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Fwd: Dueling Organizations

trauma-list@trauma.org trauma-list@trauma.org
Sat, 15 Jun 2002 12:55:29 EDT


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Date: Sat, 15 Jun 2002 11:36:06 EDT
Subject: Dueling Organizations
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1.    Over a century ago, in the pre-Flexner era, both medical schools and 
"specialty" training was non standardized.  Completion of training was not 
defined in time spent in training, but when the preceptor determined that the 
trainee was "ready" to go out on his or her own.   The Flexner report changed 
medical education for the better.  We need a new Flexner like commission.  

2.    Currently, the Accrediting Councel for Graduate Medical Education 
(ACGME) determines which residencies exist, and oversees the Residency Review 
Committees (RRC) for each specialty.   

3.    The RRC for each specialty determine the body of knowledge required for 
each specialty, to be present prior to a candidate presenting their 
credentials and being tested by the examinating board.    These RRCs have 
determined how many trainees (residents) are allowable in a particular 
training program, based on the number and the mix of the cases and conditions 
which are seen by the faculty of that program.  A program can only have the 
number of residents at each level that the RRC has determined that any 
individual program can effectively produce.   In the case of surgical and 
procedural disciplines, a shopping list of procedures has been developed in 
concert between the RRC and the examining board, a minimal number being 
essentially performed prior to an applicant being able to take the 
examination, even if their training time is double the time of that 
recommended by the RRC.   

3.    Thus for all disciplines, the trainee must be educated in the areas 
considered to be the essentials of that discipline.  During the time of all 
trainees education, procedures and new information becomes available and this 
new knowledge is a challenge.   It is much like a punch card a contractor 
uses when building a house.  This check list is used to assure all things are 
covered.   For some residents the learning and completion of the "punch card" 
is accomplished quickly and for others it requires extra time.   This 
assessment is a continuing challenge for the program director.   

4.    The American Board of Surgery (and other boards) examine applicants who 
have completed the requisite course of education as defined by the RRC.   
Successful examination results in the awarding of a certificate of board 
certification.  

5.    Thus every program is limited by its number of residents at each level. 
  Now enter the hospital that supplies the salary for the residents at each 
level.  They do receive Medicare pass through dollars to assist in this 
educational mission.   In some instances the amount of money received by the 
hospital for "resident salaries" actually exceeds the amount of money they 
pay the residents, so this is a revenue stream.   I am aware of one hospital 
administrator that bragged in an open meeting that after all of the resident 
salaries and fringes were paid, their hospital made over $78,000,000.00 in 
one year.   Other hospitals loose money on resident salaries and are looking 
at alternate ways to provide the "services."

6.    Now enter yet other quasi-regulatory agencies, like the American 
College of Surgeons Committee on Trauma.   The RRC has required that "trauma" 
be part of the education, and the ACS COT has determined that when residents 
are assigned to a trauma center, they must be IN HOSPITAL, available and 
respond immediately after a trauma alert has been called.  During VRC 
reviews, one of the most stringent reviews is to check to see that the 
resident and faculty arrived in a timely manner.   Now if one does the math, 
and calculates the clinic, operating room, elective surgery, consults, 
rounds, lectures, M&M etc.  THERE IS NO WAY MOST trauma centers can have 
residents immediately available for trauma response 24 hours a day, 7 days a 
week and still get the other work done.   The hospitals and the residency 
program cannot add more residents because the RRC will not allow it.   

Yes, we will get through this.  Yes, there are solutions, but they will not 
be easy.   I have called several persons I know on some of the boards and 
committees.   Each seems to say that it is someone else's problem and that 
their committee must hold firm.   With this attitude, we will never reach a 
solution.   This is not solely a RRC, ACGME, ABS, AAST, ACS, or hospital 
issue.   It is ALL of our opportunity.   I would recommend that we together 
recommend that our leaders, starting with the Board of Regents of the ACS 
seed a major foundation in this country (RWJ, Kellogg, etc) to form a new 
Flexner like commission to address the many facets of this problem.  

