Yale surgery residency stripped

[Juice]

Yale just last week had its surgical residency removed by the RRC. This is the first time this has ever happenned to a university program. My question is what does this mean to current interns and recently matched students. The university will be allowed to graduate 4s and 5s, and be allowed to reapply in 2003 for a new license. The recently appointed chairman, Dr. Udelsman, a renowned endocrine surgeon who took the spot coming from JHU seems caught with his pants down. The place seems to be in shambles, and I feel bad for any students who matched there this year. My advice would be to take one of the hundreds of open prelim spots at a solid program. It will be easy to find a very strong university PGY-2 spot the following year. I have heard this all from a friend who is a fellow at the program. Anyone else know anything about this???

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[BeeGee]

I was going to do an away elective in Gen Surg at Yale and definitely apply there this upcoming fall. FREIDA and the program's website never seems to go into the very important details that 99% of upcoming 4th years like myself NEED to know. Hope their PGY 1 - 3s find a spot somewhere, that has got to be the worse thing to happen to you. Especially after being elated s/p THE MATCH and then having it taken away from you in an instant. There should be some by-law in the The Match Agreement that requires programs to fully train every resident that is accepted without us being left high and dry if they happen to discontinue to residency at that institution. It seems that we as students are legally bound. Well, so should the programs be legally held responsible. I'm sure some PGY-1s invested a lot of time and money to research, audition, and interview at Yale. To be made to go to a Prelim spot is utterly insulting to students having gone through all that. I couldn't imagine how irate I would be right now if I were one of them.

 

[Future GI Guy]

Are the decisions of the RRC published anywhere?

I understand they recently approved Duke's ER residency, and this whole Yale thing.

I'd like to see their website, if you know of one.

 

[Stormreaver]

I've been looking around, and I can't seem to find confirmation of the news. I would like to know whether it's just a rumour, or has this news been published somewhere. A friend of mine's in Yale (in research) and he didn't know anything about this, and wanted to know also where this decision has been mentioned.

 

[surg]

From <a href="http://www.acgme.org" target="_blank">www.acgme.org</a>
Don't know if there were actions beyond this but this is the official info available.
Definitely at least a provisional accreditation was awarded since they had a full accreditation before...

ACCREDITED PROGRAM SEARCH - VIEW PROGRAM

PROGRAM INFORMATION
Yale-New Haven Medical Center Program [4400821064]
Yale University School of Medicine
Department of Surgery
333 Cedar Street
New Haven, Connecticut 06520

Sponsoring Institution: Yale-New Haven Hospital
Specialty: Surgery-General

DIRECTOR INFORMATION COORDINATOR INFORMATION
John Seashore, MD
Director, Surgery Residency Program

Phone: (203) 785-2697
Fax: (203) 737-5209
Email:
Janel L. Walker
Program Coordinator

Phone: (203) 785-5479
Email: [email protected]


ACCREDITATION AND GENERAL INFORMATION
Original Accreditation Date:
Accreditation Status: Provisional Accreditation
Accreditation Effective Date: October 27, 1997
Accredited Program Length: 5 years

Program Format: Standard

Last Site Review Date: July 24, 2001
Next Site Review Date (approximate):

Program Requires Prior or Additional GME Training: NO
Program Requires Dedicated Research Year: NO
Program Participates in National Resident Matching Program: YES

Number of MD/DO Teaching Staff Whose Primary Responsibility is Resident Education: 2
Governement Affiliation: Veterans Administration


ACGME APPROVED POSITIONS ACGME FILLED POSITIONS
Year 1 Positions: 22
Year 1 Categorical: 5
Year 1 Preliminary Designated: 7
Year 1 Preliminary Non-Designated: 4
Year 1 Combined:
Year 2 Positions: 14
Year 2 Categorical: 5
Year 2 Preliminary Designated: 4
Year 2 Preliminary Non-Designated: 4
Year 2 Combined:
Year 3 Positions: 7
Year 3 Categorical: 5
Year 3 Preliminary Designated: 2
Year 3 Preliminary Non-Designated:
Year 3 Combined: 7
Year 4 Positions: 5
Year 5 Positions: 5

Total Number of Approved Resident Positions: 53
Year 1 Filled Positions: 16
Year 2 Filled Positions: 12
Year 3 Filled Positions: 7
Year 4 Filled Positions: 7
Year 5 Filled Positions: 3

Total Number of Filled Positions (Residents on duty as of Aug 31st of the current academic year): 45


MEDICAL SCHOOL AFFILIATIONS
Yale Univ Sch of Med, New Haven, CT


Date most recently updated: April 4, 2002

 

[draper]

I'm a combined plastics resident at Yale. The situation is as follows: the RRC has threatened to remove accreditation of Yale's general surgery program in the summer of 2003 unless a new proposal is met with approval. The principal points are: 1)decrease residency hours 2)increase caseload and 3)increase conferences. Now, it is exceedingly unlikely that Yale with lose its accreditation. The RRC is striving to make an example of Yale so that other programs in the nations will follow the lead of the Bell Commission in NY and implement change. Most surgical programs suffer from the same problems that exist at Yale and the thought is, if it can happen here, it can happen anywhere.

Not only the surgical residency, but the entire hospital would suffer from a loss such as accreditation- for example, how could you have a medical residency program without surgical backup for many of the procedures? Who could neurology refer inpatients to with abd pain? etc, etc.

