The Foundation for The Gator Nation

An Equal Opportunity Institution

College of Medicine 1600 SW Archer Road

Graduate Medical Education PO Box 100321

Gainesville, FL 32610-0321

352-265-0152

352-265-8966-fax

February 14, 2013

Dear Colleagues:

The Accreditation Council for Graduate Medical Education (ACGME) requires that the

Designated Institutional Official (DIO) provide an annual report to the Organized Medical Staff and governing body of the major participating Joint Commission accredited hospitals

involved in graduate medical education. This report must include a review of the activities

of the Graduate Medical Education Committee (GMEC) during the previous year and

discussion of resident supervision, resident responsibilities, resident evaluations,

compliance with duty hours and resident participation in patient safety and quality of care education. This report covers activities between January 1, 2012 and December 31, 2012.

In addition, this letter will provide information regarding the ACGME Next Accreditation

System (NAS) that is important for all faculty to know.

The University of Florida College of Medicine sponsors 63 ACGME accredited programs based in Gainesville. There are 688 residents in these 63 programs. There are 48

residents and fellows currently training in 39 programs that the ACGME does not accredit

(not all of these programs have current housestaff). The primary participating institutions

include Shands Hospital at the University of Florida, and the North Florida/South Georgia

Veterans Health System. Shands Healthcare supports 495 FTE, and the VA supports 159 FTE. Departments or grants support the remainder.

Appendix 1 shows the current status of all ACGME accredited training programs sponsored

by the University of Florida. There are no programs on probation or with a warning. The

mean program cycle for the Gainesville programs is 4.6 years (no significant change over

the last several years) and the national average is 3.8 years, but this average varies significantly among different specialties. Listed below are the site visits that occurred during

2012 with results when available. A brief summary of citations with institutional relevance

follows below:

Surgical Critical Care – 03/01/12 – Continued Full Accreditation with a 4-year cycle length. The program’s single significant citation involved adequacy of case

mix exposure to trainees – a theme that is repeated more significantly in several of

our other programs.

Family Medicine – 7/10/12 – Continued Full Accreditation with a 5-year cycle

length. Although the program received the maximum review cycle (5 years) there were several citations again relating to inadequate housestaff educational experience

in key patient populations.

Endovascular Neuroradiology (Neurosurgery) – 10/31/12 – Notification pending

Neuropathology – 12/19/12 – Notification Pending

Vascular Neurology -12/20/12 - Notification Pending

Newly Accredited Programs

Child Neurology – New Accreditation Effective 7/01/2013 – 3 year cycle length (maximum possible for a new program), no institution related citations

Plastic Surgery – Integrated – Effective 7/01/2013 – 3 year cycle length, no

citations

IM – Advanced Heart Failure and Transplant – Effective 7/01/2013 – 3 year cycle

length

Applications Pending ACGME Approval

EM – Emergency Medical Services

Follow-up information from 2011 site visits (results came in after last year’s

annual letter):

OB/GYN – 10/26/11 – Continued Accreditation with a 3-year cycle– The important citations related again to case mix and adequacy of training in certain key

procedures. A progress report was requested by the ACGME and submitted. The

ACGME responded that their efforts should continue, but the cycle length was

further reduced to 2 years following their review of the progress report.

Thoracic Surgery: This program was scheduled to be reviewed on 12/18 – The ACGME cancelled the site visit the day before it was scheduled to occur following

receipt of a complaint alleging non-compliance with multiple ACGME program

requirements in thoracic surgery. The ACGME requested a rapid response to

these allegations which has been provided. Careful investigation revealed that

the allegations of non-compliance were not substantiated. The ACGME has now rescheduled the site visit for April 11, 2013. This program was previously

accredited with a short (2-year) review cycle, again because of inadequate

training in certain key procedures.

Otolaryngology – Continued Accreditation with a 3-year cycle. This program was

reviewed near the end of 2011 and the results were received in March, 2012. Again, the major citations involved inadequate housestaff exposure to certain key

procedures.

The next portion of this letter provides vital information to you regarding how our programs

will be evaluated and accredited in the future. Beginning in July, 2013, the ACGME will implement its Next Accreditation System (NAS) for seven core programs and their

subspecialties. In July, 2014, all the remaining core programs and subspecialties will be

accredited under the NAS. I am including edited excerpts from a New England Journal of

Medicine article about the NAS – Nasca TJ, Philibert I, Brigham T, and Flynn TC. The Next

GME Accreditation System – Rationale and Benefits. N Engl J Med 2012; 366: 1051-6. I would strongly encourage ALL faculty to read this section carefully since implementation of

the NAS and its accompanying milestones project will require substantial revisions in how

residents, and ultimately medical students are evaluated.

