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RESOURCES

2018 GMEI Working Meeting: Comprehensive National GME Reform
Working Meeting Summary - Snapshot, Materials, and Resources
DAY 1: Sunday, January 28, 2018

January 28, 2018

DAY 1: EDUCATION

For the educational portion of the day, participants were provided with a curriculum to understand the context within which the GME Initiative is working on reform. 

January 28, 2018

Introductions

Dan Burke, Kim Marvel, Mannat Singh

Participants went around the room and introduced themselves with brief information including: name, state, organizational affiliation, position/title, and GME knowledge level. Find the full roster here.

Dan Burke set the context by outlining the problems with the output of the Graduate Medical Education system, presenting a logic model for reform, the activities required, and proposed how we could get there.

January 28, 2018

History of the GME Initiative + Video message

Kim Marvel, Mannat Singh

Kim Marvel started with the roots of The GME Initiative, starting with the original group of leaders in 2010, listing the activities and accomplishments of the group, the summits held from 2010-2015, and ended with a video message with compelling commentary from leaders around the country highlighting the need for comprehensive reform.

 

Video message: https://www.youtube.com/watch?v=wc5zESlNmsc

 

Mannat Singh continued with the recent history of The GME Initiative, describing activities 2016 to the present, the expansion of the GMEI to its current size and scope, the creation and management of current workgroups and their activities, and the future plans for the GMEI and its participants.

January 28, 2018

History of GME: Explanations of the beginnings of Medicare funding for GME

Hope Wittenberg

Hope Wittenberg, one of the key experts on the GMEI started this session with a description of GME Fundamentals (Medicare, Medicaid, VHA, HRSA). A timeline of events was provided, milestones of key events during the history of GME funding and reform attempts, Congressional perspectives on GME, how Family Medicine fits in to the big picture, and the growing appetite for reform.

January 28, 2018

Basics about Payment (IME/DME): GME size, scope, and trends

Lou Sanner, Kent Voorhees

Lou Sanner presented an overview and critique of the current payment system. Topics covered: CMS, DME/IME, payment calculations, PRAs, caps, Medicare/Medicaid, counting residents, rural training tracks, disproportionate share payments, teaching health centers, and rules that further complicate the system. Exhaustive resources, sources, and appendices were provided.

January 28, 2018

Rural Story

Tom Told

Over lunch, Tom Told gave a presentation on how “the more things change, the more they stay the same” and the importance of improving upon rural medicine training, given its unique challenges to provide care to the community, and training opportunities that would help with reform.

January 28, 2018

Federal reform attempts, proposals, and controversies

Dan Burke

Dan Burke kicked continued the Sunday curriculum day with a presentation on GME problems and solutions, highlighting the failure of the system to adequately train the workforce this country needs. He reviewed the existing “literature” on reform attempts (past recommendations such as the IOM report from 2014), why these reform attempts were unsuccessful, “gotcha rules” that further complicate and hinder the system, and a brief overview of the GME Initiative’s proposed recommendations/platform for reform. 

January 28, 2018

RAP-GME as a demonstration model

Randy Longenecker, Lou Sanner, Kent Voorhees

Randy Longenecker, Lou Sanner, and Kent Voorhees shared the new “RAP-GME” proposal that came out of the LIFT (Legislative Initiatives Focused Taskforce) work group of the GME Initiative. The speakers gave an overview of how this proposal came to be, the process of defining and creating a Rural Alternative Payment mechanism for rural training, the value it adds to the system, the financing of such a mechanism, and the political context in which it exists.

January 28, 2018

State Based Initiatives

Mannat Singh

The GME Initiative, in tandem with the comprehensive, national reform work it takes on, also looks at state based initiatives – and sees the states as the innovation labs for enhancing GME funding and reform. Mannat Singh reviewed the need to continue to focus on state based work, the activities the States Initiatives work group has taken on, highlights from past summits and projects, and a reminder that while we continue with comprehensive reform, supporting states initiatives will remain a priority.

January 28, 2018

Stakeholders: Who are the players?

Mannat Singh + Panel: Lloyd Michener, Al Steinmann, Hope Wittenberg

After a day of lecture-style information, the GME Initiative opened the last session as a panel on stakeholders: who are the players, what is their stance on reform, where they align/differ from the goals of the GME Initiative and reform attempts, and why they should care about this activity. Mannat Singh went over the GMEI network and broader nonprofits, Lloyd Michener briefed the group on public/state health stakeholders, Al Steinmann shared the internal medicine perspective, and Hope Wittenberg shared her expertise with the political players and context.

January 28, 2018

Curriculum Evaluation: How/when/where can we replicate?

