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January 12, 2009
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IN
THIS ISSUE
Editor's Column:
Competency
Comments On 'Competency'
Longtime Children's Surgeon-In-Chief To
Take New Role
WSUSOM Hires New Radiation Oncology
Chair
Oakwood Imaging Center Earns Multiple
Accreditations
Docs Who Care For Poor Patients Might
See IT Relief
Announcing 'MSMS Connect'
Kevin Kelly Memorial
Service Wednesday
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Editor's
Column: Competency
By
JOSEPH WEISS, MD
The Accreditation Council for Graduate Medical Education (ACGME)
has issued new requirements for judging the fitness of graduates
of residency programs. The ACGME calls these standards the Six Competencies.
The competencies are:
1) Medical Knowledge: apply basic and
clinical science to patient care
2) Patient Care: communicate with patients
and family, make informed decisions on interventions, counsel
and educate patients, provide preventive care, cooperate
with other health care professions
3) Practice-Based Learning & Improvement:
show capacity to evaluate and improve personal medical
practice & effectively use modern information technology
4) Systems Based Practice: be capable
of practicing cost-effective health care in a variety of
medical practice and delivery patterns, coordinate with
health care managers and other providers
5) Professionalism: demonstrate respect,
compression, commitment to ethical principles, integrity
and respect for patients’ culture
6) Interpersonal & Communication
Skills: create and sustain a sound relationship with the
patient, including the ability to provide information using
nonverbal, explanatory, questioning and writing skills,
and take on the role of team leader or group member as
needed
No question an individual whose character
encompassed all these qualities, would make a remarkable
doctor; for most of us meeting all these guidelines for
competency are probably beyond us.
The definition told to me of a true medical
professional is: one who is knowledgeable, skilful and
conscientious. The ACGME is too zealous in its effort to
mold the perfect doctor. Requiring an evaluator to pass
judgment on if a resident reaches all these competencies
and their components will make a sham of the process. The
Board is best advised to move back and ask the residency
director’s opinion, if after three years or more of training,
the resident shows understanding of the art and science
that is our craft.
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Comments
On 'Competency'
The
ACGME And The Six 'New' Competencies
By
Allen Silbergleit, MD, PhD
When the ACGME issued the six “new” competencies for all approved
allopathic residency programs nearly a decade ago, many if not most
Program Directors (PDs) would have enthusiastically echoed Dr. Joe
Weiss’s concerns. PDs had their hands full enhancing and sustaining
their programs without six “new” mandated requirements.
Since
then, PDs have become more accepting of the competencies
for a few reasons. The six requirements are here to stay;
it’s a fait accomplis and will not be rescinded by complaints.
Additionally, and perhaps more important, close scrutiny
reveals that the competencies are not as onerous as they
may have seemed at first blush. Indeed, four of the six
competencies are not new and immediately appear as wholesome
as motherhood and apple pie. What is not to like in the
education of resident physicians who learn medical knowledge,
patient care, professionalism and interpersonal communication
skills? The remaining two competencies are pertinent to
the new realities of practicing medicine in the current
era. Patient-Based Learning refers to utilization of modern
information technology, including scientific evidence,
and Systems-Based Practice refers to the new health care
delivery patterns that are part and parcel of our profession.
Implementation
of the competencies has not been a quick and easy process,
nor was it intended to be. PDs are still involved in developing
assessment methods for the competencies. The ACGME, fully
aware of the ramifications of the program, has not mandated
an immediate full-blown compliance requirement, but has
rather planned a gradual phasing in over a period of years.
The
Myth Of Marcus Welby
By
GEORGE SHADE JR., MD
This is another excellent and timely article from Joe Weiss. Everyone
would love to have Marcus Welby as their personal physician. Unfortunately,
if Dr. Welby was required to practice in today’s health care environment
he would be a professional failure. He spent too much time with each
patient. He got too involved in their personal lives (Board of Medicine
Professional Boundary Violation). He would never meet the required
daily, weekly or annual WRVU standards for a primary care doctor
and thus he would be fired by the CEO of his hospital or practice
group. In today’s economic environment, he would not choose to be
a primary care physician.
