Minutes of Resident Education Committee Meeting Friday, October 4, 2002 at San Diego, CA

 

Attendees: Margaret Winkler (co-chair), Mohan Mysore (co-chair), Heidi Appel, Katherine Biagas, Tim Corden, Maria Enrione, Heidi Flori, Jane Fong, Lorry Frankel, Gary Goulin, Keith Lewis, Rita Ongjoco, Steve Schexnayder, Pat Sheehan, Mark Siegel, Rick Taylor, Heinrich Werner and John Winters.

 

Meeting was called to order, lunch was served and we oohed and aaahed at the absolutely gorgeous day outside as we looked out on San Diego’s Mission Bay.

 

1.     Core curriculum presentations:

New presentations on Hepatic Failure, Fluids and Electrolyte emergencies and Oncologic Emergencies have been added to the site.  Five new presentations in the works are on ECMO, Trauma, Patient Safety, Office Emergencies and  Submersion/Environmental emergencies.  We discussed the need to have one on Respiratory Failure and Drs. Biagas and Enrione agreed to co-author one on this subject.

 

2.     Mohan proposed arranging the presentations into weekly “modules” with basic concepts tackled in the first couple of weeks and more involved topics being covered in the latter half of the rotation.  Will look for input from the whole group on this.  As our web-based curriculum grows to encompass more than just the “core topics” it might be even more important to have a structured template for the curriculum.  Template is the operative word here in order to allow flexibility to programs.

 

3.     Fee or free ?  This was brought up (thanks, Ed Conway) at the Pediatric Section Executive Committee meeting earlier in the day.  This issue was discussed by the co-chairs with the Pediatric Section Chair (Dr. Moss) and the Section leadership is more inclined to have us offer this as a fee-based service with the fees specifically earmarked to go to the Pediatric Section.  We will work with the Section leadership to enter into a contractual agreement with the SCCM.  The web site will most likely migrate over to the SCCM in January.

 

4.     Feedback on web site: Two concrete suggestions emerged (the rest was hot air): An index or content page listing all the presentations was recommended.  This was already being developed by the software developer and should be available by early next week with direct links to each presentation.  Another suggestion was to have an (anonymous) evaluation and feedback form at the end of each presentation.  We will pass on this request to the site developers and look into cost and feasibility.

 

5.     Updates to presentations: ACTION ITEM for the authors.  Target date for updates: DECEMBER 1, 2002.  Various enhancements to the presentations were suggested.  The following suggestions will need to be implemented in EVERY presentation (new and old):

: Please send the entire updated presentation to Dr. Mysore (rather than just slides that need to be added/deleted/modified).  The new Index/Contents page will note the version that is available.

: Please list goals and objectives at the beginning of each presentation.  We will need to work eventually on having these goals and objectives gel or mesh with the Goals and Objectives defined by the Working Group.  Yes, the issue of the horse and cart were brought up.

: Please include a slide toward the end listing “Suggested Reading” with either sections from textbooks or landmark articles on the subject (either historic landmarks – say Ashbaugh and Petty’s from Lancet 1967 on ARDS or more recent studies or reviews).  A short list (6-10) is more helpful than 200 references.  These articles can then be pulled by programs and placed in a teaching file for the residents to peruse during their 40 hours/week in the PICU.

: Members of the committee are requested to draw the attention of the authors to landmark articles to help with the task.  Please send directly to the authors their e-mail addresses are on the web site with the presentations.

: Authors are requested to include a slide or two on Preventive Medicine/Advocacy/Public Health issues pertaining to the topic.  This is to comply with the new ACGME requirements to stress these aspects in resident education.  Since most programs use the presentations as a “template” for their didactic sessions, they can expound on these aspects further.

: Please include two or three interactive/case scenarios in the presentations.  These were considered particularly helpful in “involving” the house staff.  Some topics lend themselves more readily to this than others.

: One final recommendation for the updates was to include notes/key points for the slides so the presenters can know what the authors are wanting to stress.  This does involve considerable extra work and we will include them as the authors get them done, but will not insist on the December 1 deadline for this part of the update.

:When working on the updates to your presentations, please cite the source of your graphics/tables/data.  We have been lax about enforcing this but the SCCM will require it and there is no reason why we should not comply with that standard.

 

6.     A Working Group will be set up to define Goals and Objectives that we can hopefully all agree on and possibly use as a template at our own institutions.  The ACGME is requiring these as part of the new Outcome Project initiative (see www.acgme.org and use the navigation bar on the left to go to competencies and assessment).  Kathleen Donnelly from Albany, NY is going to head this Working Group and if any of you wish to participate or provide input, please contact her (before 10/15 if you want to be in on the group) at donnelk@mail.amc.edu

 

 

7.     Discussion related to the new resident work hours overtook many of the agenda items (imagine that !).  There is no simple, universal solution to this problem and the residents and their education are bound to suffer in this new environment.  As a result of these work hour changes, it is increasingly important for us to have clearly defined objectives (#6 above) and a plan for how best to train the pediatricians of the future.  Some of the details of how each division approaches/solves this problem will remain institution-specific, however, this committee can serve as a forum for discussion, shared experiences (shared pain/angst) and might provide a lone voice in the wilderness.  It was proposed that the Committee draft a letter to the ACGME and RRC (with all of you signing) voicing concern about the impact these new restrictions (combined with the continuity clinic requirements) are going to have on adequacy of training residents to deal with critically ill or injured children.  Meanwhile, the Fellowship Directors at their meeting voted to draft a letter congratulating/supporting the ACGME on the work hour restrictions.  We will have a Working Group headed by Amy Hardin from Louisville, KY work on this document and seek potential approaches/solutions to this vital issue that concerns us all.  Please e-mail Amy with your thoughts and ideas on this issue at amy.hardin@louisville.edu and cc Mohan also at mmysore@chsomaha.org

Mohan is also going to serve on a newly formed SCCM Committee on Graduate Medical Education and will look into working with this committee to lobby the ACGME and RRC on these issues.  Having the weight of the SCCM and other specialties represented by this committee behind a lobbying effort might give us a little more clout.

 

8.     Online Examination: Got sidetracked by 6 and 7 above.  The examination is up and running.  We will need more questions (ACTION ITEM) for a second examination for residents rotating through the second time.  Launch date for the second examination is June/July ’03.  Please provide feedback on the examination.  We are looking for 6 to 10 centers that will agree to be sites for a Pilot Study of the exam/scores/database development/report generation.  We will need a commitment from these sites to REQUIRE every resident completing the PICU rotation during the next 6 months to take the examination.  Please let mmysore@chsomaha.org know ASAP if you wish to be a test site (commitment is going to be important here).  We should plan to present the results at the SPR or AAP meeting to “generate a buzz” among Program Directors/Chairman.  Anyone interested in data collection, analysis and presentation of this information, please contact Mohan ASAP.

 

The next committee meeting is tentatively scheduled for Wednesday, January 29 in San Antonio. The Pediatric Current Concepts course is on 28 and 29 and we might hopefully have the meeting scheduled for right after the course (Margaritas on the Riverwalk, anyone ?).

 

 

Respectfully submitted,

Mohan R. Mysore, M.D.