In July 2013, the NAS will be implemented by 7 of the 26 ACGME-accredited core specialties (emergency medicine, internal medicine, neurologic surgery, orthopedic surgery,

pediatrics, diagnostic radiology, and urology). In the remaining specialties and the

transitional year (a year of preparatory education for specialties such as ophthalmology and

radiology that accept residents at the second postgraduate year), the NAS will be implemented in July 2014. Educational milestones (developmentally based, specialty

specific achievements that residents are expected to demonstrate at established intervals

as they progress through training) have been completed for the seven specialties in the first

phase of implementation. The NAS moves the ACGME from an episodic “biopsy” model (in

which compliance is assessed every 4 to 5 years for most programs) to annual data collection and program assessment. Each review committee will perform an annual

evaluation of trends in key performance measurements and will extend the period between

scheduled accreditation visits to 10 years. In addition to the milestones, other data

elements for annual surveillance include the ACGME resident and faculty surveys and

operative and case-log data. Programs will conduct a self-study before the 10-year site

visit, similar to what is done, for example, by the LCME which accredits medical schools. Ongoing data collection and trend analysis will base accreditation in part on the educational

outcomes of programs while enhancing ongoing oversight to ensure that programs meet

standards for high-quality education and a safe and effective learning environment.

Programs that demonstrate high-quality outcomes will be freed to innovate by relaxing

detailed process standards that specify elements of residents’ formal learning experiences (e.g., hours of lectures and bedside teaching), leaving them free to innovate in these areas

while continuing to offer guidance to new programs and those that do not achieve good

educational outcomes.

The Educational Milestones A key element of the NAS is the measurement and reporting of outcomes through the

educational milestones, which is a natural progression of the work on the six competencies.

In each specialty, the milestones result from a close collaboration among the ABMS

certifying boards, the review committees, medical specialty organizations, program-director

associations, and residents. The earliest efforts involved internal medicine, pediatrics, and

surgery, and by late 2011, milestones were being developed in all specialties. The aim is to create a logical trajectory of professional development in essential elements of competency

and meet criteria for effective assessment, including feasibility, demonstration of beneficial

effect on learning, and acceptability in the community. Programs in the NAS will submit

composite milestone data on their residents every 6 months, synchronized with residents’

semiannual evaluations. Although each program’s collection of milestone data may be more comprehensive, the data submitted to the ACGME will consist of 30 to 36 dimensions that

represent the consensus of the assessment committee on the educational achievements of

residents, informed by evaluations the program has performed. The milestones are based

on the published literature on these competencies and were developed by an expert panel

with representation from the specialties in the early phase for use in milestone development. At the completion of training, the final milestones will provide meaningful

data on the performance that graduates must achieve before entering unsupervised

practice. This process moves the competencies “out of the realm of the abstract and

grounds them in a way that makes them meaningful to both learners and faculty.” The final

milestones also create the entry point into the maintenance of certification and licensure phase of lifelong learning. The initial milestones for entering residents will add a

performance-based vocabulary to conversations with medical schools about graduates’

preparedness for supervised practice. Over time, the milestones will reach into

undergraduate medical education to follow the adoption of the competencies by many

medical schools. This will contribute to a more seamless transition across the medical-education continuum.

Another key element of the NAS is emphasis on the responsibility of the sponsoring

institutions for the quality and safety of the environment for learning and patient care, a

key dimension of the 2011 common program requirements. This will be accomplished through periodic site visits to assess the learning environment (the Clinical Learning

Environment Review – CLER). The next section is excerpted from the ACGME web site and

will provide you with key information about the CLER.

As a component of its next accreditation system, the ACGME has established the CLER program to assess the graduate medical education (GME) learning environment of each

sponsoring institution and its participating sites. CLER emphasizes the responsibility of the

sponsoring institution (and its educational programs) for the quality and safety of the

environment for learning and patient care, a key dimension of the 2011 ACGME Common

Program Requirements. The intent of CLER is “to generate national data on program and institutional attributes that have a salutary effect on quality and safety in settings where

residents learn and on the quality of care rendered after graduation.”

The CLER program’s ultimate goal is to move from a major targeted focus on duty hours to

that of broader focus on the GME learning environment and how it can deliver both high-

quality physicians and higher quality, safer, patient care.

CLER assesses sponsoring institutions in the following six focus areas:

Patient Safety – including opportunities for residents to report errors, unsafe

conditions, and near misses, and to participate in inter-professional teams to promote and

enhance safe care.

Quality Improvement – including how sponsoring institutions engage residents in the use of data to improve systems of care, reduce health care disparities and improve

patient outcomes.

Transitions in Care – including how sponsoring institutions demonstrate effective

standardization and oversight of transitions of care.

Supervision – including how sponsoring institutions maintain and oversee policies of supervision concordant with ACGME requirements in an environment at both the

institutional and program level that assures the absence of retribution.

Duty Hours Oversight, Fatigue Management and Mitigation – including how

sponsoring institutions: (i) demonstrate effective and meaningful oversight of duty hours

across all residency programs institution-wide; (ii) design systems and provide settings that facilitate fatigue management and mitigation; and (iii) provide effective education of faculty

members and residents in sleep, fatigue recognition, and fatigue mitigation.

Professionalism—with regard to how sponsoring institutions educate for

professionalism, monitor behavior on the part of residents and faculty and respond to issues

concerning: (i) accurate reporting of program information; (ii) integrity in fulfilling educational and professional responsibilities; and (iii) veracity in scholarly pursuits.

The initial round of CLER evaluations will seek answers to the following central questions:

Who and what form the infrastructure of a Sponsoring Institution’s clinical

learning environment? What organizational structures and administrative and clinical processes do the SI and its major participating sites have in place to support GME learning

in each of the six focus areas?

