All GME Is Local: A Novel Approach to GME Governance in a Consortium Model

Setting and Problem

In a newly formed graduate medical education (GME) consortium model supporting a complex academic health system, one of the initial challenges involved preserving the important role of leadership and relationships at the local level, while at the same time formalizing a consortium model of GME governance. In our consortium, consisting of 72 Accreditation Council for Graduate Medical Education (ACGME) accredited programs, 8 programs accredited by other entities, and 17 non-accredited programs, we recruited 4 Associate Designated Institutional Official (DIO) leaders from within our system, each with an extensive background in GME as a current or former program director. We have further created a job description (box) with specific expectations for the Associate DIO role.

Intervention

In response to the need for centralized governance, as well as leadership and oversight at the local level, we instituted a tiered organizational structure utilizing an Associate DIO model. Each Associate DIO maintains a critical role and function within the consortium model. The Associate DIO has protected time (with a goal of at least 20% effort) carved from their clinical productivity expectations to dedicate to this role and its responsibilities. The cost of this time is covered by the local entity.

The Associate DIO serves as the designated entity leader for local GME oversight of the clinical learning environment. In this capacity, the Associate DIO is known and recognized locally by program directors, coordinators, residents, and fellows as the local GME leader. The Associate DIO also serves as the chair of the Local Graduate Medical Education Committee (GMEC), a subcommittee of the Consortium GMEC, and also represents the hospital entity to the Consortium GMEC.

In addition to Local GMEC oversight and Consortium GMEC representation, the Associate DIO maintains a key role in oversight of programs and the GME workforce, including integration of GME with quality and safety initiatives as well as ongoing surveillance of the overall clinical learning and working environment.

The Associate DIO maintains a list of hospital or entity program citations or concerns, and works with local program directors to develop improvement plans. All program citations or concerns are also contemporaneously monitored by the Consortium DIO and Consortium GMEC. The role of the Associate DIO is to provide local assistance, follow-up, and expertise to assist programs and to provide regular reports to consortium leadership. The Associate DIO maintains a central role in the special focused review process for programs within their hospital or entity, and also contributes to special reviews for other programs within the consortium.

The Associate DIO serves as a first-level reviewer for academic due process, and maintains a hands-on role as part of any inquiry related to misconduct or a grievance. If a conflict of interest exists, another Associate DIO within the consortium provides cross-coverage. They also serve as a coach, advisor, and mentor to new and rising program leaders to ensure smooth transitions and succession planning. Other responsibilities include leadership in local chief resident meetings and GME town halls, communications, championing of resident and fellow efforts in hospital quality and safety initiatives, and participating in wellness initiatives.

Outcomes to Date

Experience from the first full year employing the Associate DIO model within our consortium has been universally endorsed as a success. Each Local GMEC serves to further enhance opportunities for program director and resident involvement and engagement in the consortium. The Associate DIO model has allowed us to embrace the nuance and diversity within our consortium at the local hospital or entity level, while simultaneously maintaining a centralized GME governance structure reporting to the DIO and Consortium GMEC.