At this point, we are confident that by hiring PAs, recording our caseloads more accurately and dedicating more academic days to conference, these problems will be rectified. This is my perspective as a plastics resident- general surgery accreditation does not affect me at this point.

 

[draper]

I'm a combined plastics resident at Yale. The situation is as follows: the RRC has threatened to remove accreditation of Yale's general surgery program in the summer of 2003 unless a new proposal is met with approval. The principal points are: 1)decrease residency hours 2)increase caseload and 3)increase conferences. Now, it is exceedingly unlikely that Yale with lose its accreditation. The RRC is striving to make an example of Yale so that other programs in the nations will follow the lead of the Bell Commission in NY and implement change. Most surgical programs suffer from the same problems that exist at Yale and the thought is, if it can happen here, it can happen anywhere.

Not only the surgical residency, but the entire hospital would suffer from a loss such as accreditation- for example, how could you have a medical residency program without surgical backup for many of the procedures? Who could neurology refer inpatients to with abd pain? etc, etc.

At this point, we are confident that by hiring PAs, recording our caseloads more accurately and dedicating more academic days to conference, these problems will be rectified. I believe that the shortcomings present at Yale exist to different levels at most, if not all, general surgery programs in the nation.
Since I am a plastics resident- general surgery accreditation does not affect me at this point and loss of accreditation would not affect my own training- therefore, I am providing my best at providing an objective opinion.

 

[surg]

Draper, I'm glad to see that someone has cleared this up. To be honest I am not surprised. The RRC has been on the warpath the past year to show some teeth on the work hours issues. I mentioned in one of the other work hours threads that this was a major point of emphasis and that programs were going to get called on the carpet for it. Looks like the parade has begun. Yale is not the first program to go on provisional accreditation, nor will it be the last. I have no doubt that Yale will find a way to satisfy the RRC and come out of this on the other end a stronger program.

 

[navs]

I am not a surg. guy, but agree the chances of Yale losing its accred. is NIL!!

There is no way it will happen. Most hosp. make their money off the surg. they do and to lose a gen. surg. program would mean serious lose in revenue. I'm sure the program and the instituition will make SURE this is corrected and probably will only make the program stronger.

 

[MacGyver]

I for one am glad the RRC is finally working to put some bite into the regulations.

Its about time that residency programs understand that they cant willfully ignore the rules and not expect any consequences to come from it.

 

[droliver]

Draper,

As I understand it (after talking to one of the RRC board members involved in the matter), the RRC has in fact already pulled the accredidation for the program. Yale will have a chance to appeal for reinstatement soon, but as it stands it is officially unaccredited. Have they told you different?

 

[draper]

Droliver, the RRC presented the situation as one in which Yale has one more chance to come up with a package in July 2002 to comply with the RRC demands or it will lose accreditation.

When Bridgeport Hospital lost its surgical program 8 years ago, it merged with Yale and therefore created a provisional accreditation which precludes a probation period. Therefore, whereas other programs with full accreditation would probably be placed on probation, Yale cannot.

In any event, as posted above, I believe it's going to be extremely difficult to lose accreditation because of the ramifications throughout the entire Yale-New Haven Hospital system and medical school. The hospital wouldn't be able to function without surgical residents.

BTW, where would you like to end up for plastics?

 

[Mustafa]

<a href="http://www.acgme.org/adspublic/institution/program.asp?programid=7142&masterid=271&stateid=7" target="_blank">http://www.acgme.org/adspublic/institution/program.asp?programid=7142&masterid=271&stateid=7</a>

Yale surg-general residency has indeed lost its accreditation.

 

[MacGyver]

draper,

You seem to be of the belief that the RRC SHOULD NOT strip Yale of accreditation regardless of how bad the program is, simply because its important to the hospital.

I'm sure its very important, but the RRC is charged with finding violations punishing the offenders, they cant just look the other way because their program is important.

I hope the Yale people change their system to meet the demands of the RRC instead of simply whining about how they cant afford to lose their accreditation. They should have thought of that before. This isnt a new revelation to them, they knew they had problems and yet still didnt meet the guidelines the RRC set out.

I understand that changing programs is difficult, but still everything they needed to do was in black and white and they failed to do so. I hope Yale does get re-accredited, but they need to realize that things have to change there in order for this to happen.

 

[draper]

On the contrary MacGyver, I think that if changes are not made within Yale's surgical residency training, the program should lose accreditation. I am making the point that this is extremely unlikely because the hospital and the department can ill afford to allow this to happen. Yale has already begun to install moonlighters to prevent q2 call and has focused particularly on reducing the hours of intern call with moonlighters and night float. Residency hours, of course, is the easiest problem solved by opening your checkbook.

Residency teaching can also be improved in part, by money. By paying its faculty on a per lecture basis, I'm sure Yale can drum up improved conferences and lectures. One can, of course, attract new faculty members as well by offering higher salaries.

Improving case numbers may be the largest stumbling block. Connecticut is limited by its population; furthermore, New Haven itself has competing hospitals both within New Haven and in nearby cities. This is a problem that will probably not go away by spending money.

In summary MacGyver, I think that spending money will make much of the department's problems go away. And I firmly believe that the program should lose accreditatation if changes are not made. However, I don't think that realistically this will happen and I hope the changes wrought will truly benefit the general surgical residents.

According to my understanding, if Yale passes the RRC revisit in July 2002, Yale will be granted 1 year probation; a revisit then would ensue in summer 2003 whereupon a 5 year accreditation could be granted.