How integrated is the GME leadership and faculty within the SI’s current

clinical learning environment infrastructure? What is the role of GME leadership and

faculty to support resident and fellow learning in each of the six areas? How engaged are the residents and fellows in using the SI’s current clinical

learning environment infrastructure? How comprehensive is the involvement of

residents and fellows in using these structures and processes to support their learning in

each of the six areas?

How does the SI determine the success of its efforts to integrate GME into the

quality infrastructure? From the perspective of the SI and its major participating sites, what are the measures of success in using this infrastructure and what was the level of

success?

What areas have the Sponsoring Institution identified as opportunities for

improvement? From the perspective of the SI and its major participating sites (if

different), what are seen as the opportunities for improving the quality and value of the current clinical learning environment infrastructure to support the six focus areas?

The last Institutional Site Visit occurred on January 16, 2009. The Institution received

Continued Full Accreditation with a 5-year review cycle. The next site visit is expected to occur in April, 2014. However, as discussed above, the ACGME has developed and is now

implementing the CLER program. Every ACGME accredited institution will be visited at least

every eighteen months for a detailed review of the housestaff learning environment. CLER

site visits are announced only 10 days prior to their occurrence, and key faculty from each

discipline may be required to participate in the CLER site visit (with little or no notice).

The Graduate Medical Education Committee and Graduate Medical Education Office report

the following activities:

Monthly committee meetings that include a review of all communications and

citations from the RRC’s. Programs are required to respond to the GMEC on each citation even if not requested by the ACGME. The GMEC, through its Internal Review

Subcommittee, has completed the internal review process on all programs expecting site

visits in a timely manner and continues an ongoing dialog with programs who have

outstanding issues identified in the internal reviews. Continued monitoring by the

Internal Review Committee and the GMEC works to resolve identified issues. The Internal Review Subcommittee is chaired by Jacqueline Hobbs, MD, PhD, a faculty

member and core program director from the Department of Psychiatry. Members of the

committee come from many different parts of the institution and included (R=resident, F

= Faculty): Julia Close, M.D., (F) Internal Medicine; Kyle Fargen, M.D., (R)

Neurosurgery; Janet Farrington (Shands Healthcare – Nursing); Lisa Dixon, M.D., (F) Pathology; Meridith Mowitz, M.D., Fellow, Neonatology; Sukanthini Subbiah, M.D.,

Fellow, Hematology/Oncology; Anuja Mehta, M.D., (R) Psychiatry; Joel Rowe, M.D., (R)

Emergency Medicine; Lars Beattie, M.D., (F) Emergency Medicine; Karen Hall, M.D., (F)

Community Health and Family Medicine; Lynn Kohn, Manager GME, John Malaty, M.D.,

(F), Community Health and Family Medicine; and Jacqueline McGhee, GME Office. Programs that were reviewed in 2012 by the Internal Review Subcommittee included:

Vascular neurology, Urology, Dermatopathology, Transplant Hepatology, Thoracic

Surgery, Anesthesia – Pain Management, Adult Nephrology, Family Medicine – Sports

Medicine, Pediatric Critical Care Medicine, Pediatric Pulmonology, Radiology (core),

General Surgery (core), Ophthalmology (core), Vascular and Interventional Radiology, Orthopaedic surgery (core), Radiation Oncology, Pediatrics (core), Pediatric

Endocrinology, Pediatric Gastroenterology, Pulmonary/Critical Care Medicine, and

Pediatric Hematology-Oncology. Special commendations and thanks are due to Lynn

Kohn, the Manager of the GME office for her superb organizational skills in arranging

these reviews and in assisting each program coordinator and program director in

preparing these reviews. Lynn also assists program coordinators and program directors in preparing for their RRC site visits, and the institution’s programs would not have

received their excellent review cycles without Lynn’s expertise. Behind the scenes in the

GME office, Jackie McGhee provides outstanding support to Ms. Kohn and to me as the

DIO as we work together to improve all our GME programs.

During the 2nd half of the academic year 2012-13, the Internal Review Subcommittee

will gradually change function from scheduled snapshots of programs to continuous

monitoring of all programs with scheduled focused, in-depth reviews of programs as

indicated.

The GMEC reviews the results of the Annual ACGME Resident Survey. The ACGME

Resident Survey is conducted every year in all core programs and subspecialty programs

regardless of size. This survey includes questions about the environment of care,

educational programs and duty hours. For every area of non-compliance identified in the

survey (especially duty hours), the program director is required to submit a plan for

correction to the GMEC and DIO. In addition, the Internal Review process carefully looks at all issues identified in the ACGME Resident Survey to ensure that corrective measures were

implemented and compliance with requirements improving. As noted above, accreditation

citations and reductions in accreditation cycle lengths are now appearing based on results

available from the ACGME resident survey. Given the increased importance and emphasis

placed on these survey results, I thought that including the UF Institutional Aggregate Results for each question along with comparative national data would be informative. See