Kim Marvel

The GME Initiative would like to ensure that the information shared is useful, relevant, and available for all who need it. With that in mind, the organizers asked the participants at the beginning of the day to keep in mind how/if this “curriculum” would be helpful in their local communities, regions, for their organizations, for their advocacy work, or in any other capacity. The group opened up the conversation to the audience, asking: how was this forum as an educational resource, how can we (and should we) recreate this in your communities in a way that would be helpful, what were the most helpful elements/format/medium and what are the gaps?

January 28, 2018

Review plan for Monday: Pre-Reading Reminder

Dan Burke

As the GMEI closed the educational day, Dan Burke outlined the “Journey to Comprehensive GME Reform” – as an expedition. How are we to prepare, what tools do we need, what is our map for reform, and a review of the “homework” reading assignment that was given to all participants. The homework is a proposed set of “planks” that will create a “platform” that will guide us to comprehensive reform, the elements of which were sourced from past GME reform recommendations from national organizations that have looked at this same question. Also provided was a recap for the next two days, the “working” portion of the meeting.

Sources: download

Reading/homework: download

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DAY 2: Monday, January 29, 2018

January 29, 2018

DAY 2: STRATEGY

For the strategy portion of the meeting, participants were provided with an opportunity for a structured, working discussion to develop a strategy for reform moving forward.

January 29, 2018

Welcome and Plan for the Day

Dan Burke, Mannat Singh

Dan Burke re-reviewed the “Journey to Comprehensive Reform” as a reminder to participants, and went over the ideological plan for the day. Mannat Singh described the process, structure, and logistics of the subsequent working/strategic discussions.

January 29, 2018

Goals: Platform Working Meeting

Kim Marvel, Mannat Singh

Participants moved to their assigned tables/groups to begin a strategic, working discussion of the elements of the proposed “platform” for reform. Each participant was provided materials for pre-reading (proposed platform), note taking, and sources (for the proposed planks within the platform). Each group consisted of 10-12 people, each with a dedicated recorder and a form to capture the discussion. Facilitators were assigned for each subcategory within the platform, and facilitated their respective sessions for each rotation. The goal for each rotation was to assess the proposed planks within each category, provide feedback, revise/wordsmith, list pros/cons, list any outstanding questions and ultimately rank the viability, feasibility, and necessity for each plank within the platform. Each rotation lasted 30 minutes, with 4 rotations total that included the following subcategories: workforce, payment, governance/accountability, and transformation/innovation.

January 29, 2018

Deliberate and Decide

Kim Marvel, Mannat Singh

At the end of the 4 rotations for the proposed platform and planks/elements, facilitators and recorders were asked to come to the front, and “rank” (label) each of the planks/elements as “include” “maybe” “do not include” with color coded sticky-notes to act as a visual guide for the following discussion. Mannat Singh captured this snapshot information on an easel with all the planks listed, and created a spreadsheet to start the “Deliberate and Decide” portion of the working meeting. The group went through each ranked element, line by line, to deliberate and decide on if/how it should be included in the ultimate “platform” for GME reform. This discussion lasted 3 hours.

 

A summary of the final discussion, notes, outstanding questions, and final outline/brief for a proposed platform is currently in development.

January 29, 2018

Strategy Session

Dan Burke

After the in depth working discussion on the platform, the next step was for the group to look at the overall strategy as a whole. The ultimate goal is to “transform the healthcare system,” and the group needed to work on a strategy. What is the role of the GMEI to transform the system, what roles must the group play in order to bring about a transformed system, and how does the group get this work done?

 

Dan Burke provided a review of different project/strategic management processes (12 step plan, HRSA models, etc.) and the group settled on discussing “roles.” The roles the group proposed, which leads into the Tuesday tactics discussion, were that of: educator (catalyst, facilitator), advocate, data steward, and convener.

January 29, 2018

Next Steps: Review Plan for Tuesday

Mannat Singh

Mannat Singh reviewed the plan for Tuesday, included a modified agenda based on outstanding questions that were not addressed (the need for a preamble to the platform, certain platform details that had not been decided upon), and ended the day with a reminder to come prepared to discuss more clearly defined roles, activities within each of those roles, which will all lead to a workplan for the GMEI as a whole.

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DAY 3: Tuesday, January 30, 2018

January 30, 2018

DAY 3: Tactics and Workplan

For the last day of the working meeting, participants were provided an opportunity to review the previous days' discussions, define future roles/activities for the GMEI in its reform attempts, and began building a workplan for future success. 

