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Graduate & Undergraduate Medical & Dental Education

Graduate & Undergraduate Medical & Dental Education. CHRISTY CLARY, MSW, MEDICAL & DENTAL EDUCATION, OAA. Medical & Dental Nationwide. 60% of US Physicians Trained at the VA. 120,890 total trainees AY 2018* 71,687 Medical & Dental Total Trainees Physician Residents 45,296

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Graduate & Undergraduate Medical & Dental Education

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  1. Graduate & UndergraduateMedical & Dental Education CHRISTY CLARY, MSW, MEDICAL & DENTAL EDUCATION, OAA

  2. Medical & Dental Nationwide 60% of US Physicians Trained at the VA • 120,890 total trainees AY 2018* • 71,687 Medical & Dental Total Trainees • Physician Residents 45,296 • Medical Students 24,643 • Dental Residents/Students 1,748 • 10,675 physician resident/fellow positions AY 2018 • Overall Trainee Satisfaction 93% • Willingness to work at the VA 73% *Paid & WOC

  3. Important Players • ACGME – Accreditation Council for GME (allopathic/osteopathic) • AOA – American Osteopathic Association (osteopathic) • LCME – Liaison Committee on Medical Education (undergraduate) • AAMC – Association of American Medical Colleges • UME – Undergraduate Medical Education (Students) • GME – Graduate Medical Education (Residents/Fellows)

  4. Program Director Ensures quality of the overall education and training program in a given discipline and for ensuring that the program is in compliance with the policies of the accrediting bodies. • Maintenance, evaluation, and improvement of a specific education and training program • Program Operations and logistics, educational objectives and curriculum development • Evaluation methodologies and mechanics, and relationships with accrediting agencies and certifying bodies. • May be VA or Affiliate paid • In GME this is the person noted on the ACGME/AOA documentation 1400.01 pg. 18

  5. VA Site Directors Ensures supervising practitioners are appropriately fulfilling their responsibilities to provide supervision to residents • Ensures evaluations are conducted • Residents function with in their graduate levels of responsibility • Structures training programs w/Program Director • MTT is completed • In GME often the person with daily responsibilities regarding resident activity tracking 1400.01 pg. 18

  6. Designated Institution Officer (DIO) • Authority and responsibility for the oversight and administration of the sponsoring institution’s ACGME accredited programs and is responsible for ensuring compliance w/ACGME institutional requirements. • Signs all program info and forms submitted by PD’s that address program citations or request changes in the programs that would have an impact on the education program or institution. 1400.01 pg. 19

  7. ACOS/E Designated Education Officer ADVANCED FELLOWS NURSING MEDICAL & DENTAL ASSOCIATED HEALTH VHA Handbook 1400.05: j. Designated Education Officer. The Designated Education Officer (DEO) is the single, designated VA employee who has oversight responsibility for all health professions trainingat a VA medical facility. 1400.01 Pg 18 1400.05 Pg 10 1400.09 Pg 10

  8. Foundation • Relationships • Affiliation Agreements • Mutual Interest VA and Affiliate • Disbursement Agreements

  9. Affiliation Agreements • Agreement between your VAMC & Sponsoring Institution • Only 2 – UME or GME • Must Include • Name, ACGME/AOA Number, Termination Date & Signatures • All VA Signatures are required to be E-signed w/PIV Card • Cannot be altered • Template has been approved by all accrediting bodies and the Office of General Council VA 1400.03

  10. STIPEND PROCESS DISBURSEMENT PROCESS VAMC VAMC AFFILIATE TRAINEE

  11. 1400.05

  12. Disbursement Agreements • Agreement between your VAMC and your affiliate/sponsoring institution • Disbursing Agent • Usually cannot be altered • Must be updated if there are changes 1400.05

  13. Disbursement Rate Schedules • Must be updated annually • Provided by your Affiliate • VA CAN ONLY PAY WHAT YOU HAVE UPLOADED!! • CR – waiver for higher pay available • Separate rate schedules 1400.05

  14. Separate CR & Regular Residents 2 different schedules

  15. Stipend Memos • Only 1% of the trainees in VHA will be paid this way • Direct payment from the VA to the trainee • Usually used for CRQS positions or those at 100% • Must be a US Citizen • Dental mostly stipend – market survey 1400.05

  16. Program Letters of Agreement • ACGME Requirement • Includes competencies/goals/objectives • Provided to the VA by the Affiliate • Keep on a share drive • Must have one on file for each specialty • Sample & Q/A on ACGME website: https://www.acgme.org/Portals/0/PDFs/Sample-PLAs.pdf 1400.05 Pg 5

  17. National Medical & Dental Policies • 1400.01 – Resident Supervision • 1400.03 – VHA Educational Relationships • 1400.05 – VA Disbursement Agreements • 1400.09 – Education of Physician and Dentist • 1400.10 – Health Care Resources • ALL OAA POLICIES