Appendix 2 for this information. While precise comparisons with previous years are not

possible because of significant questionnaire changes each year, the slight trend toward

increased non-compliance noted previously has been reversed. In addition, the areas

where previous year results are either worse than national averages or show a significant non-compliance rate have all improved. This is an accomplishment of which all our

Departments and Programs should be very proud. We do, however, still have some areas

where we, as an institution could do better, and these are listed below. I would ask each

program director and Department Chair to carefully examine whether or not these issues

are out of compliance for your individual program. These areas are: Provision of sufficient instruction by faculty (13% non-compliant answers)

Faculty and staff interested in resident education (15% non-compliant answers)

Faculty and staff create an environment of scholarship and inquiry (17% non-compliant

answers)

Programs use evaluations of the program to improve (19% non-compliant answers) Housestaff are satisfied with feedback after rotations / assignments (19% non-compliant

answers)

Satisfaction with opportunities for scholarly activity (16% non-compliant answers)

Appropriate balance between service and education (17% non-compliant answers)

Education not compromised by service (24% non-compliant answers) Residents given data to show their own clinical effectiveness (33% non-compliant

answers)

Opportunity to transition care when fatigued (21% non-compliant answers)

Satisfaction with process to deal with housestaff issues and concerns (15% non-

compliant answers)

Ability to raise concerns without fear (15% non-compliant answers) Participation in quality improvement (13% non-compliant answers)

All of these categories have improved over previous surveys and none are significantly

different from national averages. We can do better, however, and if we improve to a

similar degree in this year’s survey, we will likely be significantly better than national averages – which is our goal.

Given the increased emphasis by the RRCs on the resident survey results, I have asked

each Chair and Program Director to provide their housestaff with instruction about the

importance of these surveys and make certain that each housestaff member understands the meaning and intent of each question. The impact of non-compliance in these areas

clearly has a significant impact in two areas. First, survey results are now resulting in

citations in accreditation letters, and snap site visits. The second impact has been felt in

program requests for increases in resident complement. These requests have now been

denied several times because of issues identified by the resident survey.

Duty Hours. Each program has a mechanism for recording duty hours and these

mechanisms vary depending on the workload of the program. All programs have

transitioned to the New Innovations program (a commercially available residency data

management system) for duty hours monitoring. Based on New Innovations data, duty hour

requirement compliance is good across the institution, although there are some services and some programs that are still challenged to provide continuity of care and keep within

the duty hour rules. Appendix 3 details New Innovations documented violations by

Department. There may be some inaccuracies, particularly in the 10 hour time off

requirement as some of these reflect lunch hour type breaks entered by housestaff. We

have done our best to correct these, but I am sure we missed a significant number. The most commonly noted violation, as in previous years, is the 10-hour time off requirement

between consecutive scheduled duty shifts. There are also more violations of the 1 day off

in seven and 24 continuous duty requirements than I would like to see, especially in

individual departments. I work with program directors to ensure compliance. Program

directors and I receive weekly reports about duty hour compliance for every program in the institution. These reports provide near real-time feedback to individual program directors

and to the GME office. I would like for us as a faculty to set a goal for the coming year to

eliminate violations of the 1 day off in seven and 24 hour continuous duty requirements.

Finally, to educate faculty and housestaff regarding the impact of sleep deprivation and

fatigue on performance, the GME office has made available the Sleep, Alertness, and Fatigue Education in Residency (SAFER) Program. This online program provides

education for all our trainees and faculty and is available 24/7. Completion of training is

documented in New Innovations.

Ongoing evaluation of resident supervision is accomplished by reviewing the ACGME site visit report, internal review reports, and ACGME Resident Survey reports along with

patient safety reports that suggest supervision issues. Previously, these reviews showed no

evident patterns or systemic problems with supervision. The 2011 resident survey

suggested a modestly increased dissatisfaction with the adequacy of supervision and

education. This year’s survey has reversed that trend in both of those realms. To further

assist the GME office with evaluating adequacy of supervision, the SUF Quality and Safety Office provides reports regarding incidents that fall out from their review that involve

residents. When a patient safety report is received by the GME office, program directors are

asked to address these on an individual basis, as applicable and appropriate. In addition,

the VA reports on supervision are reviewed and on the whole these show compliance with

the extensive VA Supervision Requirements.

Resident evaluation processes are examined at every internal review. One area where

compliance has improved significantly during the past year is the requirement that each

program have an organized meeting each year that includes faculty and residents to review the goals and objectives, to provide an analysis of the success of the program and to

identify opportunities to improve the program. Programs are now required to submit a

report of their annual meeting in a standardized format using New Innovations. All

programs are now using New Innovations for their formative evaluations of residents. A

few programs are also using New Innovations to automatically develop 6-month summative

evaluations and final letters of evaluation. The GME office, working with UF&Shands IT (special thanks to Kari Cassel and her team) now provides to all our programs an expert

New Innovations application specialist. Sony Kuruppacherry has done an outstanding job in

making sure all programs are using New Innovations for demographics and resident /

faculty/ program evaluations. Standardization across the institution is greatly improved

thanks to his efforts.