We can be part of the solution, if the energies of the persons on this list 
server are directed toward a solution, rather than an ineffectual flail.    
Let us use the power of this web site to better our educational 
responsibilities.  

k

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<HTML><FONT FACE=arial,helvetica><FONT  SIZE=2>1.&nbsp;&nbsp;&nbsp; Over a century ago, in the pre-Flexner era, both medical schools and "specialty" training was non standardized.&nbsp; Completion of training was not defined in time spent in training, but when the preceptor determined that the trainee was "ready" to go out on his or her own.&nbsp;&nbsp; The Flexner report changed medical education for the better.&nbsp; <B>We need a new Flexner like commission.&nbsp; <BR>
<BR>
</B>2.&nbsp;&nbsp;&nbsp; Currently, the Accrediting Councel for Graduate Medical Education (ACGME) determines which residencies exist, and oversees the Residency Review Committees (RRC) for each specialty.&nbsp;&nbsp; <BR>
<BR>
3.&nbsp;&nbsp;&nbsp; The RRC for each specialty determine the body of knowledge required for each specialty, to be present prior to a candidate presenting their credentials and being tested by the examinating board.&nbsp;&nbsp;&nbsp; These RRCs have determined how many trainees (residents) are allowable in a particular training program, based on the number and the mix of the cases and conditions which are seen by the faculty of that program.&nbsp; A program can only have the number of residents at each level that the RRC has determined that any individual program can effectively produce.&nbsp;&nbsp; In the case of surgical and procedural disciplines, a shopping list of procedures has been developed in concert between the RRC and the examining board, a minimal number being essentially performed prior to an applicant being able to take the examination, even if their training time is double the time of that recommended by the RRC.&nbsp;&nbsp; <BR>
<BR>
3.&nbsp;&nbsp;&nbsp; Thus for all disciplines, the trainee must be educated in the areas considered to be the essentials of that discipline.&nbsp; During the time of all trainees education, procedures and new information becomes available and this new knowledge is a challenge.&nbsp;&nbsp; It is much like a punch card a contractor uses when building a house.&nbsp; This check list is used to assure all things are covered.&nbsp;&nbsp; For some residents the learning and completion of the "punch card" is accomplished quickly and for others it requires extra time.&nbsp;&nbsp; This assessment is a continuing challenge for the program director.&nbsp;&nbsp; <BR>
<BR>
4.&nbsp;&nbsp;&nbsp; The American Board of Surgery (and other boards) examine applicants who have completed the requisite course of education as defined by the RRC.&nbsp;&nbsp; Successful examination results in the awarding of a certificate of board certification.&nbsp; <BR>
<BR>
5.&nbsp;&nbsp;&nbsp; Thus every program is limited by its number of residents at each level.&nbsp;&nbsp; Now enter the hospital that supplies the salary for the residents at each level.&nbsp; They do receive Medicare pass through dollars to assist in this educational mission.&nbsp;&nbsp; In some instances the amount of money received by the hospital for "resident salaries" actually exceeds the amount of money they pay the residents, so this is a revenue stream.&nbsp;&nbsp; I am aware of one hospital administrator that bragged in an open meeting that after all of the resident salaries and fringes were paid, their hospital made over $78,000,000.00 in one year.&nbsp;&nbsp; Other hospitals loose money on resident salaries and are looking at alternate ways to provide the "services."<BR>
<BR>
6.&nbsp;&nbsp;&nbsp; Now enter yet other quasi-regulatory agencies, like the American College of Surgeons Committee on Trauma.&nbsp;&nbsp; The RRC has required that "trauma" be part of the education, and the ACS COT has determined that when residents are assigned to a trauma center, they must be IN HOSPITAL, available and respond immediately after a trauma alert has been called.&nbsp; During VRC reviews, one of the most stringent reviews is to check to see that the resident and faculty arrived in a timely manner.&nbsp;&nbsp; Now if one does the math, and calculates the clinic, operating room, elective surgery, consults, rounds, lectures, M&amp;M etc.&nbsp; THERE IS NO WAY MOST trauma centers can have residents immediately available for trauma response 24 hours a day, 7 days a week and still get the other work done.&nbsp;&nbsp; The hospitals and the residency program cannot add more residents because the RRC will not allow it.&nbsp;&nbsp; <BR>
<BR>
Yes, we will get through this.&nbsp; Yes, there are solutions, but they will not be easy.&nbsp;&nbsp; I have called several persons I know on some of the boards and committees.&nbsp;&nbsp; Each seems to say that it is someone else's problem and that their committee must hold firm.&nbsp;&nbsp; With this attitude, we will never reach a solution.&nbsp;&nbsp; This is not solely a RRC, ACGME, ABS, AAST, ACS, or hospital issue.&nbsp;&nbsp; It is ALL of our opportunity.&nbsp;&nbsp; I would recommend that we together recommend that our leaders, starting with the Board of Regents of the ACS seed a major foundation in this country (RWJ, Kellogg, etc) to form a new Flexner like commission to address the many facets of this problem.&nbsp; <BR>
<BR>
We can be part of the solution, if the energies of the persons on this list server are directed toward a solution, rather than an ineffectual flail.&nbsp;&nbsp;&nbsp; Let us use the power of this web site to better our educational responsibilities.&nbsp; <BR>
<BR>
k</FONT></HTML>

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