Medicine

Liaison Committee on Medical Education Awards MCW Full Eight-Year Accreditation Status

In July, the LCME awarded MCW an eight-year accreditation status, the maximum possible, for our medical doctorate program. The Committee recognized our institution for strengths in leadership, expertise, collegiality, and a commitment and dedication to our medical students. This accomplishment is a testament to all faculty and staff who support our education mission. A heartfelt thank you and congratulations to all!

As we celebrate our success, we must acknowledge the journey ahead. Our next LCME site visit will take place during the 2018-19 academic year. In the interim, we are required to submit status reports to address areas of noncompliance or programs in transition identified during our site visit. Course and clerkship directors across our campus are beginning work on these areas. As work progresses, we will call on the continued support of our faculty and staff to improve in the following areas.

Timely Submission of Grades
Clinical clerkships were cited for excessive time between the end of rotations and submission of grades to the Registrar. MCW policy requires all final grades be on file with the Registrar within 30 days. To facilitate compliance, DOM policy requires all physicians (faculty and resident) submit their student performance evaluations in OASIS within 14 days.

Inconsistent Mid-Clerkship Feedback
All required courses and clerkships must have a formal mechanism to provide formative feedback to students at the mid-point of their rotation. For M3 students, this takes place at the end of the first month. For M4 students, this takes place after the first two weeks.

Currently, M3 students receive feedback based on the OASIS performance evaluations. M4 students ask senior resident and attending physicians to complete a paper-based form. These systems are under review and will likely change as decisions are made at the College level. In the interim, compliance with current procedures is essential.

By April 15, 2012, Dean Kerschner must submit a status report to the LCME addressing these and other citations. Immediate and sustained compliance with the above requirements is crucial in ensuring the Department of Medicine continues to serve as a leader in education on our campus.

If you have any questions regarding the LCME or undergraduate medical education, please contact Kerrie Quirk, Medical Education Coordinator for DOM Student Programs, at 805-0530 or kquirk@mcw.edu.

Article written by Kerrie Quirk, Medical Education Coordinator II

Like Herding Cats—trying to comply with the new work hour rules on busy inpatient services

On July 1, we initiated new team structures and call schedules to comply with the new work-hour rules from the ACGME. While I’ve heard a lot of comments from a lot of people about the new rules, the one universal is that nobody likes them—and that includes the new interns. The most significant change was the reduction in maximum shift length for interns to 16 hours. This means that an intern cannot work overnight if they have been at the hospital that same day. A working group spent a few months last year deciding the best way to deal with the changes for this year, first identifying principles to guide us in the process. These included that we wanted to minimize night float rotations since they have minimal educational value, that we wanted as much as possible to preserve team continuity and continuity for the resident-patient relationship, and that we would individualize the solution to a given service rather than try to utilize a one-size-fits-all approach.

Now that we have been in the new system for a few months, it is time to look critically at what is working well and what isn’t. For the most part, we have been compliant with the new rules. We have avoided adding new night float responsibilities for the housestaff. We have received generally good feedback on most of the services affected. But we’ve also realized some real (though not surprising) challenges. These primarily involve disruptions to team continuity on ward rotations caused by the fact that the overnight call intern cannot work the day of their overnight call shift nor the day after it. Thus they miss two days for each call night. And this means that the team is missing members much more frequently now (including the same number of days off and clinic days). This is not only disruptive to the educational missions of the service (affecting both housestaff and students), but also to patient care with a lot more handovers of patients and more coverage of patients by other team members who did not admit the patient. We must face these challenges with better training and monitoring of handover communication and understanding of shared responsibilities and teamwork. But we also need to look again at the trade-off involved in having interns on overnight call vs. alternative means of nighttime coverage including night float. The work hour limits are not flexible, not optional, and not negotiable, and there are only so many ways to run a service and be in compliance with them. Our challenge is to keep in the forefront our desire to provide the highest quality training and patient care as we think constructively about our limited options for meeting the requirements.

Kathy Rafel, Program Coordinator