Residents participate in quality and patient safety activities in a variety of venues,

both in Shands Healthcare and the Veterans Administration facilities. All programs have a

review of cases for quality issues and this is monitored by the internal review process. All

programs have quality assurance topics presented at Grand Rounds. Most programs require residents to work on specific quality improvement projects. Many programs are now having

“Quality Days” where the work of residents and faculty in this area is highlighted and

presented. Residents participate in Root Cause Analysis committees and the monthly

Multidisciplinary Peer Review Committee at the VA and in root cause analyses conducted at

Shands Health Care on a regular basis.

The Internal Review will carefully examine each program’s housestaff participation in quality

improvement activities, and the GMEC will assure an interdisciplinary component to patient

safety and quality improvement activities for housestaff.

The Office of Graduate Medical Education carefully monitors instances when a resident was

involved in an incident that could result in patient dissatisfaction or harm. These referrals

(Patient Safety Reports – PSRs) are identified by resident name and department. Once a

referral is received from the SUF Quality and Safety Office, the Office of Graduate Medical Education contacts the appropriate residency program director and asks her / him to

investigate the referral and respond with how the involved resident will be counseled, if

necessary. In addition, suggestions as to how to avoid similar problems with residents in

the future are solicited. The housestaff office and program directors monitor these referrals

carefully to make sure that no residents repeatedly have these system referrals. The issues

are classified into global types including inadequate communication, equipment problems, coverage related, inappropriate behavior, medication administration errors, order errors,

and procedure-related problems. The SUF Quality and Safety Office, under the leadership

of Randy Harmatz, has simplified the PSR process (express report) with the intent of

making it easier for housestaff and faculty to submit reports about patient safety and

quality issues. During the coming year, there will be a strong educational program and push to involve housestaff (and faculty) in this important process.

The GME office has now formed the first interdisciplinary housestaff Patient Safety and

Quality Committee. This committee will work under the leadership of Dr. Lee Titsworth, a

resident in the Department of Neurosurgery. Lee will also be a member of the Institutional Quality and Safety Committee and will seek to integrate the work of this housestaff

committee with institutional goals for quality and safety. Committee members have been

appointed from core residency programs and fellowship programs across most specialties.

Committee members will be responsible for taking back what they learn and develop to

each of their individual programs. The committee has already had its first meeting, and

Randy Harmatz and I are very excited about this committee’s potential contributions to the quality of care and the safety of our patients.

Residents as Teachers Program: The UF Residents as Teacher Program has two

components: a one-day course for all incoming PGY1s and a longitudinal certificate

program. In the fall of 2012, a total of 154 residents attended seven full-day basic workshops assuring that our new housestaff would be well-prepared to mentor our medical

students and less-experience housestaff during their training. Eight faculty members

donated their time and skills as large and small group facilitators for this program including

Drs. Dixon, Quillen, Peng, Sultan, Close, Lombard, Chheda, and Black. These faculty come

from a broad base of our Departments including Pathology, Family Medicine, Anesthesiology, Internal Medicine, Neurosurgery, Otolaryngology, and Pediatrics. There are

currently 70 housestaff enrolled in the longitudinal certificate program, and in 2012,

sessions were offered covering motivational interviewing, patient education / safety, setting

goals and expectations, small group and case-based teaching, teaching medical procedures,

leadership and team management, preparing an effective medical lecture, and teaching with an audience response system. Drs. Merlo-Greene, Ferguson, Davis, Collins, Quillen,

Duff and Euliano facilitated these sessions.

Additional educational opportunities The Graduate Medical Education Committee

continues to sponsor several non-clinical grand rounds. These are evening sessions that include residents and their significant others. Appendix 4 details these activities.

Other activities of the GMEC include review of policies, recommendation on resident

numbers and stipends, review of correspondence with the ACGME, and discussions of

national GME issues. The GMEC minutes and packet of materials is sent to medical school and hospital leadership and all program directors each month to facilitate communication.

The DIO reports monthly the activities of the GMEC to the Medical Executive Committee of

Shands UF, and quarterly to the VA Dean’s Committee. As per policy, the GMEC will

annually review and update ALL its policies in the last 3 months of each calendar year. This

review was completed in 2012 during December. This annual review will assure compliance

with frequently changing ACGME programmatic and institutional requirements. Policies during the coming year will need substantial revision to come into compliance with the NAS.

GME Annual Program Review by the DIO: In anticipation of the NAS, during the past

academic year, I have instituted an annual review for all accredited programs in the

institution. This review looks at 7 measurable performance elements annually: the quality of applicants to the program, the academic productivity of housestaff, board certification

rate over the previous 5 years, in-training examination performance, practice outcome

(location, type- academic or private), annual meeting for program improvement

documentation, performance on the ACGME resident and faculty surveys, and specific

compliance with ACGME requirements. Performance in these seven domains will be tracked over time and feedback given to program directors and Department Chairs. The system will

be revised during the coming year to accommodate the NAS and the milestones.

GME Program Accomplishments

Our own Lynn Kohn has become one of 18 ACGME Professionals of Central GME Offices to be certified by the National Board of Certification of Training Administrators of

Graduate Medical Education (C-TAGME)! This certification program was created to

establish standards for the profession, to acknowledge the expertise needed to

successfully manage central GME offices of ACGME training programs and to recognize

those training administrators who have achieved competence in all fields related to their profession. We have known that Lynn is special for many years, and this recognition is

very well-deserved.

