EMERGENCY MEDICINE RESIDENCY RULES AND REGULATIONS

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EMERGENCY MEDICINE RESIDENCY RULES AND REGULATIONS

• Stephan Rinnert, MD
• Vice Chairman for Education and Faculty
  Development
• Associate Professor of Clinical Emergency
  Medicine
• SUNY Downstate / Kings County Hospital
• Brooklyn, NY

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Kings County Hospital
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Objectives

• Why are there Rules / Regulations?
• Who makes the Rules / Regulations?
• ACGME
• RRC
• Program requirements
• Who enforces the Rules?
• Role of the institution
• Role of the PD
• FAQs
• Other questions

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Why are there Rules / Regulations?

• H. J. Res. 30 introduced in 2000, Rep. Pete
  Stark
• The health of every American is vital to their
  unalienable rights of life, liberty, and the
  pursuit of happiness,
• To ensure these rights are fully enjoyed, we
  must be certain that every American can access
  quality health care regardless of their income,
  race, education or job status.
• And for all the praise of the advanced medical
  technologies available in this country, high-tech
  does not necessarily equate to high quality
• H.J. Res. 30 would amend the Constitution to say
  all persons shall enjoy the right to health care
  of equal high quality.

http//www.house.gov/stark/news/109th/floorstateme
nts/03-02_healthamend.htm
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Do Doctors need Rules?

• Health care of equal high quality?
• Is there inequality in care and why?
• Arent doctors supposed to act ethically?
• Can we influence outcomes?
• Do we need quality improvement?

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Accreditation, Licensure, Certification the
Carrot and the Stick

• Accreditation
• Power behind educational process, content
• Defines minimal standards
• Ensures basic standards
• Protects public welfare
• Licensure and Certification
• Meet specific standards
• Maintain competence

Health Professions Education A Bridge to Quality
(2003), IOM
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Who makes the Rules in Residency Education?

• Education ACGME Accreditation Council for
  Graduate Medical Education
• Institution Regulatory agencies (JCAHO Joint
  Commission on the Accreditation of Healthcare
  Organizations aka Joint Commission) and Local,
  State, Federal Laws
• Personal Federal and State Licensing bodies
• Specialty American Board of Medical Specialties

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What is the ACGME?

• Accreditation Council for Graduate Medical
  Education
• Since 1981
• Private NFP
• Member organizations
• ABMS, AHA, AMA, AAMC, CMSS
• 28 RRCs
• 8355 programs
• 107,245 residents

www.acgme.org
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Who does the ACGME Serve?

• Accountable to member societies
• (ABMS, AHA, AMA, AAMC, CMSS)
• Public interest
• Interest of trainees
• Not the interest of institutions or individuals
• No financial interest

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ACGME Mission, Vision and Values

• Mission Statement To improve health care by
  assessing and advancing the quality of resident
  physicians' education through accreditation.
• Vision StatementExemplary accreditation

www.acgme.org
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The Enforcer

• ACGME institutional review
• Residency Review Committees (RRC)

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RRC Friend or Foe?

• RRC Role
• Develop and maintain Program requirements
• Program review and quality control
• Accreditation
• Innovation
• Who is the RRC?
• Elected representatives of member organizations
• Resident member

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Program Requirements

• PR Constitution, defines
• Structure of program and rationale
• Number of residents, number of institutions,
• Qualifications, role and responsibility for
• PD, Faculty and chair and other personnel
• Resident duty hours
• Number of procedures
• Educational program
• Evaluations and outcomes assessment

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The Program Director

• Requirements
• 3 years out of residency
• lt 20 clin. hours / week
• Longevity to maintain stability
• Licensed, boarded, in EM or other acceptable
  specialty
• Active in regional, state or national committees
• Scholarly active

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The PD continued

• Responsibility
• Report to RRC / ACGME , prepare PIF (Program
  Information Form)
• Verification of resident education
• Evaluations of residents and faculty
• Design educational program according to RRC
  guidelines
• Record resident performance and growth
• Comply with institutional guidelines
• Leadership qualities
• Provide mentorship
• Monitor resident fatigue
• Establish due process guidelines

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FAQs

• What do all programs have in common?
• Is there a difference in programs?
• Do I have rights as a resident?
• Does a program need to disclose its RRC
  citations?
• What can I do if my program does not follow RRC
  guidelines?
• What happens if I violate the rules and
  regulations?

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What Do All Programs Have in Common?

• All share extensive and detailed minimum
  requirements
• All have qualified personnel (PD, Faculty, Chair)
• All have same basic educational expectations (
  Model of Clinical Practice of EM)
• All have same max. work hours
• All have due processes
• All are regularly reviewed and evaluated

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How do Programs Differ?

• Geography
• Residency size and length
• Hospital size, ED visit numbers
• Faculty size
• Patient mix, Acuity
• Rotations
• Electives
• Innovations
• Individuals
• Educational program
• Research agenda
• Mission and vision
• Rules

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Do I have Rights as a Resident?

• Extensive rights (service vs. education)
• Due process
• Support systems GMEC, RRC, ACGME, DOH, CIR

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What Happens if Rules are Violated?

• Program / Institution violating rules
• Institutional investigation
• RRC investigation
• Immediate review and citations
• Review of Accreditation status
• Resident violating rules
• Due process
• Consequences warning, probation, dismissal

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Advantages to Rules and Regs

• Basic (high) standard of education
• Transparency
• Equality
• Frame work
• Accountability
• Reproduceability
• Public confidence in your education

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How Do I Proceed From here?

• Get informed
• Read program requirements
• Review handbook
• Review hospital policy and procedure manuals
• Ask
• Do the right thing

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Thank You andGood Luck