Program:

“Management of Alcoholism and Drug Additon in Surgery Residents and Faculty”

TSDA Featured Speaker:

Dr. Hyde, who has substantial personal experience with incidents of abuse and rehabilitation,  presented a lecture and a video that emphasized the prevalence and impact of substance abuse among all physicians and specifically among thoracic surgeons and residents.  The video has been distributed to Program Directors with the intent that the material will be shared with residents and staff within individual programs.

Highlights:

• The overachieving resident is prone to suicide by drug overdose.
• 60-80% of physician suicides are secondary to alcohol and/or drugs.
• Particulars from a 1992 Survey of Residents were presented:
• 75% of residents admitted to excessive alcohol use within the previous two weeks
• 24% of residents admitted to at least one use of cocaine (obtained from a hospital)
• Abuse and suicide rates are much higher for psychiatry residents than for surgery residents, and the conclusion was that stress does not lead to drug abuse.
• Should drug testing be mandatory in residency? (comments offered)
• What to do when abuse is discovered or suspected:
• Confront the individual
• Immediately invoke the process of the hospital’s impaired physician committee
• Immediately invoke the process of the state’s impaired physician committee
• If help is refused, then suspend the individual
• If help is accepted, then offer treatment program and re-evaluate
• A potentially important resource is the American Society of Addiction Medicine

• Stress is real and multifactorial
• Symptoms include deterioration of interpersonal relationships, geographic changes (new people and friends, multiple moves to different locations), and deterioration of clinical skills.
• 22% of categorical surgery residents change specialties compared to 1% of OB-Gyn residents
• “Burnout Syndrome” written about by Skip Campbell at the University of Michigan, who offers a day-long management course at $50.00 per resident.  Issues discussed include time management, stamina, relationships, and spirituality.

Ad Hoc Committee on the Thoracic Surgery Match (Bartley Griffith, John Calhoun)

1. Can we improve?  (General discussion of ERAS [Electronic Residency Application System])
2. Is the NRMP office adequate? (Yes)
3. Timing of the Match (Currently better, and perhaps optimal)
4. Cost of interviews (mixed considerations and suggestions, including:  preliminary screenings at STS or AATS meetings; set interview dates by geographic regions; limiting the number of interviews granted by individual programs; providing deadlines for interviews)
5. Input from Residents
6. “Violators” of the Match (increasing compliance by education of Directors, letter  of censure)

 ERAS consists of four components: the Student Workstation (SWS), the Dean’s Office Workstation (DWS), the Program Director’s Workstation (PDWS) and the ERAS PostOffice (ERASPO).  Using ERAS Student Workstation software, an applicant completes a common application and selects residency programs to receive their application on a Student Workstation Data Diskette.  That diskette is then delivered to student affairs, academic affairs, or other designated dean’s office.  At the dean’s office, the completed electronic application is uploaded on the Dean’s Office Workstation and joined with the student’s Dean’s Letter, transcript, and faculty letter of recommendation in an electronic file folder.  Software at the Dean’s Office Workstation then encrypts the files for security and transmits them to the ERAS PostOffice over the Internet using ftp (file transfer protocol).
 The programs designated by students download application materials using their Program Directors Workstation, decrypt the files, and have the option to review, sort, or print the application data using criteria established by the program.  There is no direct connection between schools and programs.  All transmissions are sent to and received from the ERAS PostOffice.

The National Board of Medical Examiners (NBME) contacts the ERAS PostOffice to download requests from the U.S. and Canadian applicants for USMLE/NBME transcripts and forwards the USMLE transcripts to the ERASPO for downloading by programs designated by the applicants.  The Educational Commission for Foreign Medical Graduates (ECFMG) acts as the designated dean’s office for students and graduates of foreign medical schools and processes USMLE requests for these applicants.  ECFMG also provides an ECFMG certification status report for all international applicants.

Further information is available from the AAMC website and from its ERAS pages.
 

Residency Review Committee Information for TSDA Directors (John Brown)

1. Provisional accreditation
2. Continued full accreditation
3. Proposed probation (6 month grace period for rebuttal)
4. Probation (Program Director obligated to notify current and future residents; there is a 4 year limit with a requirement for repeat visit in 2 years; this decision can be appealed to the ACGME)
5. Withdrawal of accreditation (this decision can be appealed to the ACGME)

The RRC requires immediate information regarding:

• Change in Program Directors
• Change in Department Chair
• Change in hospital affiliation, mergers, deletions of affiliated hospitals
• Unscheduled termination of a resident
• Delay in completion of a resident’s education
• Any rotation greater than or equal to 4 months at a non-accredited hospital requires RRC approval