Research productivity of the faculty, fellows, and residents in our GME programs

continues to be excellent. In addition to areas of medical research, our programs’ educational efforts have become established on the regional and national stage through

the efforts of both our faculty and housestaff. This information was provided by our

program directors and may be reviewed at the web-site (which is available to applicants

to our programs): http://gme.med.ufl.edu/policy-procedures/residency-fellowship-

programs/gme-accomplishments-2012/

The GME Office expanded in an important way during the past year. Dr. Carolyn Stalvey

was appointed the Assistant DIO for Assessment and has been instrumental in

developing and implementing the initial intern OSCE. She is currently working on a follow-up intern OSCE which will be implemented in the spring of 2013. She has been to

several meetings about the ACGME milestones project and will be instrumental in

helping the seven core specialties develop and implement their own methods of

evaluating housestaff for milestones.

The GME Office will be expanding further in the coming year with the hiring of a full-time

educator. Funding was approved (thank you Drs. Good and Flynn and Mr. Goldfarb) for

this position and a search is currently ongoing. This individual will be tasked specifically

with helping our programs develop and implement validated evaluation tools for the

milestones in each specialty and subspecialty. He/she will also help develop

interdisciplinary processes for evaluating the milestones that all programs could use.

Finally, with the much appreciated help of many individuals from UF&Shands, many

changes have been made which will enhance the residents’ and fellows’ experience while

they are here. These are also listed in Appendix 4.

This office is very grateful to the many individuals who have made these changes possible.

I have attached a list of program directors and current accreditation status

(Attachment 1).

The Graduate Medical Education Committee is anxious to receive feedback about the quality

of our GME Programs from the Organized Medical Staff and governing bodies of the

participating hospitals. Regular communication about the safety and quality of patient

care and education of the residents is an important part of our mission and is welcomed. If

there are any concerns or questions, please feel free to call.

Respectfully submitted,

Michael E. Mahla, M.D.

Professor of Anesthesiology and Neurosurgery

Associate Dean for GME

Designated Institutional Official

Cc:

Bradley Bender, M.D., Chief of Staff, NF/SG Veterans Health System

Thomas Wisnieski, MPA, FACHE, Director NF/SG Veterans Health System

Joseph C. Fantone, M.D., Senior Associate Dean for Educational Affairs Timothy C. Flynn, M.D., Senior Associate Dean for Clinical Affairs and Chief

Medical Officer, Shands at UF

Mr. Timothy Goldfarb, Chief Executive Officer, Shands at UF

Michael Good, M.D., Dean, UF College of Medicine

David Guzick, M.D., PhD, Senior Vice President Health Affairs, University of

Florida and President, UF&Shands Health System

Connie Haan, M.D., Senior Associate Dean for Educational Affairs, Jacksonville Edward Jimenez, Chief Operating Officer and Senior Vice President, Shands at

the University of Florida

J. Bernard Machen, D.D.S., Ph.D., President, University of Florida

Daniel Wilson, M.D.,PhD, Vice President for Health Affairs; Dean, College of Medicine-

Jacksonville; Senior Vice President for Academic Affairs, Shands Jacksonville Ms. Cindy Seidman, Director, Medical Staff Services, Shands at the University of

