Practice-based Learning & Improvement Project Committee Evaluation
CONFIDENTIAL (Peer Review Document)16
Title of Project:
Date Project Submitted: Click here to enter a date.
Reviewed by committee:
Check “YES” if the project meets the item specification and “NO” column if the project does not meet the item specification.
1.
Residents/Fellows were involved in the planning, implementation and evaluation of the project.
2.
The project had an appropriate level of faculty supervision.
3.
The project topic is related to a needed change in medical care education, research /administration processes and/or
outcomes.
4.
The practice behavior is feasible to change.
5.
The plan or approach used to change the practice behavior is justifiable.
6.
The standards for determining measureable success are articulated.
7.
Data have been collected (i.e. baseline & outcomes data).
8.
Data have been compared to baseline data, or standards established by learner.
9.
A summary of the improvement process is presented.
10. Conclusions are presented to the committee.
11. Completion and overall quality of project.
12. If other departments might be interested in project, please list them.
13. Confidentiality
14. If this project was a collaborative effort has it been approved by departments involved?
15. If this project was a collaborative effort have all departments involved completed separate PBLI templates?
16. Please list other departments involved.
17. Please include recommendations project implementation on the back of this sheet.
Approval date: Click here to enter a date.
Program Director signature:
Required copy of PLBI completed project template and completed, signed evaluation form sent to GME office.
Note: Adapted from: Lough JRM, Murray TS. Audit and summative assessment: a completed audit cycle. Med Educ 2001;35:357-63.
Practice-based Learning & Improvement Project Committee Evaluation
CONFIDENTIAL (Peer Review Document)16
McClain EK, Babbott SF, Tsue TT, Girod DA, Clements D, Gilmer L, et al. Use of a Structured Template to
Facilitate Practice-Based Learning and Improvement Projects. J Grad Med Educ. 2012;4(2):215-219.
Note: Adapted from: Lough JRM, Murray TS. Audit and summative assessment: a completed audit cycle. Med Educ 2001;35:357-63.