January 30, 2018

Recap & Plan for the Day

Mannat Singh

Mannat Singh started off the last day of the CoNGR meeting by reviewing what the group accomplished Sunday with the educational overview, and the strategic discussions that happened on Monday. A snapshot of the “Deliberate and Decide” portion of the working meeting was shared (a re-organization of the platform and proposed planks, with brief notes on needed revisions/clarification), and described the plan for the rest of the day to review tactics.

January 30, 2018

Preamble Discussion and Address Outstanding Questions

Kim Marvel

From the previous day’s discussion, the group had a few additional items to review: a draft preamble for the platform, and two clarifying questions from the planks within the proposed platform.

January 30, 2018

Brainstorming Session: Define roles, list activities

Kim Marvel, Mannat Singh

Following Monday’s discussion about “what is the role of the GMEI” – the group identified 4 potential roles to discuss: educator (catalyst, facilitator), convener, data steward, and advocate. Participants were asked to self-select which “table” they wanted to sit at, to discuss/define the roles, and list activities for each. A recorded captured the conversation at each table, to prepare for the workplan session.

January 30, 2018

Workplan: Creating a roadmap for comprehensive reform

Kim Marvel, Mannat Singh

Mannat Singh facilitated this final session, in order to draft a tentative workplan for the GMEI as defined by the suggested roles, activities, and timelines for each. The recorders from each of the tabled “roles” shared the details of the tabled discussions, and Mannat filled in a spreadsheet that prioritized activities, clarified the roles, and drafted the beginnings of a workplan for the next 1-3 years for the GMEI, in order to create a structure within with the GMEI can tackle transformation and reform.

The final workplan is in development.

January 30, 2018

Next Steps: Moving Foward

Dan Burke, Kim Marvel, Mannat Singh

To close out the CoNGR Working Meeting, Dan Burke, Kim Marvel, and Mannat Singh left the group with a final call to action to join the GMEI, participate in the follow-up activities that the GMEI will take on, remember to use the GMEI as a resource in all advocacy, education, convening, and data stewardship work, and remind the group of the ultimate goal – a transformed, responsive, and sustainable system that produces the workforce this country needs, to care for all populations.

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Products

Curriculum

  • Presentation materials (linked above in summary)

  • Possible webinars

  • Possible presentations at regional/other meetings

 

Workplan

  • In development

  • The GME Initiative has identified roles that we are prepared to take on. Within these roles, and as a group prepared to be a catalyst for change, the GMEI has identified the following activities to build into a workplan:

    • Educator/Facilitator: Craft messages, viral video, TedTalk style messaging, communications plan

    • Convener: Target audiences, stakeholder engagement, planning annual meetings, use of key messaging, outreach strategy

    • Data Steward: Identify data questions, identify data sources and create a database, outsource help, create a library of data questions/sources/answers, create a subgroup for data questions, investigate existing databases and their use/relevance, opportunities for collaborative partnerships to share/analyze data, create a tracking plan

    • Advocate: ensure a clear policy platform (vs broad strategy/vision), clearly outline objectives (with priorities, low-medium-long term goals, create an advocacy coalition (or partner with existing), find legislative champions, create a communications plan (partner with key messaging activity), opposition engagement/neutralization, collect stories, think about how proposals solve a problem

Position Paper Outline

  • In development

 

  • From the strategic discussion during the meeting, the group re-organized the original planks to reflect the following:

  • During tactical/strategic discussions about the use of a “position” the group is now considering how to use this framework as an internal guiding document, rather than a formal position paper. A group is needed to draft a variety of messages using the discussion notes/framework.

  • A potential outline has been proposed below:

    • Who “we” are

    • Methods for Atlanta working meeting

    • Profile of participants

    • Process

    • Preamble

    • Planks/position

    • Detail, issues around implementation

    • Examples

    • Conclusion and next steps

    • References

Post-Meeting Survey

Survey Link: will be available soon

 

Sign up for workplan activities

  • Writing the "position paper" and other key messages in a variety of identified formats (preamble, elevator pitch, one-pager, position paper)

  • Developing a communications plan

  • Finalizing workplan

  • Defining roles, who "we" are

  • Joining "data steward" subgroup

  • Partnering with advocacy coalitions

  • Creating outreach plan

  • Annual convening planning

 

Curriculum evaluation/feedback

  • Was the education helpful?

  • What/where are the educational gaps?

  • Where can we recreate this curriculum? (regionally, presenting at existing meetings, etc.)

  • What formats, mediums, outlets should we use to share this curriculum?

Join the GME Initiative

  • Join the monthly call list

  • Join one of our work groups:

    • Comprehensive National GME Reform (CoNGR)​

    • Legislative Initiatives Focused Taskforce (LIFT0

    • State Based Initiatives

    • Partnerships

Thank you to our sponsors
Questions

If you have any questions about this summit, please feel free to contact us.