What
the Board of Internal Medicine is looking for is that doctor
of old who has driven into extinction by insurance companies,
corporate America and the American public. You can’t turn
back the clock on only one component of the health care
system.
Competencies
Help Nip 'Disruptive Physicians' In The Bud
By
H. MICHAEL MARSH, MBBS
(The column by Dr. Weiss) is
a rather curmudgeonly view of these six competencies. They are based
in the so-called Bloom's Taxonomy of learning, in which the major
classes of the cognitive domain from lowest to highest are: knowledge,
comprehension, application, analysis, synthesis and evaluation. When
these are applied to Medical knowledge and problem-solving, differential
diagnosis and management, and lifelong learning come to the fore
as essential skills. The ACGME, under Dr David Leach and Paul Batalden's
leadership, developed the six competencies as a suggested framework
for guiding continuously improving Resident Teaching and evaluation.
If one applies this prism to examining the spectrum of necessary
education even in Internal Medicine, where the field is terrifyingly
vast, one can appreciate that to achieve mastery one must have progressed
through each of these six levels within the cognitive domain to arrive
at the highly sophisticated state and function. A level exemplified
by Dr Weiss, who is an acknowledged expert in his field. The competencies
also embody the affective domain and the psychomotor domain, in addition
to the cognitive.
The
major difficulty with this new (Bloom and others published
this in 1948) approach in Graduate Medical Education is
lack of objective tools for evaluation in all these competencies.
We have trouble in addressing the disruptive physician
at many points in our practice, no less so during Residency,
when correction should begin. The hope is that with time
these tools will develop and will allow a better physician
to be loosed on the unsuspecting public in the future.
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Longtime
Children's Surgeon-In-Chief To Take New Role
On
Jan. 17, Children’s Hospital of Michigan pediatric surgeon
Michael D. Klein, MD, will leave his longtime post as Surgeon-in-Chief
to become Director of the Advanced Surgical Technology
Institute, a collaboration between the Detroit Medical
Center, Barbara Ann Karmanos Cancer Institute, Wayne State
University and Center for Smart Sensors and Integrated
Microsystems (CSSIM). In this new role, Dr. Klein will
coordinate the efforts of the three institutions to translate
advanced technology into the care of patients. This work
will be an extension of Dr. Klein’s research work with
the College of Engineering at Wayne State University, which
has been ongoing since 1984.
“Dr.
Klein has been an integral part of Children’s Hospital
of Michigan for more than two decades. Under his leadership,
the Department of Pediatric Surgery at Children’s has advanced
its scope of expertise and use of innovative technologies
for surgical treatment in children,” said Herman Gray,
MD, president of Children’s Hospital of Michigan. “We wish
him well in using his talent and passion for pediatric
medicine in this new endeavor.” Dr. Klein will retain active
staff privileges and continue to treat patients at Children’s
Hospital.
Dr.
Klein, 64 of Grosse Pointe Park, began his career at Children’s
Hospital of Michigan in 1977 as a fellow in pediatric surgery
and returned to practice there in 1983. Klein also serves
as Professor of Surgery at Wayne State University and The
Arvin I. Philippart, MD, Endowed Chair in Pediatric Surgical
Research and Research in Solid Tumors of Childhood, the
first incumbent of the endowed chair honoring Dr. Philippart.
Among his recent achievements, Klein established the hospital’s
first robotic surgery program and is a leading research
investigator in clinical trials of the Raman microscope,
the first device of its kind to perform instant virtual
biopsies to detect cancerous cells during surgery.
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WSUSOM
Hires New Radiation Oncology Chair
Andre
Konski, MD, MBA, has been offered and accepted the position
as chairman of the Department of Radiation Oncology for
the Wayne State University School of Medicine and service
chief for Radiation Oncology at the Barbara Ann Karmanos
Cancer Center.
Dr.
