Mystery behind the match: an undergraduate medical education-graduate medical education collaborative approach to understanding match goals and outcomes.

BACKGROUND: There is a paucity of information regarding institutional targets for the number of undergraduate medical education (UME) graduates being matched to graduate medical education (GME) programs at their home institutions. At our institution, the Duke University, the number of UME graduates matched to GME programs declined dramatically in 2011. To better understand why this decline may have happened, we sought to identify perceived quality metrics for UME and GME learners, evaluate trends in match outcomes and educational program characteristics, and explore whether there is an ideal retention rate for UME graduates in their home institutions' GME programs. METHODS: We analyzed the number of Duke University UME graduates remaining at Duke for GME training over the past 5 years. We collected data to assess for changing characteristics of UME and GME, and performed descriptive analysis of trends over time to investigate the potential impact on match outcomes. RESULTS: A one-sample t-test analysis showed no statistically significant difference in the number of Duke UME graduates who stayed for GME training. For both UME and GME, no significant changes in the characteristics of either program were found. DISCUSSION: We created a process for monitoring data related to the characteristics or perceived quality of UME and GME programs and developed a shared understanding of what may impact match lists for both UME graduates and GME programs, leaving the Match somewhat less mysterious. While we understand the trend of graduates remaining at their home institutions for GME training, we are uncertain whether setting a goal for retention is reasonable, and so some mystery remains. We believe there is an invaluable opportunity for collaboration between UME and GME stakeholders to facilitate discussion about setting shared institutional goals.

Fostering creativity: how the Duke Graduate Medical Education Quasi-Endowment encourages innovation in GME.

The Duke Medicine Graduate Medical Education Quasi-Endowment, established in 2006, provides infrastructure support and encourages educational innovation. The authors describe Duke's experience with the "grassroots innovation" part of the fund, the Duke Innovation Fund, and discuss the Innovation Fund's processes for application, review, and implementation, and also outcomes, impact, and intended and unintended consequences.In the five years of the Innovation Fund described (2007-2011), 105 projects have been submitted, and 78 have been funded. Thirty-seven projects have been completed. Approved funding ranged from $2,363 to $348,750, with an average award of $66,391. This represents 42% of funding originally requested. Funding could be requested for a period of 6 months to 3 years. The average duration of projects was 27 months, with a range from 6 months to 36 months. Eighty percent of projects were completed on time. Two projects were closed because of lack of progress and failure to adhere to reporting requirements. Thirty-nine are ongoing.Program directors report great success in meeting project outcomes and concrete impacts on resident and faculty attitudes and performance. Ninety-two percent report that their projects would have never been accomplished without this funding. Projects have resulted in at least 68 posters, abstracts, and peer-reviewed presentations. At least 12 peer-reviewed manuscripts were published.There has been tremendous diversity of projects; all 13 clinical departments have been represented. Interdepartmental and intradepartmental program cooperation has increased. This modest seed money has resulted in demonstrable sustainable impacts on teaching and learning, and increased morale and scholarly recognition.

Internal reviews benefit programs of the review team members and the program under review.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) mandates that sponsoring institutions conduct internal reviews. In 1998, the ACGME Institutional Review Committee gave Duke University Hospital a citation for an inadequate internal review (IR) process. Since then, we have instituted several iterative changes. We describe the evolution of Duke University Hospital's current internal review process. INTERVENTION: We implemented a new review team composition, template report, use of the program information form, and centralization of documentation to improve our internal review process. In 2007, a more formal evaluation of the outcome and impact of these changes was instituted. This included a yearly survey of all participants and review team members, a review of programs, and a tracking process for the decisions of our Graduate Medical Education Committee (GMEC) on the status of reviewed programs. RESULTS: Participants from both the program under review and the review team evaluated the process favorably. Review teams reported they learned from the best practices of the program being reviewed. Program directors from the reviewed programs reported the process improved their documentation. Both groups reported the process better prepared them for their next ACGME Review Committee site visit. The GMEC has recommended "probationary sponsorship" for fewer programs since the IR process changes have been implemented. The IR process was recognized as a best practice in Duke University Hospital's 2004 ACGME institutional review. CONCLUSION: We believe our IR process, review-team composition, template report, program information form, and centralized documentation now fully meets accreditation standards. Participants are reasonably satisfied and report value from the process. More programs are judged to be within substantial compliance by the GMEC.

Use of an institutional template for annual program evaluation and improvement: benefits for program participation and performance.

PURPOSE: The Accreditation Council for Graduate Medical Education (ACGME) expects programs to engage in ongoing, meaningful improvement, facilitated in part through an annual process of program assessment and improvement. The Duke University Hospital Office of Graduate Medical Education (OGME) used an institutional practice-based learning and improvement strategy to improve the annual evaluation and improvement of its programs. METHODS: The OGME implemented several strategies including the development and dissemination of a template for the report, program director and coordinator development, a reminder and tracking system, incorporation of the document into internal reviews, and use of incentives to promote program adherence. RESULTS: In the first year of implementation (summer 2005), 27 programs (37%) submitted documentation of their annual program evaluation and improvement to the OGME; this increased to 100% of programs by 2009. A growing number of programs elected to use the template in lieu of written minutes. The number of citations related to required program review and improvement decreased from 12 in a single academic year to 3 over the last 5 years. CONCLUSION: Duke University Hospital's institutional initiative to incorporate practice-based learning and improvement resulted in increased documentation, greater use of a standardized template, fewer ACGME-related citations, and enhanced consistency in preparing for ACGME site visits.