Florida

Ms. Nancy Reissener, Deputy Director, NF/SG Veterans Health System

Department Chairs

Faculty Council Program Directors

E-mail – All Faculty

E-mail – All Housestaff

Posted to GME Website

Appendix 1: Current Status of 63 GME Programs at the University of Florida

(programs with a new program director in the calendar year 2012 are shown in

bold and underlined.) Program

ID# ACGME Accredited

Programs Program Director Status Cycle

Length

0401121035 Anesthesiology Tammy Y. Euliano CF 4.0

0451121009 Anes-Critical Care Medicine Andrea Gabrielli, MD CF 4.0

0411131044 Anes-Adult Cardiothoracic Yong G. Peng, M.D. CF 5.0

5301104011 Anes-Pain Medicine Robert W. Hurley, M.D., PhD AC 3.0

0801121115 Dermatology Stanton Wesson, M.D. CF 5.0

1101131186 Emergency Medicine Bobby Desai, MD CF 4.0

1201121084 Family Medicine Karen L. Hall, M.D. CF 5.0

1271112114 FM-Sports Medicine Guy Nicolette, MD CF 3.0

1401121098 Internal Medicine N. Lawrence Edwards, M.D. CF 6.0

1591114026 Advanced Heart Failure and Transplant Juan Aranda, M.D. AC 3.0

1411121045 IM-Cardiovascular Disease Thomas A. Burkhart, M.D. CF 6.0

1431121033 IM-Endocrinology & Metab Catherine Edwards, MD CF 6.0

1441121039 IM-Gastroenterology Shanaz Sultan, MD CF 6.0

1461121033 IM-Infectious Diseases Shehla Islam, MD CF 6.0

1481121031 IM-Nephrology JogiRaju Tantravahi, M.D. CF 6.0

1501121025 IM-Rheumatology Eric Sobel, M.D. CF 6.0

1511121009 IM-Geriatric Medicine John Meuleman, M.D. CF 6.0

1521113108 IM-Interventional Cardiology Karen Smith, M.D. CF 6.0

1541121081 IM-Cardiac Electrophysiology William Miles, M.D. CF 6.0

1551121104 IM-Hematology/Medical Onc. Thomas George, M.D. CF 6.0

1561121014 IM-Pulmonary/Critical Care P.S. Sriram, MD CF 6.0**

1581114018 IM-Transplant Hepatology Roberto J. Firpi, M.D. CF 4.0

5201114065 IM-Sleep Medicine Richard Berry, M.D. CF 6.0

1601121018 Neurological Surgery Brian Hoh, MD CF 5.0

1631121003 Endovascular Surgical Neuroradiology Brian Hoh, M.D. AC 3.0

1801121025 Neurology Glen R. Finney, M.D. CF 5.0

1871121025 Neuro-Clinical Neurophysiology Stephan Eisenschenk, MD CF 5.0

1881113069 Neuro – Vascular Neurology Michael F. Waters, M.D. CF 2.0

2201111068 Obstetrics/Gynecology W. Patrick Duff, M.D. CF 2.0

2401121042 Ophthalmology Sonal Tuli, M.D. CF 5.0

2601121123 Orthopaedic Surgery Mark Scarborough, M.D. CF 3.0

2631121011 Ortho-Hand Surgery Paul C. Dell, M.D. CF 4.0

2701121009 Ortho-Musculoskeletal Onc. Mark Scarborough, M.D. CF 5.0

2801121028 Otolaryngology William O. Collins, M.D. CF 3.0

3001121073 Pathology Lisa Dixon, M.D. CF 5.0

3071121047 Path-Cytopathology Edward J. Wilkinson, M.D. CF 5.0

3111121051 Path-Hematology Ying Li, M.D. CF 5.0

3151121010 Path-Neuropathology Anthony Yachnis, M.D. CF 5.0

1001131065 Path-Dermatopathology Valdimir Vincek, M.D. CF 5.0

3201131053 Pediatrics Nicole Black, M.D. CF 5.0

3231121020 Peds-Critical Care Torrey Baines, MD CF 4.0

3251111008 Peds-Cardiology F. Jay Fricker, M.D. CF 5.0

3261131008 Peds-Endocrinology Michael Haller, MD CF 5.0

3281131006 Peds-Nephrology Eduardo Garin, MD CF 5.0

1851118101 Peds – Neurology Edgard Andrade, MD AC 3.0

3271131010 Peds-Hematology-Oncology William Slayton, M.D. CF 5.0

3291121016 Peds-Neonatal-Perinatal Josef Neu, M.D. CF 5.0

3301121017 Peds-Pulmonology Mutasim Abu-Hasan, MD CF 4.0

3321121011 Peds-Gastroenterology Christopher Jolley, M.D. CF 5.0

4001121050 Psychiatry Jacqueline A. Hobbs, M.D. CF 4.0

4051111026 Psych-Child & Adolescent Kimberly White, MD CF 5.0

4061121007 Psych-Forensic Psychiatry Tonia Werner, M.D. CF 5.0

4201121048 Radiology - Diagnostic Elizabeth Vorhis, MD CF 5.0

4231121046 Rad-Neuroradiology Jeffrey Bennett, M.D. CF 4.0

4271121033 Rad-Vascular & Interventional Darren Postoak, M.D. CF 5.0

4301112022 Radiation Oncology Robert J. Amdur, M.D. CF 5.0

4401121072 Surgery - General George A. Sarosi, M.D. CF 4.0

4501121044 Surg-Vascular Surgery Thomas Huber, M.D. CF 5.0

4451113047 Surg-Pediatrics Saleem Islam, M.D., MPH CF 3.0

4601121020 Surg-Thoracic Surgery Philip J. Hess, M.D. CF 2.0

3601121019 Surg-Plastic Surgery Bruce A. Mast, M.D. CF 5.0

3621100158

Surg – Plastic Surgery

Integrated Bruce A. Mast, MD AC 3.0

4421113125 Surg-Critical Care Philip Efron, M.D. AC 4.0

4801121034 Urology Philipp Dahm, M.D. CF 5.0

CF-Continued Full Accreditation

AC-Initial Accreditation

** see letter text

PENDING APPLICATION APPROVAL FROM ACGME

1121111002 Emergency Medical Services Chrissy VanDillen, MD pending

Appendix 2: 2012 UF Aggregate ACGME Resident Survey Data

Appendix 3: Calendar Year 2012 Duty Hour Violations by Department

Training Program 80h Call Off 24+4 SB

Anesthesiology 10

34 10 180

ANE-Cardiovascular 2

ANE-Critical Care Medicine 7 4

ANE-Pain Medicine 1

2

CHFM - Family Medicine 4

11 3 42

CHFM-Sports Medicine 23

Dermatology

Emergency Medicine 2 2

14 336

Internal Medicine 41

66 326 395

MED-Cardiovascular 1

16 17 4

MED-Clinical Cardiac Electrophysiology

