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GRADUATE MEDICAL EDUCATION COMMITTEE Roseanne C. Berger, M.D., Chair Date:

Voting Members Present Non-Voting & Others Present Voting Members Absent

Minutes October 18, 2011

Drs. Sands, Filadora (for Smith), Schaeffer, Dayton, Berger, Emily Battaglia (UBRC), Braen, D’Arcy, Bethin (PDAC), Fasiuddin, Fitzpatrick, Murray, Paroski, Rosenthal, Ms. Eckart Drs. Curtis, Hassett, Joe Paris (Cardiology), Lazar-Miller (ENT), Sinha (Dermatology), Levy (Neurosurgery), Manju Ceylony (VA Women’s Health), Ms. Jill Lamantia (VA Women’s Health), Sullivan, Cummiskey, Nawotniak, Kennedy, Margaret Sayer (4th yr medical student with Dr. Paroski) Drs. Arroyo, Dubovsky, Myers, Stanislawski, Imran Ahmad (UBRC), Homaya Aziz (UBRC), Rohith Saravanan (UBRC), Suruchi Thakore (UBRC)

GMEC DUTY1

DISCUSSION/CONCLUSION Ongoing Business The Graduate Medical Education Committee of The University at Buffalo met for a scheduled meeting on Tuesday, October 18, 2011, in Room 125 BEB.

Opening

2b, 4, 10e

Ongoing Business

1

Motion – Approval of Consent Agenda items. Motion was seconded. Discussion: September Minutes – corrections – change attendance - Dr. Fudyma represented Dr. Murray; page 4 change first sentence to read “At the discretion of the Chair, program directors will have the opportunity…” Offsite Committee recommendations New Program Director for Pediatric Surgery – Dr. Philip Glick (CV & appointment letter from Dr. Dayton was previously circulated and in the packet distributed today). Motion to accept the minutes with changes, offsite recommendations, and Dr. Glick’s appointment passed. 1. Standing Reports: University at Buffalo Residents Committee (UBRC) – Dr. Emily Battaglia was welcomed as one of the new UBRC representatives to the GMEC. She updated the GMEC on this year’s UBRC activities thus far. They had a speaker from NYC, Dr. Peter Fleischutt, Associate Director of Quality and Safety at Cornell-NYU, who gave a presentation about resident driven quality improvement. He reported on his experience with such a committee working in collaboration with hospital quality committees. At the last meeting they elected representatives and a chair, Dr. Karen Reimers. She also reported that Ms. Colleen Allen, Esq., GME Resident Benefit Manager, gave an overview of the benefits available to the residents. Ms. Allen will be available prior to some GME programming currently scheduled to answer resident questions. The UBRC spent some of the meeting time brain storming about projects for the year. Dr. Berger introduced members of the GMEC to Dr. Battaglia and explained their role on the committee. She encouraged UBRC members to bring any areas of concern to this committee. Annual Plan – The committee was provided with a chart showing requests for new lines. This committee will review the requests from an educational standpoint. Representatives from the programs were invited to discuss their requests today. At the conclusion of the presentations, the GMEC will consider the proposals in executive session. Requests that are approved will be presented to the hospitals for funding consideration.

