“The THREE Ts of GME” planned by Coordinators for Coordinators

““The THREE The THREE TsTs of GME” of GME”

planned by Coordinators for Coordinatorsplanned by Coordinators for Coordinators

Charles Daschbach, MD MPHCharles Daschbach, MD MPHDirector of Academic AffairsDirector of Academic Affairs

St. Joseph’s Hospital and Medical CenterSt. Joseph’s Hospital and Medical Center

GME Coordinator Conference GME Coordinator Conference Apr 8-9, 2004 Apr 8-9, 2004

Westcourt at the Buttes, Phoenix, ArizonaWestcourt at the Buttes, Phoenix, Arizona

OUR AGENDA(disclaimer first!)

• Review of the GME Coordinator RoleReview of the GME Coordinator Role• Why would any Why would any Sane PersonSane Person Want This Job ? Want This Job ?• What are 4 Formidable Challenges ?What are 4 Formidable Challenges ?• Is There ANY HOPE ?Is There ANY HOPE ?• Suggestions from High in the BleachersSuggestions from High in the Bleachers

THE GME COORDINATORS’ THE GME COORDINATORS’ “ROLE”“ROLE”

• Keep the Program AccreditedKeep the Program Accredited• Manage the BudgetManage the Budget• Document all the Duty HoursDocument all the Duty Hours• Send the Evaluation RemindersSend the Evaluation Reminders• Track the 80 Hour/ week ruleTrack the 80 Hour/ week rule• Complete all the CorrespondenceComplete all the Correspondence• Find those “&+#%$” Affiliation AgreementsFind those “&+#%$” Affiliation Agreements• Answer the phone in 31 Foreign LanguagesAnswer the phone in 31 Foreign Languages

Is that all it is…Is that all it is…or is it an evolving professional niche ?or is it an evolving professional niche ?

• Well, what is a “profession” ? Well, what is a “profession” ? – Select body of knowledgeSelect body of knowledge– Specialized TrainingSpecialized Training– Certification Certification – Code of EthicsCode of Ethics– Sanctions its Members Sanctions its Members

The GME Coordinators’ The GME Coordinators’ Evolving ProfessionEvolving Profession

– Select body of knowledgeSelect body of knowledge

– Specialized TrainingSpecialized Training

– Certification Certification

– Code of EthicsCode of Ethics

– Sanctions its MembersSanctions its Members

The $40,000 QuestionThe $40,000 Question

• Should someone with these skills have toShould someone with these skills have to– Type LettersType Letters– Take DictationTake Dictation– Page Residents to do their RecordsPage Residents to do their Records– File Routine PapersFile Routine Papers– Fix the Call ScheduleFix the Call Schedule– Page Residents (AGAIN!) to do their RecordsPage Residents (AGAIN!) to do their Records– Take Attendance Take Attendance (for Adults)(for Adults) at Noon Conference at Noon Conference

The $40,000 QuestionThe $40,000 Question

• Should someone with these skills have to…Should someone with these skills have to…( the answer is “NO”…)( the answer is “NO”…)

– But the economics of Hospital based GME But the economics of Hospital based GME dictate that GME Programs will not get more dictate that GME Programs will not get more help with these functions unless the Program help with these functions unless the Program faces a faces a CRISISCRISIS or is the or is the BiggestBiggest Money Maker Money Maker in the Institution…in the Institution…

What Can / Should What Can / Should YOUYOU do ? do ?

• We’ll come to this in a few minutes…We’ll come to this in a few minutes…

• But first a few words about the many But first a few words about the many challenges that you face…challenges that you face…

• This is very, very difficult..This is very, very difficult..

• Where, oh, where… to begin ?Where, oh, where… to begin ?

Challenge # 1 Challenge # 1 Keeping Quiet in Faculty MeetingsKeeping Quiet in Faculty Meetings

• You sit there and you want to You sit there and you want to – LaughLaugh– CryCry– Shout “ YOU IDIOT!”Shout “ YOU IDIOT!”– Explain that we’ve tried that solution 32 times beforeExplain that we’ve tried that solution 32 times before– Ask if anyone present really got a College DegreeAsk if anyone present really got a College Degree– Scream “He’s BLUFFING ! HE NEVER DID THAT !”Scream “He’s BLUFFING ! HE NEVER DID THAT !”– Suggest that a Resident being evaluated might be better Suggest that a Resident being evaluated might be better

suited for a career in Forestry far away from civilization suited for a career in Forestry far away from civilization and live people… and live people…

Challenge # 1 Challenge # 1 AAll Faculty are Pretty Much the Samell Faculty are Pretty Much the Same…

• one Crusty Curmudgeonone Crusty Curmudgeon• one Dudley Do-Rightone Dudley Do-Right• one…no, make that make that two Prima Donnasone…no, make that make that two Prima Donnas• one Jedi Knightone Jedi Knight• one “let’s create a policy to fix this” Guyone “let’s create a policy to fix this” Guy• one deaf mute perfecting the “low profile”one deaf mute perfecting the “low profile”• one person whose in love with his palm pilot one person whose in love with his palm pilot • one “this is the residents’ fault” Guyone “this is the residents’ fault” Guy

P.S.P.S.