MED-Interventional Cardiology 1

MED-Endocrinology 2

6

MED-Gastroenterology 2

5 12

MED-Geriatric Medicine 45

MED-Hematology/Oncology 5

22

MED-Infectious Disease 8

MED-Nephrology 1

5 2 3

MED-Pulmonary & Critical Care 2

MED-Sleep Medicine

MED-Rheumatology 1

1

Neurological Surgery 6

17 10 39

NS:Endovascular Surgical Neuroradiology 10

Obstetrics & Gynecology

Ophthalmology 2 60

Otolaryngology 2

18 4 128

Neurology 1

12

NEURO:Vascular/Stroke

NEURO-Clinical Neurophysiology

Orthopaedic Surgery 2 2 3 10 35

ORTHO-Hand Surgery

ORTHO-Musculoskeletal Oncology

Pathology

PATH-Cytopathology

PATH-Dermatopathology

PATH-Hematology

PATH-Neuropathology

Pediatrics 5

5 16 86

PEDS-Pediatric Cardiology 1

PEDS-Pediatric Critical Care 3 39 2

PEDS-Pediatric Endocrinology 1

PEDS-Pediatric Gastroenterology 11

PEDS-Pediatric Hematology/Oncology

PEDS-Pediatric Neonatal-Perinatal 2 14 10

PEDS-Pediatric Nephrology 8

PEDS-Pediatric Pulmonary

Psychiatry 1

PSYCH-Child & Adolescent Psychiatry

PSYCH-Forensic Psychiatry

Radiation Oncology 1

Radiology 1

1

6

RAD-Neuroradiology 1

RAD-Vascular/Interventional Radiology

Surgery 13

27 12 58

SURG-Pediatric Surgery

SURG-Plastic Surgery 1

6

SURG-Surgical Critical Care 1

1

SURG-Thoracic Surgery 1

SURG-Vascular Surgery

Urology 1

Total Violations by Type 99 6 240 492 1535

Average # violations / housestaff in a single year

0.14 0.009 0.35 0.72 2.23

Key

80h=duty hours >80h/wk averaged over 4 wks

Call=call >every 3rd night averaged over 4 wks

Off=< 1 day in seven off averaged over 4 wks

24+4 = > than 24h continuous duty SB=Short break violation (<10h between duty shifts)

APPENDIX 4: HOUSESTAFF AFFAIRS ACCOMPLISHMENTS 2012

Event Description

Doctor’s Day, Veteran’s Day Celebrations Talent Show, Festivities, Celebrations

The Impaired Physician

New Housestaff Orientation Program about recognition of the impaired physician

Resident Assistance Program Ongoing confidential counseling and referral for housestaff and family.

Rehab, intervention.

Transition to Practice Program

Informative overview of the first few years of practice. Provides experienced guidance for

individuals entering practice.

Student Debt:

How to Manage

Income-Based

Repayment and Public Service Loan Forgiveness talks, consults, etc.

Transition to Practice Program

Guidelines for contract review, managing finances, interviewing, etc.

Mortgage Talks Options for young physicians

Added computer workstations to Resident

workrooms in north and south towers.

Added computers on wheels to various Units for housestaff.

GME Web site expansion / improvement Extensive revision and improvement of the UF GME

web site – http://gme.med.ufl.edu.

Meal Tickets Program Developing GatorBites = new Housestaff (GatorOne

card swipe) Meal Program – eliminates paper meal

tickets effective July, 2013 = much more convenience for housestaff

Renovated work rooms for housestaff – provided new furniture; relocated and

renovated work rooms for multiple services

Maintained and Updated GME space for several programs, lounge and gym in both towers.

Temporary relocation of OBGYN housestaff during renovations. Moved GI Medicine space off 10th floor.

Care for Colleagues Program Represented housestaff on this new program

supported by a grant from the Self-Insurance Program. This program is designed to assist the second victim (healthcare providers) in cases of serious, unexpected complications or medical

errors.

Urgent Care for Housestaff Immediate Care for Housestaff to treat minor

illnesses and injuries and help them return to work quickly; Free flu shots

Sports Medicine Clinic Immediate care for sports injuries.

Shands Wellness Center On campus gym, reduced prices.

Childcare Worked with Baby Gators childcare staff to assure that housestaff have top priority for childcare site

adjacent to Shands.

Financial Reps

Disability Reps Tax Reps Insurance Reps (life)

Personal individual meetings, conversations and

guidance. Coordinated Open Enrollment for acquiring additional UF Benefits (dental, ophthalmology, pet insurance, etc.)

Facilitated Investment Reps Sessions with Fringe Benefits Office

Valet Parking for night/weekend call. Also facilitated that all programs based at South Tower can obtain a South Tower

parking decal

Housestaff on call are afforded free Valet parking to attend patients in the E.D. and on the Units, both towers.

FOB / Scrub Access Configured all FOBS to access ScrubEx machines,

no more need for punching in codes to access scrubs.

Accommodate locations and re-locations for sleep rooms for programs – both towers.

Ongoing continuous process as new requirements for space arise throughout UF&Shands. Facilitates location and assignment of sleep space for housestaff - for on-call purposes as well as

“strategic napping”.

Support for Shands “campaigns” – I

Promise, Epic, Physician Engagement Service Team (BEST Initiatives)