Utilizing Germane's Pre-Year Check-In

Matt Boll | February 27, 2019

With over a decade in the Graduate Medical Education space, Matt is an expert on necessary key competencies for an effective GME program. He possesses a keen ability to detect & address areas of weakness in programs of any size, year, or specialty. Matt will explain how Germane's Program Pre-Check will ensure success for your program.

“Hi I’m Matt from Germane Solutions. Today we’re going to talk about new programs. To start off with, I’d like you to think about new programs as an airplane. Now I know this isn’t the analogy people normally use to think of new programs, but I think you’ll see it’s a pretty good one. This is because, in their essence, airplanes are just thousands and thousands of pieces that are all closely aligned and come together to bring enough force and thrust to life an 80-ton metal box off the ground and into the air, traveling at 500 miles an hour.

Now, GME programs have their own level of complexity. Let’s take your average primary care program of 30 residents. Each one of those 30 residents are going to have 13 blocks of rotations. So, that means the program is going to have 390 blocks that they need to staff with a bunch of residents and faculty. Add to that continuity clinics. To be conservative, let’s say residents are going to go to the continuity clinic once a week. So now, you have 30 residents, times 48 weeks per year, that’s 1440 sessions that the residents are going to go to that you need to manage. Finally, most GME programs have at least three sites for their clinical training. So that 1440 continuity clinic sessions and the 390 rotations are all occurring over various locations. So, there is clearly a lot of complexity in GME that rivals that of an airplane.

So, you’re a manager of a GME program, what do you do about this level of complexity? Well, you do what the airlines do. You have a pre-check before the program takes off. You’re making sure you’ve looked at the core things of your program and that they’re solid before the program gets up and running. For us there are five of these core areas, the first is curriculum development, the second is schedule balancing, the third is space management, the fourth is budget development, and the fifth is staff education. Now, since this is a short video, we’re only going to talk about schedule balancing today, but we have several other videos that you can see if you’d like.

In terms of balancing a schedule, this may be the most complex part of any GME program. Largely because there are so many stakeholders. Think about this, the average schedule has to manage the ACGME’s expectations, the program director’s desires and wishes, and the needs of the hospital all in a schedule. With that many moving pieces, every schedule is going to be unique. But we’ve discovered after working with so many programs that there are three key numbers to keep in mind that can really help build a foundation for your program. The first is 3-1. That’s three residents to one faculty member in your continuity clinic session. Why 3-1? Well, because 2-1 really actually proves the myth of residency to slow you down. We’ve seen the numbers that say a faculty member would be better off practicing by themselves or with an extender than they would with two residents. And at 4-1, that is the optimal amount, but it also leaves you with the smallest margin of error. You have to have the staff, and rooms, and faculty, everything has to operate perfectly and align perfectly to really use 4-1. And if something goes wrong, it goes wrong in a big way. So, 3-1 is very much where we try to keep it. The second number is 10. As in 10 residents in every inpatient team. Why 10? Same reasons. Below 10, you’re really not maximizing your faculty leverage. Above 10, you can’t possibly supervise that many residents. The final number is 2-1. That’s the number of residents to specialist faculty member. As a general rule, specialists are not core faculty of your program, but they are a key piece of that program. So, keeping them happy is very, very important to the program’s success. And at more than 2-1, you’re really clogging up the faculty’s offices and their specialty and their patients. Back to efficiency again, they’re better off without the resident than with the resident.

So, hopefully these three numbers will give you a good foundation to build your new schedule and balance your program. So, if you do these pre-checks consistently, your program will have what it needs to take off. Thank you for watching the video today, and we encourage you to check out our other videos and information at GMEUniversity.com”

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