ACTION (AND BY WHOM) Dr. Berger called the meeting to order at 3:30 pm

DATE COMPLETED

Page 2 of 5 Dermatology – Dr. Anhi Sinha, Chair of Dermatology anticipates expanding the Department mission over the next few years. Derm currently has 8 residents. They seek an increase to 9 this year with a goal to add one resident per year until reaching 12. There is a national and local shortage of dermatologists. In WNY patients wait 4-6 months for an appointment. The department plans to double their faculty over the next 4-5 years. Their goal is to increase clinical, research, and their academic mission while meeting community needs. Dr. Murray stated that Medicine received an RRC citation for lack of dermatology consultations in the hospital. Dr. Sinha indicated that an increase in residents and faculty will help address this issue. He stated they will work on adding dermatology consult services at ECMC and BGH as faculty are recruited. He is also addressing this issue with community doctors. Cardiology - Dr. Joe Paris, Program Director of the Cardiology fellowship is seeking to convert a temporary 13th fellow to a permanent position. There is an abundant patient base, a wealth of clinical opportunities and procedures to support the fellows. The 13th fellow permits rotations into level 3 training for COCATS while maintaining clinical presence on services. The fellows seeking special training are taken off required modules . The additional fellow would allow them to complete in 3 years, rather than extend training, and lead to a clinical distribution that would benefit the educational mission of the program. The PGY level of the trainee will be rotated. Their most recent RRC letter had no citations. Dr. Paroski explained that a study done recently indicated that WNY currently has an appropriate level of Cardiologists, but within the next 5 years several older practitioners are expected to retire which will lead to a shortage. Neurosurgery - Dr. Elad Levy, Assistant Program Director of Neurosurgery, requests an increase of 2 positions in order to convert from a six to a seven year program. 70% of neurosurgery programs throughout the country are seven year programs and others are converting to this model. It would allow the chiefs to be better prepared surgically by giving them an extra year of training. New technology has exploded and the residents have more to learn both due to the new technology and new RRC requirements. The department was recently ranked 7th in North America in academics. The fellows would have a protected research experience designed to advance an academic career. From 2004 to the present time the clinical volume has increased 500%. The 7th year is a chief year. The committee discussed the limitations in funding research time. Dr. Sands informed the committee that the VA can pay for research time if it is done with a VA faculty member physically practicing in the VA. Surgery - Dr. James Hassett, Program Director of Surgery, requesting 8 additional preliminary positions at the PGY1 and PGY2 levels. Common program requirements now require scholarly activity in their preliminary year. Scholarly activities must be incorporated into duty hour limits. To meet scholarly activity requirements, the program added courses (both on-line and in person). Addition of undesignated prelims will permit the completion of the requirements while retaining the clinical activity at the current level. In the past, strategic planning initiated by the GMEC resulted in program downsizing which made the program decrease the number of nondesignated preliminary residents. Basic index procedures are primarily performed at BGH. They utilize resources at RPCI for basic task training. The program modified clinical commitments at Gates and VAMC. These modifications have resulted in the program successfully meeting all RRC requirements. There must be on-site supervision for all residents. Dr. Murray commented that mid-level providers or increased faculty presence could meet hospital clinical needs without increasing resident count. Dr. Berger voiced concern about finding placement at the PGY-3 level for undesignated prelims. Dr. Dayton believes undesignated positions are in demand and the program has a huge pool of applicants. Ms.

Asking for an increase of 1 position in 201213

Asking for an increase of 1 position in 201213

Asking for an increase of 2 positions when entering class reaches PGY VII level . Convert from a 6 to a 7 year program.

Page 3 of 5 Eckart noted that nationally, positions go unfilled at this level. Dr. D’Arcy stated that all the hospitals are dealing with significant budget deficits. There is some offset with having residents as far as staffing issues go, but there are significant budget issues. GMEC Executive session – All except voting members were excused. Cytopathology and Pediatric Dentistry – Dr. Berger reported that there is no cap for pediatric dentistry and cytopathology will be funded by RPCI. The floor was opened for discussion of all five requests for increases. Dermatology - 5 years accreditation commended for the way they run their program. Motion to approve was seconded and passed. The committee approved one PGY2 in 2012. GME is developing a strategic plan which will map out a strategy for the next 5-10 years. Recommend that the GMEC approve positions for 2012 with the expectation of adopting a strategic plan prior to the next annual planning process. Dr. Paroski indicated approval of the derm position is given with the expectation of reinstituting dermatology clinical services at BGH. Dr. Berger responded that the GMEC will track this because it is essential for Internal Medicine training. Emergency Medicine summary from the last GMEC was reviewed. Responses to concerns were accepted by the committee. Many graduates stay in the area. WNY is relatively low in Emergency Medicine physicians. Currently the program trains 36 residents and they would eventually like to increase by 12 to 48 for the 3 year residency. They intend to establish a junior/senior relationship at the hospitals. Motion to approve 4 for 2012 was seconded and passed. Assuming this is consistent with the strategic plan results, the committee agreed to continue the approvel for subsequent years. Cardiology – the program has been operating with 13. This is a request to make the assignment permanent. Dr. Dayton questioned who is going to fund additional “research” lines. Dr. Berger acknowledged that this is challenging. Obtaining T32 grants is one mechanism for securing bench research training. Dr. Battaglia (UBRC) is enrolled in a research tract in medicine. The clinical and research experience are fairly integrated. It may be possible to obtain funding for the 7th year. Dr. Paroski stated that the hospitals attempt to support clinical research. Motion: to approve was seconded and passed Neurosurgery – Most other neurosurgery programs nationally are already a seven year program. GMEC approval would be contingent on getting RRC approval. This additional year would enhance the research being offered. Motion to approve was second and passed. Surgery – The program is asking for 6 additional PGY1 preliminary positions and 2 additional PGY2 preliminary positions. Neurosurgery, Orthopaedics, Urology, ENT, and OM programs have