  18. HANDBOOK 1400.01 Resident Supervision • GRADUATED LEVELS OF RESPONSIBILITY • SUPERVISION • DOCUMENTATION • EVALUATION • ARRTP • CHIEF RESIDENTS & MOONLIGHTING • MONITORING THE ABOVE • ROLES & RESPONSIBLITIES DEO, MCD & NETWORK DIRECTOR

  19. HANDBOOK 1400.03 Educational Relationships • AFFILIATION COUNCIL PARTNERSHIPS • DISBURSEMENT AGREEMENTS • AFFILIATION AGREEMENTS • PROGRAM LETTERS OF AGREEMENTS • ACADEMIC REPORTS & FORMS • BASE & GME VERIFICATION REPORTS BREAD & BUTTER

  20. HANDBOOK 1400.05 VHA Disbursement Agreements Procedures • FUNDING FOR TRAINEES • DISBURSEMENT AGREEMENTS • AFFILIATON AGREEMENTS • STIPENDS • REIMBURSABLE ITEMS • RESIDENT TRACKING ACTIVITY/CBI AUDIT • RATE SCHEDULES • NEEDS & EXCESS REPORTING • EDUCATIONAL COST CONTRACTS 1400.05 – PAGE 23 SECTION 11/B

  21. HANDBOOK 1400.09 Education of Physician and Dentist • ACCREDITATION • COMMITTEES • DETAILED DEO ROLE • MEDICAL & DENTAL STUDENTS • ON-BOARDING: APPOINTMENT & PAY OF TRAINEES • LEAVE • DISCIPLINARY ACTIONS • TORT CLAIMS (MALPRACTICE) • QUARTERS, FOOD, ETC • TRAVEL

  22. Auditing • Resident Supervision (1400.01) • Resident Activity (1400.05) • Clinical Training & Quality of Care (1400.01/1400.09) • Disbursement Agreements Process (1400.05)

  23. Resident Activity Tracking 1400.05: (1) Ensuring that local policies and procedures, including assignment of auditing responsibility, are in place to fulfill the requirements of this Handbook; this includes having a local policy defining the procedures for resident activity record keeping that includes assignment of record keeping duties to appropriate staff; Who Is Doing It Well? • Baltimore (POC: Linda Keldsen) • Oklahoma City (POC: Tyler Duerr) • Chicago (POC: Abdul Sarmasth) • Columbia SC (POC: Thomas Wiseman) • East Orange (POC: Dr. Joseph Green) #1 SITE VISIT FINDING

  24. Trainee Satisfaction Survey How Do You Use This Feedback? TSS for Trainee can be found at: https://www.va.gov/oaa/surveys/

  25. Educational Cost Contracts • 1400.10 Health Care Resources • Developed to create a mechanism for the payment of our share or pro-rated portion of educational costs of training physician and dentist. • Local Medical Center Funds/VERA are used to cover cost • Non-Competitive Contract • May NOT include salary or other items included in the disbursement agreement 1400.10 Health Care Resources

  26. What’s included???Educational Cost Contracting • Accreditation Fees • National Match participation fees • In-service examination fees (for those rotating at the VA at the time) • Residency program management software fees • Required training/recertification fees • ACLS/BLS • Property that is “borrowed” by the trainee for the duration of training, e.g. pagers 1400.10 Pg 5

  27. What’s NOT included???Educational Cost Contracting • Licensing fees • Licensing examinations • Board certification exam fees • Malpractice Insurance • Administrative expenses • Recruitment or orientation expenses that involve meals, travel or entertainment • Faculty salaries or benefits • Etc. POC: Andrea Birnbaum, MD Andrea.Birnbaum@va.gov 1400.10 Pg 6

  28. Local Policies May Include……But NOT Limited Too • Resident Activity Record Keeping Policy (1400.05) • Monitoring Resident Supervision (1400.01) • Academic Relationships/Affiliation Agreements (1400.03) Every 3 Years!

  29. Meetings and Committees • Affiliation Partnership Council (1400.09) Historically “Deans Committee” • VA Residency Review Committee (1400.09) • Graduate Medical Educational Committee (1400.09) – If Dental than GRE • Education Committee (1400.09)

  30. LONG TERM PLANNING WHAT WILL WE USE? SHORT-TERM PLANNING WHAT WILL WE REALLY USE? VERIFICATION ALLOCATION BASE ALLOCATION JULY 1 JUNE 31 OCT - NOV MARCH MATCH POSITION ALLOCATION

  31. Staffing guidelines BASED ON ALL TRAINEE POSITIONS

  32. Training Resources • DEO National Conference • 2 Monthly Trainings via Skype • National Call • Quick Guides • HPE Training • Recorded Monthly…Indexed on OAA Site

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