BMC Rebuilt Surgical Residency Program Earns New Accreditation
Dr. Michael DiSiena worked to revamp the residency program, which received a new accreditation last month.
The Accreditation Council for Graduate Medical Education pulled its accreditation and with it, a large part of the surgical unit's identity was going to change. The pool of residents shipped off to other hospitals and universities, dropping the total number of residents from around 15 to just two. The program head resigned.
Things were looking bleak and no matter what, the hospital had to find a way to adjust.
"That was the year things changed radically around here. We had to regroup and rethink about surgical education. We had to develop a whole new process and whole new program," Dr. Michael DiSiena said.
DiSiena, a doctor of osteopathic medicine, was trained through the residency in the 1990s, went off to a fellowship, and returned in 2005. He knew it was a good program. He saw plenty of surgeons go on to do great things and others stick with the hospital for years afterward. DiSiena wasn't going to let the entire program fall to pieces.
So what he did was develop a whole new program to save it. The hospital still had accreditation from the American Osteopathic Association to run one type of residency program and two residents had committed to remain despite the major hit to the learning environment.
"They had the opportunity to leave and find training somewhere else. But they were committed to the hospital, to the community. They believed in believed in our mission and they stood it out. They really helped us get through these difficult times," DiSiena said.
On Thursday, Jan. 19, hospital staff got the word: BMC was among just nine of 54 programs to be accredited through a newly merged ACGME and American Osteopathic Association process.
The path to get there wasn't easy. After losing the accreditation, hospital staff met on a weekly basis. The teaching program was completely revamped, the documentation process improved. The temporary residencies were eliminated while the number of physician assistants was increased.
"We have to monitor everything the residents are doing. We have to provide didactics, scholarly activity. We have to be involved in doing research, clinical research. Our residents have to leave this program with a minimum number of cases. Starting next year, it is 850 cases," DiSiena said.
The newly revamped program grew in participation and now there are nine in the program. On July 1, the full complement of 10 residents will be on board.
The clock was working against the hospital as AOA and ACGME began the process of merging. The programs are integrating by 2020 so the program had to be well structured and up to standards quickly or else the AOA accreditation would expire and no more residents could be accepted.
Last March, the hospital got a pre-accreditation for the new program and applications came in in greater amounts. Then in January, a site visit was held and the hospital was approved with a single site accreditation under the merged agencies.
Over the next five years, two residents will be accepted each year. The programs are five years long so 10 residents will be on site at a time. That number is what BMC's Chief Operating Officer Diane Kelly hadn't expected for a while.
"We believed that if we could get back to 10 residents who were committed to us from the beginning to the end of their residency career, that would be a success for us," Kelly said. "I knew we'd be successful because I believe in us. But I'm not sure I believed our success would have been that great, that quick."
Being a teaching hospital had really been a part of BMC's identity for years. There are four other residency programs operating in the hospital and the surgical one had been there for some 50 years. The program acts as a feeder system for future surgeons to continue working in the Berkshires. It improves to work the entire team does.
"When you are a teaching program, it ups everybody's game. People are always learning. People are bringing in new energy. They are always researching and finding new ways and questioning why we do things and wanting to improve on how we do things," Kelly said. "Our commitment to education is a big part of why we are as strong as we are."
And it has a lot to do with surgery outcomes. Kelly boasted of the hospital achieving high marks from third-party rating agencies and credits much of that to the surgical outcomes.
"This is a very busy hospital and when you are on call here you are very busy. You need that support in order to take care of the surgical service and provide quality care," DiSiena said. We're so heavily reliant on our residents as well as our other practitioners."
On a larger scale, BMC offers a "community-based" program and not a university one. The two types have different missions and the community-based program helps fill a future need. DiSiena said a shortage of surgeons to work in smaller towns and areas is on the horizon and programs like BMC's help fill that void.
"This is an outstanding hospital to do surgical residency in. Community-based hospitals offer a different experience than a university-based program. You get more hands on experience in a smaller program than you get in a larger university program," DiSiena said.
Tags: BMC, residency, surgeon,