GME Office to meet with hospitals about funding approved positions

Page 4 of 5 significantly decreased the amount of designated preliminary time they spend in surgery. The decrease in these positions coupled with the new ACGME 16 hour requirements have severely impacted the program and training. To allow residents to attend required training sessions, they need additional residents to cover clinical load. PAs cannot be hired to cover these services due to billing restrictions. The committee strongly suggested that the program make it very clear to incoming undesignated preliminary residents that the obligation is for one year only. The RRC for surgery understands that there are applicants being brought in that are going to be without a positon at the completion of their training at UB. . Dr. Murray told Dr. Dayton that he would discuss mid-level provider needs with him. Surgery has a critical shortage of general surgeons in New York. Motion to approve a one or two year commitment. The program needs to closely monitor placement and recruitment of quality applicants. Dr. Dayton explained that the program is committed to finding positions for these residents at the end of their contract. Motion to approve on a two year cycle was seconded and passed. VAWNY Women’s Health – Dr. Manju Ceylony, WNYVA Director of Women’s Health, addressed the committee to discuss an unaccredited Women’s Health training program. She explained that many medical schools have a women’s health track due to the recognition of the difference between men and women’s health issues. There are VA programs throughout the country that are increasing their training in this area. There is an expectation that this type of specialty will be increasing in the near future. It is a two year fellowship. 50%-75% of the time will be spent in research. The VA Central Office will fund the program. There is a need and Dr. Ceylony has been working to establish relationships with departments that will assist in the training of these fellows. She is bringing the opportunity to this committee for their consideration. Motion to approve the request to sponsor this training was seconded and approved. Neurosurgery RRC Letter – Accreditation letters and citations are monitored by the Internal Review subcommittee chaired by Dr. Braen. Dr. Braen reviewed the RRC letter to Dr. Silvestri dated September 21, 2011. A progress report on issues flagged in the resident survey needs to be submitted to the RRC by February 29, 2012. The IRSC and GMEC will review the drafts. There was no further discussion Responding to Residents Update: Resident lockers have been installed at Millard Fillmore Suburban Hospital. Private space for hand-offs for Family Medicine residents needs to be addressed. Dr. Paroski said she will address the issue with the appropriate parties.

4. New Business

Program Directors Advisory Committee (PDAC) – due to time constraints, no report this month. New Business – Dr. Gil Wolff has been appointed Chair of Neurology. Dr. Wolff is Professor of the University of Texas, Southwestern. He is a renowned expert in neuromuscular diseases. He is expected to relocated in December and begin his official duties on January 1 st. -

Due to time constraints, Dr. Berger asked if Dr. Schaeffer’s presentation on the Medicine

RRC progress report due 2/29/12

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ENT placement and re-configuration - The program does not need to have a new site until May. ENT has been accumulating data that has been shared with Dr. Hassett. Dr. Lazar-Miller confirmed that they have funding for one position from RPCI. Adjournment – Motion to adjourn was seconded and passed at 5:35 Regarding GME Committee Responsibilities (ACGME Institutional Requirements section III.B.1-13), the GMEC must: establish and implement policies and procedures regarding the quality of education and the work environment for the residents in all accredited programs (1) annual review and recommendations to the Sponsoring Institution regarding resident stipends, benefits, and funding for resident positions; (2) ensure that communication mechanisms exist between the GMEC and all program directors within the institution; ensure that program directors maintain effective communication mechanisms with the site directors at each participating institution for their respective programs to maintain proper oversight at all clinical sites; (3) develop and implement written policies and procedures regarding resident duty hours to ensure compliance with the Institutional, Common and specialty-specific Program Requirements; (4) monitor programs’ supervision of residents and ensure supervision is consistent with: provision of safe and effective patient care; educational needs of residents; progressive responsibility appropriate to residents’ level of education, competence, and experience; and other applicable Common and specialty/subspecialty-specific Program Requirements; (5) communication between leadership of the medical staff regarding the safety and quality of patient care that includes: the annual report to the OMS; description of resident participation in patient safety and quality of care education; and, the accreditation status of programs and any citations regarding patient care issues; (6) assurance that each program provides a curriculum and an evaluation system that enables residents to demonstrate achievement of the ACGME general competencies as defined in the Common and specialty/subspecialty-specific Program Requirements; (7) selection, evaluation, promotion, transfer, discipline, and/or dismissal of residents in compliance with the Institutional and Common Program Requirements; (8) review of all ACGME program accreditation letters of notification and monitoring of action plans for the correction of citations and areas of noncompliance; (9) review of the Sponsoring Institution's ACGME letter of notification from the IRC and monitoring of action plans for correction of citations and areas of noncompliance; (10) review for approval, prior to submission to the ACGME by program directors program changes as outlined in the Institutional Requirements section III, B,10; (11) oversight of all phases of educational experiments and innovations that may deviate from Institutional, Common, and specialty-specific Program Requirements; (12) oversight of all processes related to reductions and/or closures of individual programs; major participating institutions, and, the Sponsoring Institution; (13) provision of a statement or institutional policy that addresses interactions between vendor representatives/corporations and residents/GME programs; (IV) develop, implement and oversee an internal review process in accordance with the ACGME Institutional Requirements IV, A & B.