2004 Regional Breakfast Minutes from Spring Meeting  
  Issues discussed:
  1. Duty hours:
      a. Large variation among programs in methods of tracking:
      1. Review of a specific 4 week cycle(s) of all resident hours (to stand as representation sample)
      2. Spot checks of a cross section of residents on all rotations at a particular point in time
      3. Attestation statement linked to the rotation evaluation ("I have not violated duty hour regulations on this rotation")-problematic if the RRC wants to see specific work hours
      4. Sample of specific rotations
      5. Paper and pencil, on-line (various vendors-New Innovations seems most popular, at least in the region), swipe cards
    1. Dealing with violations-what is the definition of program compliance?
      1. Residents staying beyond their shifts-individual residents must be accountable, Program Director speaks with individual residents inclined to stay, changing the culture
      2. Programs must have a way for residents to report violations confidentially
      3. Many programs have compliance as the default and resident attests
      4. Unclear how many violations, handled in what way would constitute compliance problem per the RRC
Conclusion: We will know what is accecptable as RRC completes site visits of programs
  1. Remediation of resident knowledge/skill/attitude-how to fit it into the work week
    1. Residents who are struggling cannot simply stay longer to get their work done, some may be cutting corners (eg: not writing notes) in order to get out on time
    2. Need to develop a PDlearning module on organization and efficiency
    3. Bright Futures has a time management module we could adapt
    4. Since time at work is shorter and needs to be focused on patient care, residents must have the expectation that they will go home and READ
Conclusion: There is good work that our regional groups could do in this area.
  1. Incorporating the Competencies into Learning Goals and Objectives
    1. General agreement that not every competency needs to be taught or assessed on each rotation
    2. Competency should be defined by level of training
    3. Faculty need to be involved in defining competency and developing methods of assessment
Conclusion: There is much sharing of methods that can be done at our regional APPD meetings in fall.
  1. Technology
    1. Learning Technology Task Force will work to make computer-based learning modules available on the APPD website for programs to use and review.
    2. Consider a survey of APPD membership: what do you have that works, what do you need?
    3. Consider linking with curriculum task force to develop Likert scales for web-based curricula
Conclusion: Shared learning modules would be a great asset
  1. Conference attendance
    1. Programs need to set a standard for the proportion of "required conferences" residents need to attend and motivate residents to attend:
      1. Emphasize conference attendance at intern orientation, instill as part of the culture
      2. Improve quality of conferences
      3. Book funds as a reward for attending required conferences
      4. Make attendance part of the permanent record
      5. Tie to assessment of professionalism: "point system" for violations
      6. Show residents the ABP form assessing professionalism as a condition for Board Eligibilty
      7. Give extra call for falling below expectations
    2. Some programs have devoted a weekly 3 hour block of protected time to didactics instead of 3 separate hour long conferences
      1. Chiefs initially held pagers until the culture changed
      2. 45 minute talks, specialty specific blocks, case-based
Conclusion: Program attendance methods vary but there appear to be many effective methods
  1. Program Coordinators are interested in meeting with Program Directors at the Regional meeting, they have much to contribute and not all can get to the National meeting
Conclusion: Inviting Program Coordinators and chief Residents to regional meeting would be a real asset.

ACTION PLAN:
  1. Invite Program Coordinators and Chief Residents to the fall Regional meeting (John Mahan at Columbus is happy to host). Friday, October 22, 2004 from 10:00 - 3:00 has been identified as the date for the Regional Meeting
  2. Develop a module on organizational skills-remediation, time managment
    1. survey members and chiefs to see who would like to work on this
  3. Continue to share experience with RRC site visits re: duty hours compliance, competency assessment, etc
Respectfully submitted,

Dena Hofkosh, MD

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