• Tell the Faculty to stop spending hours Tell the Faculty to stop spending hours on SCREWING AROUND WITH on SCREWING AROUND WITH FANCY POWER POINT CRAP…FANCY POWER POINT CRAP…

• If we spent Half that time working on the If we spent Half that time working on the CONTENT and CONTENT and teaching pointsteaching points, we , we would be much more effective !!!would be much more effective !!!

Challenge # 2 Challenge # 2 Prioritizing the Prioritizing the Urgent !Urgent ! Email from the Email from the

Department of Medical EducationDepartment of Medical Education

• You sit there and you want to You sit there and you want to – LaughLaugh– CryCry– Shout “ YOU IDIOTS !”Shout “ YOU IDIOTS !”– Explain that we’ve tried that solution 33 times beforeExplain that we’ve tried that solution 33 times before– Ask if anyone there had formal education…at ANY levelAsk if anyone there had formal education…at ANY level– Suggest that the Director of Medical Education might be Suggest that the Director of Medical Education might be

better suited for a career in Geology in a developing better suited for a career in Geology in a developing country…far away from people…and live animals…country…far away from people…and live animals…

Challenge # 3 Challenge # 3 Understanding the Student-PhysicianUnderstanding the Student-Physician

• They’ve had 8 years of CollegeThey’ve had 8 years of College• They have people’s Lives in their handsThey have people’s Lives in their hands• They get Lunch every dayThey get Lunch every day• They get a Book Allowance They get a Book Allowance • They get a Travel Conference AllowanceThey get a Travel Conference Allowance• They make $40,000 / year now…They make $40,000 / year now…• But will make over $100,000 / year the day they finishBut will make over $100,000 / year the day they finish• (They do not have to punch the clock)(They do not have to punch the clock)

• (and everyone outside of medicine admires them!)(and everyone outside of medicine admires them!)• WHO ARE THESE CHOSEN FEW ? WHO ARE THESE CHOSEN FEW ?

Challenge # 3 Challenge # 3 Understanding the Student-PhysicianUnderstanding the Student-Physician

• Richie – RichRichie – Rich• Ferris BuellerFerris Bueller• Bart SimpsonBart Simpson• Mel GibsonMel Gibson• Martha StewartMartha Stewart• Marcel MarceauMarcel Marceau• Ellen DeGeneresEllen DeGeneres

• SchwartzeneggerSchwartzenegger• Brittany SpearsBrittany Spears• Martin LawrenceMartin Lawrence• Tom CruiseTom Cruise• OprahOprah• Cheech and ChongCheech and Chong• Meadow SopranoMeadow Soprano

Challenge # 4 Challenge # 4 Working in a Larger BureaucracyWorking in a Larger Bureaucracy

• The FY Budget will not be really finally “approved” ever The FY Budget will not be really finally “approved” ever …so stop asking about it…so stop asking about it

• Somewhere it is written that surgeons are better than the Somewhere it is written that surgeons are better than the rest of us…so get over itrest of us…so get over it

• The New Reorganization Chart is going to allow us to work The New Reorganization Chart is going to allow us to work more efficiently…so believe itmore efficiently…so believe it

• The Vice President who’s leaving decided to The Vice President who’s leaving decided to pursue “other interests” ( so stop laughing )pursue “other interests” ( so stop laughing )

• We fully support We fully support [ INSERT PROGRAM NAME HERE ][ INSERT PROGRAM NAME HERE ] because because of our historical commitment to this specialty…it has of our historical commitment to this specialty…it has nothing to do with revenue…Cha-ching ! Cha ching !nothing to do with revenue…Cha-ching ! Cha ching !

Are These Challenges Unique Are These Challenges Unique to Graduate Medical Education ?to Graduate Medical Education ?

• DIFFERENT or the SAME as…

– Pilot Training at Luke AFB ?– Journalism at the Arizona Republic ?– Executive Decisions at ENRON or TYCO ?– Leadership in our Churches ?

