Program on Probation

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Our ACGME site visit is coming up.

What infractions or incidents would place a program on probation? Does the ACGME interview residents? Can what a resident tell the ACGME place a program on probation? i.e. Do we have to carefully select who we choose to represent us?

Thanks!

 

[southerndoc]

Yes, what residents say can place programs on probation. Particularly if things occur such as exceeding work hour rules, no programs in place for formal feedback, etc. There are a list of requirements for each residency that is distributed by the RRC. If your program is coming up for review, then it should have these. Too many violations will place the program on probation, or worse revoke its accreditation.

Do we have to carefully select who we choose to represent us?

This statement worries me.

 

[NotAProgDirector]

RRC requirements are not a secret. Goto http://www.acgme.org, choose residency review committee's from the menu on the left, then choose the specialty. If you're in a fellowship, choose the core (i.e. if you're in a Cardiology program, choose Internal Medicine). You'll find a link to Program Requirements on the next page. Happy reading.

The RRC does interview residents/fellows as part of the visit. They require that the residents be "peer nominated". We usually simply have a vote for representatives.

You can be put on probation for 1) too many violations, 2) one major, unforgivable violation (like, for example, saying "what duty hour rules?" when the site visitor asks), or 3) Not fixing the things the RRC asked last time. Usually, you get an Accrediation with Warning first, then Probation if not fixed.

 

[exPCM]

The ACGME is a big f***ing joke IMHO. They act like the Red Cross representatives going into German POW camps in WWII and asking the prisoners how they are being treated. What resident is going to speak the truth to the ACGME when they are interviewed without anonymity in a group setting. I have seen a chief resident go straight to the program director after the group resident meeting with an ACGME representative to report on which residents made any negative comments or criticisms to the ACGME representative. This is a situation that is ripe for retaliation against the resident, In addition, if the ACGME pulls your program's accreditation it may totally mess up your residency plans as you may not be able to sit for the boards if your program is not accredited and transferring to another program in some specialties may be very difficult.
If the Red Cross wanted to really know the true conditions at the POW camps they should have concentrated more on interviewing prisoners who had escaped.
Similarly, if the ACGME was really serious about finding out about the true nature of a residency program they would speak confidentially on an individual basis with residents who had already graduated from the program.

 

[dragonfly99]

agree w/above comments
I never was asked, nor do I know anyone who was asked, about conditions in our residency program. I was at a pretty good program. I am sure the residents the RRC interviews are handpicked by the program director and/or other administrators. I shudder to think what it is like at a "bad program".

 

[f_w]

- the ACGME is not your friend (hello, we are from the goverment and we are here to help you...)

- don't bank on confidentiality in the resident interviews

- nothing good comes from having your program on probation. If it stinks now, it will still stink afterwards. Except that someone will have fixed the paperwork errors that led to the probation. The ACGME visit is more of an IRS audit. If you want to have things changed, go through the channels of your institution, don't try to have the ACGME come in and fix it for you, because they don't.

- the ACGME rarely ever pulls a programs accreditation without a 2 year warning period. It is uncommon (but has happened before) that residents can't finish up because their program lost accreditation while they where there.

 

[DadofDr2B]

- the ACGME is not your friend (hello, we are from the goverment and we are here to help you...)

- don't bank on confidentiality in the resident interviews

- nothing good comes from having your program on probation. If it stinks now, it will still stink afterwards. Except that someone will have fixed the paperwork errors that led to the probation. The ACGME visit is more of an IRS audit. If you want to have things changed, go through the channels of your institution, don't try to have the ACGME come in and fix it for you, because they don't.

- the ACGME rarely ever pulls a programs accreditation without a 2 year warning period. It is uncommon (but has happened before) that residents can't finish up because their program lost accreditation while they where there.

Let's see, Johns Hopkins had its ability issue accreditations withheld about 3 or 4 years ago because they overworked the residents. The resident involved had to finish at Ohio State. He fell asleep while doing a C section after exceeding the 120 hour work rule that was in place at the time. His actions help bring attention to the violations. My understanding is that he was "farmed out" to another hospital for a profit. The ACGME was in the process of looking at the number of hours worked and received his complaint. The 80 hour rule followed the public outcry at the time.

All of this of course is "alledged".

ACGME is your last place to get protection from abuse, since there are no unions to protect you. JMO

 

[JHopRevisit]

I thought the Hopkins incident happened after the 80 hour work week; someone complained they had gone over 80 hours and Hopkins was suspended, overnight, with no warning. Not absolutely sure about that, it definitely was a work hours violation but forget if it's before or after 80 hrs. The story goes that the medicine PD had to run back from a vacation in France because his program was suspended.
Obviously, Hopkins violated the rules and deserved to be punished, but the abruptness of it all was a bit unusual, so a lot of people think ACGME was trying to set an example. That's why I also think it was after the 80 hour thing, they had a new law and wanted to enforce it once or twice to make sure everyone got in line.

