgramQuality Fellows Program

Nomenclature, QI project member, Q p j

4 modules, project, p j

Courses, lead 2 QI projects, scholarshipp j p

Courses, mentor, publication

Quality FellowsQuality Fellows

CP1000000-19

Education Technology/EMREducation Technology/EMR

• Opportunities to drive practice decisions pp pthrough care process models

• Knowledge management systemsg g y

• Point-of-care practice and learning

• Blaze rules• Blaze rules

Blaze RulesBlaze Rules

Software rules that trigger a specific response.gg p p

Prolonged QT drug interactions:• Prevents use of contraindicated medicationsPrevents use of contraindicated medications

through EMR and computer-based clinical decision support

• Alerts physician at time of electronic order prescribing

Ask Mayo ExpertAsk Mayo Expert

• Online resource for Mayo-vetted medical yknowledge and expert contact information

• Disseminates care process modelsp• Atrial fibrillation• Depressionp• Hypertension• Health screening for asymptomatic patientsg y p p

Ask Mayo Expert: Heparin-induced Thrombocytopenia

What do I tell a patient with newly diagnosed cancer?What do I tell a patient with newly diagnosed cancer?

Design, implement, measure, and disseminate g , p , ,high-value best practices…

Science of Health Care DeliveryScience of Health Care Delivery

• Study of the systems and processes that y y psupport the delivery of high value health care

• Branch Mayo Medical School campusy p

Primary ValuePrimary Value

“The best interest of the patient is the only p yinterest to be considered, and in order that the sick may have the benefit of advancing knowledge union of forces is necessary ”knowledge, union of forces is necessary.

William James Mayo

SummarySummary

• Value

• Leadership, innovation, teamwork, systems of health care deliveryy

• Leverage EMR

• Quality and professionalism• Quality and professionalism