Konski comes to Wayne State and Karmanos from the renowned
Fox Chase Cancer Center in Philadelphia, Pa., where he
serves as chief medical officer for the center’s Partners
Program. He will assume his new responsibilities by the
end of March.
In
addition to his current duties as chief medical officer
at Fox Chase Partners Program, Dr. Konski served as clinical
research director for Radiation Oncology and clinical director
of the center’s Prostate Cancer Risk Assessment Program.
Dr.
Konski joined Fox Chase in 2002. After completing his fellowship,
he pursued his MBA and MA in economics.
Active
in the Radiation Therapy Oncology Group (RTOG), a national
organization sponsoring clinical trials using radiation
therapy for cancer patients, he chairs the economics subcommittee
on treatment outcomes. He also serves on the group’s research
strategy committee.
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Oakwood
Imaging Center Earns Multiple Accreditations
Oakwood
Imaging Center has recently been awarded accreditation
in magnetic resonance imaging (MRI), computed tomography
(CT) , and vascular/general ultrasonography as the result
of a recent survey by the American College of Radiology
(ACR). Earning accreditation in all of these areas makes
Oakwood Imaging Center the only hospital-owned outpatient-imaging
center to be accredited in all three services in southeastern
Michigan.
The ACR
awards accreditation to facilities for the achievement
of high practice standards after a peer-review evaluation
of its practice. Board-certified radiologists and medical
physicists who are experts in the field conduct image
quality and procedure evaluations.
The program
also evaluates personnel qualifications, adequacy of
facility equipment, quality control procedures and quality
assurance programs. The surveyors report their findings
to the ACR’s Committee on Accreditation, which subsequently
provides the practice with a comprehensive report.
The
ACR is a national organization serving more than 32,000
diagnostic-interventional radiologists, radiation oncologists,
nuclear medicine and medical physicists. Programs focus
on the practice of medical imaging, radiation oncology
and the delivery of comprehensive health care services.
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Docs
Who Care For Poor Patients Might See IT Relief
A
bi-partisan group of federal legislators including Michigan
Sen. Debbie Stabenow (D) introduced legislation early this
year that would grant $4 billion for health information
technology improvements to physicians and other health
care professionals who treat poor or those covered by state
and federal health insurance plans, reported HITS, a publication
covering health information technology issues.
Olympia
Snowe (R-Maine) is the other sponsor of the bill, dubbed
the Health Information Technology Act.
“As
healthcare costs continue to soar and devastate middle-class
families that are already hurting, this legislation can
reduce costs, while improving care,” Stabenow stated.
According
to HITS, the legislation comes at the same time that the
National Research Council issued a report critical of how
health IT systems are being used by a number of major health
centers and one day after President-elect Barack Obama
called for a $50 billion investment in order to provide
all Americans with an electronic heath record within the
next five years.
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Announcing
'MSMS Connect'
As
a free Michigan
State Medical Society member benefit, MSMS Connect is
a means for physicians to easily adopt technology in
a cost-effective, minimally-disruptive way in their practices. A
key benefit is that physicians need to sign-in only once
to have secure access to applications providing
clinical and administrative information, including labs
reporting, e-prescribing, billing systems, patient registries
and other data. It’s compatible with 200+ PMS systems,
as well.
MSMS
Connect will continue to add optional services and
resources over time to the electronic portal. As these become available,
if you belong to a physician organization (PO), you
may wish to explore whether your PO provides further
discounts on these portal services.
You
are encouraged to read the Frequently
Asked Questions and
to view the online
demo.
You can also read the entire MSMS
Connect brochure.
For
more information, visit the MSMS website at www.msms.org
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Kevin
Kelly Memorial Service Wednesday
As
a way for MSMS members and others to honor and remember
former MSMS Executive Director Kevin
A. Kelly, MSMS has created a web page for
users to post their own comments and/or memories of Kevin.
Click here to
post your own comment and read more about Kevin’s life.
A
public memorial service has been scheduled for Wednesday,
January 14, 2009, at 1 p.m., at The
Peoples Church in East Lansing.
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