 

[Samoa]

I'm pretty sure that was the IM program at Hopkins (so, not likely that the resident fell asleep performing a C-section), and that it occurred after the 80 hour rule was put in place.

 

[Winged Scapula]

No, no no...The story goes like this:

Dr. Troy Madsen, one of SDN's own (http://forums.studentdoctor.net/showthread.php?t=200071), was an EM resident there AFTER the 80 hour work week restrictions (there were never restrictions before, 120 hours or not...they could work you more than that [speaking from experience]). He was on an off-service rotation on IM, not doing a C section, when he made a mistake blamed on work hours:http://www.cbsnews.com/stories/2004/01/13/health/main592994.shtml I can't remember what it was, something like ordering serial troponins.

He complained to the ACGME about the work hour violations and was really the first whistleblower and sacrificial lamb as ACGME apparently made no attempt to conceal his indentity. His experience made years of residents fear reporting anything to the ACGME.

He is now back home working in Utah and reportedly doing well:http://www.utahhealthsciences.net/pageview.aspx?id=16986

 

[NotAProgDirector]

It was the IM program, after the 80 hour rule, and the story is here.

JH was "threatened" with loss of accreditation. They were given from Sept to July to fix the problems. Their accreditation was never actually lost or suspended.

I can't find a story about a resident falling asleep during a c-section using google.

EDIT: WS beats me to the punch, as usual.

 

[Winged Scapula]

It was the IM program, after the 80 hour rule, and the story is here.

JH was "threatened" with loss of accreditation. They were given from Sept to July to fix the problems. Their accreditation was never actually lost or suspended.

I can't find a story about a resident falling asleep during a c-section using google.

EDIT: WS beats me to the punch, as usual.

Eh, only because I"m sitting outside waiting for the AC repair man to arrive (its cooler outside than inside).

(I can pull some administrative action and make my post appear after yours, if you like). 😛

 

[elwademd]

Does the ACGME interview residents?

my program had its rrc/acgme review either my intern or 2nd year. the questions were pretty basic (what are your hours, how do you log them, does your hospital have a ct scanner, etc.). your program must really be in violation, or you just have an axe to grind if you're giving negative answers. i suppose otherwise you could just be clueless, and make the program look bad (i've heard of stories of residents saying they don't know who to call when on call, or unsure of how the paging system works).

btw, as far as i know, only residents are supposed to be at the interview, so the program director/coordinator/etc. won't be there... of course, there will likely be at least one resident who would/could go back and report any negative comments made by you or anyone else.

No, no no...The story goes like this:

Dr. Troy Madsen, one of SDN's own (http://forums.studentdoctor.net/showthread.php?t=200071), was an EM resident there AFTER the 80 hour work week restrictions (there were never restrictions before, 120 hours or not...they could work you more than that [speaking from experience]). He was on an off-service rotation on IM, not doing a C section, when he made a mistake blamed on work hours:http://www.cbsnews.com/stories/2004/01/13/health/main592994.shtml I can't remember what it was, something like ordering serial troponins.

He complained to the ACGME about the work hour violations and was really the first whistleblower and sacrificial lamb as ACGME apparently made no attempt to conceal his indentity. His experience made years of residents fear reporting anything to the ACGME.

He is now back home working in Utah and reportedly doing well:http://www.utahhealthsciences.net/pageview.aspx?id=16986

It was the IM program, after the 80 hour rule, and the story is here.

JH was "threatened" with loss of accreditation. They were given from Sept to July to fix the problems. Their accreditation was never actually lost or suspended.

I can't find a story about a resident falling asleep during a c-section using google.

EDIT: WS beats me to the punch, as usual.

thanks for the clarification you two. 😍

 

[f_w]

Let's see, Johns Hopkins had its ability issue accreditations withheld about 3 or 4 years ago because they overworked the residents. The resident involved had to finish at Ohio State. He fell asleep while doing a C section after exceeding the 120 hour work rule that was in place at the time. His actions help bring attention to the violations. My understanding is that he was "farmed out" to another hospital for a profit. The ACGME was in the process of looking at the number of hours worked and received his complaint. The 80 hour rule followed the public outcry at the time.

I think you confuse a number of issues and timelines here (kind like the 'surge' and the 'sunni awakening' situation).

Having the ACGME 'fix' your problems is like when I fight the thistles in my strawberry garden using 'Round Up'. Yes, the thistles are gone, but so are the strawberry plants (using a flame-thrower would have been less work and the same effect).