Starting from Scratch: Graduate Medical Education Program Development from the Bottom Up

One of the most fascinating aspects of working as a clinical informaticist is the ability to help blaze new trails, develop innovative ideas, and, most importantly, make change. Endeavoring into a brand-new project can be daunting but exciting. Starting a graduate medical education (GME) initiative has all the makings for a complex project. The hospital was expected to take on 70 residents with little more than a year of preparation.

During initial meetings, the vision was explained, and high-level requirements were detailed out. The designated institutional official led the facility while working with hospital leadership to align with regulatory policies that could affect the facility. The vision was also explained, and the strategy unveiled to have a successful initiation of the first resident group. Teams were developed to track timelines and meet key deliverables. The multiple meetings that followed included focus on developing the workflow for an entry to service for the resident teams. Critical work in the electronic health record (EHR) included creating resident positions, roles, privileges, note routing, prescription routing, residency specific orders, new communication pathways for the residency service with nursing, lab, pharmacy, and other ancillary departments, and, finally, developing education.

Always a major concern, education is a key factor when starting a new service line. This was best described by Fredrick: “You're already teaching them a block on this system and a block on that system. Instead of thinking of them as blocks, think of them as bricks, with EHR as the mortar.” He went on: “You deliver the case from the EHR. You find the symptoms in the EHR. You’re teaching the same content.”

This was a worthwhile approach. The true challenge ahead was trying to conceptualize the vision while contemplating the method using the EHR systems. Internal meetings with the informatics team were scheduled to discuss strategies moving forward. Once the workflow design was finished, meetings with the IT team were scheduled to discuss options using the technology available in the electronic system. Multiple working sessions, demonstrations to the program directors, and meetings with other institutions ended with a successful product.

Informaticists listen carefully making every attempt to gain knowledge of the vision so they can help facilitate moving forward in a method that makes sense, is efficient, and helps align with the facility’s goals. This quite possibly could be the first time you have been exposed to these innovative ideas/initiatives; however, you will be (mostly) an expert by the time the journey ends. One of the final steps was to educate the residents so that they had the tools they needed to be successful, and they could use the EHR to the fullest.

In the summer of 2023, the inaugural GME program was launched. The day was an exciting and electrifying day for the hospital. Preparation was the key to success.