YES…and NO…

WHAT’S SINGULAR ABOUT OUR JOBS IN WHAT’S SINGULAR ABOUT OUR JOBS IN MEDICAL EDUCATION ?MEDICAL EDUCATION ?

• WE train people to heal other people…WE train people to heal other people…

• WE directly help care of the sick…WE directly help care of the sick…

• WE directly prevent disease…WE directly prevent disease…


• WE train people to heal other people…WE train people to heal other people…• WE directly help care of the sick…WE directly help care of the sick…• WE directly prevent disease…WE directly prevent disease…

THEY CANNOT DO IT WITHOUT US !!!THEY CANNOT DO IT WITHOUT US !!!


……not very often…but often enough…not very often…but often enough…

A resident stops by your office…maybe an A resident stops by your office…maybe an intern…maybe a graduating senior…maybe intern…maybe a graduating senior…maybe an alumnus of the program…an alumnus of the program…

……and they “thank” us…and they “thank” us…

……and we know we have made a difference…and we know we have made a difference…

The GME Coordinators’ The GME Coordinators’ Evolving ProfessionEvolving Profession

– Select body of knowledgeSelect body of knowledge

– Specialized TrainingSpecialized Training

– Certification Certification

– Code of EthicsCode of Ethics

– Sanctions its MembersSanctions its Members

What Can / Should What Can / Should YOUYOU do ? do ?some suggestionssome suggestions…

THE FACULTYTHE FACULTY

……assess their skill levels assess their skill levels what does the Program need what does the Program need in the skill set of a Faculty Member in the year in the skill set of a Faculty Member in the year

2004 ?2004 ?……what in-house training is available ? what in-house training is available ? ……offer keyboarding class one-on-one…offer keyboarding class one-on-one………offer Word / Excel / PowerPoint Classes…offer Word / Excel / PowerPoint Classes………work with HR to get them into Relationship Skill Classeswork with HR to get them into Relationship Skill Classes……send the evals send the evals earlyearly and block time on and block time on

their schedules to do evals their schedules to do evals

What Can / Should What Can / Should YOUYOU do ? do ?some suggestions…some suggestions…

THE GME OFFICE / ADMINISTRATIONTHE GME OFFICE / ADMINISTRATION

……communicate in writingcommunicate in writing……ask for a deadline on a promiseask for a deadline on a promise……document meetings in a F/U memo or email document meetings in a F/U memo or email

““thanks for meeting today…as I understand…thanks for meeting today…as I understand…“…“…and thanks again for looking into this”and thanks again for looking into this”

……you have a right to respectfully ask how “urgent” you have a right to respectfully ask how “urgent” something is…but they have a right to saysomething is…but they have a right to say ‘‘make it so’…make it so’…


THE RESIDENTSTHE RESIDENTS

……remind them that they are adultsremind them that they are adults……begin EARLY in July…begin EARLY in July………remind them that they are adults again remind them that they are adults again ……do not engage them in their excuses do not engage them in their excuses ……you need to be a tougher parentyou need to be a tougher parent……you DO have some authorityyou DO have some authority


FOR YOU !FOR YOU !


FOR YOU !FOR YOU !

1.1. RETRAINRETRAIN …take every training class offered …take every training class offered2.2. EXCEEDEXCEED …develop skills BEYOND those currently …develop skills BEYOND those currently

required for your positionrequired for your position(TODAY’S CONFERENCE !!!)(TODAY’S CONFERENCE !!!)

3.3. CROSS-TRAINCROSS-TRAIN with other Coordinators / Staff with other Coordinators / Staff4.4. SHARE BEST PRACTICESSHARE BEST PRACTICES with each other with each other 5.5. FOCUSFOCUS…disengage from “personality driven” issues…disengage from “personality driven” issues

……with the residentswith the residents……with the facultywith the faculty……and with each otherand with each other

OUR AGENDAOUR AGENDA(disclaimer AGAIN ! )

• Review of the GME Coordinator RoleReview of the GME Coordinator Role• Why would any Why would any Sane PersonSane Person Want This Job ? Want This Job ?• What are FOUR Formidable Challenges ?What are FOUR Formidable Challenges ?• Is There ANY HOPE ?Is There ANY HOPE ?• Suggestions from High in the BleachersSuggestions from High in the Bleachers

……andand

If no one thanked you this last few weeks for doing a great job on something,

take some solace that while the recognition would be nice,

true professionals do our jobs because we know we make a difference

“The THREE Ts of GME” planned by Coordinators for Coordinators

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