Transforming hospital into teaching facility complex process

The creation of a residency program at MountainView Hospital in Las Vegas illustrates the exacting nature of physician training, and the complexity and precision required to turn a community hospital into a teaching institution.

Officials at MountainView and the University of Nevada School of Medicine are creating new educational and research programs to allow for the training of 150 residents per year. Converting Mountain­View into a teaching hospital gives the facility cachet and prestige, but accreditation takes years of effort.

Here are the key numbers:

■ Officials went public with the project in June.

■ The first residents won’t have their surgical booties on the ground until June 2016.

■ The programs will not reach their target goal of 150 residents until 2019.

“It could be 150. It could be 200,” said Dr. Darren Swenson, MountainView’s chief medical officer. “It’s really defined by community need and building a program that adds value. We’re not going to create positions just to create positions. What does the community need? What can Mountain­View support to give an excellent, high-level, high-caliber experience?”

Planning at this stage focuses on hiring the right people to bring the project to fruition, primarily a program director and assistant director for a residency in internal medicine and a program director for general surgery. The recruitment efforts are being spearheaded by Swenson, who hopes to have the positions filled this year.

The next task will be assembling the team who can teach the doctors in training. Those residents work under an attending physician, who ultimately is responsible for patients seen by the medical residents. The plan is to have 20 residents in internal medicine and four in general surgery when the programs open next year.

“At MountainView, we looked to our medical staff and our community doctors to drive the training,” Swenson said. “They’ve supported the hospital 100 percent. Everyone we’ve talked to has said they want to be involved.”

Faculty from the University of Nevada School of Medicine will help hospital and community doctors learn how to teach and evaluate residents and how to ensure all curriculum objectives are achieved. The goal is to have private doctors with years of experience deliver the training to the residents, Swenson said.

“The responsibility of teaching the doctors in residency, that’s different than treating pneumonia,” Swenson said. “You’re actually teaching young physicians how to be the physician three years from now.”

Those residents start mastering the health care delivery system, and they learn how to develop a plan of care, inter­acting with other doctors, nurses and therapists, and then execute that plan of care.

“They’ve learned all the science,” Swenson said. “Now they learn how to put the science into practice in the clinical setting.”

A review of the hospital’s suitability as a teaching facility actually started in early 2014 by the Accreditation Council for Graduate Medical Education, a private, nonprofit group that accredits some 9,500 residency programs in 140 disciplines involving 109,000 residents. Field staff visited MountainView and talked to hospital officials, and the group granted the programs initial accreditation.

An expansion of undergraduate and graduate medical education also is happening in Washoe County. Renown Health has committed $5 million over the next three years to expand the School of Medicine on the UNR campus allowing more teaching capacity for third- and fourth-year medical students. The result will raise UNR to a full four-year campus for medical student education as early as 2018. Today most UNR medical students complete their clinical experience in Southern Nevada.

Also, new residency programs are being created in pediatrics and neurosciences, but the effort is expanding to include other medical specialties, Renown Health President and CEO Anthony Slonim said.

Starting residency programs is complicated, but creating a medical school is even more daunting. Officials at Roseman University of Health Sciences and the University of Nevada, Las Vegas are on roughly parallel paths toward having the capacity to teach 60 medical students each year starting in 2017. If the accreditation process goes as planned, the first graduates from both schools will be looking for residencies in 2021.

The first hurdle is preliminary accreditation, which Dr. Mark Penn, the dean of Roseman’s College of Medicine, hopes to achieve by spring 2016.

Once MountainView’s program is in full swing, Swenson said, the hospital could feature a continuity clinic where patients who have been discharged can get efficient follow-up care with the goal of reducing readmissions. Such a clinic could be staffed by resident physicians who could see those patients three to five days after discharge because their primary care provider might not be able to see them for weeks.

“This is really about elevating the quality of care in the hospital. When you bring in (graduate medical education), the entire organization right off elevates because you’re evidence based, you’re research based,” Swenson said. “But ultimately it’s best for the community.”

Contact Steven Moore at smoore@reviewjournal.com or 702-380-4563.