Douglas Char, MD – Emergency Medicine
We think
act like
this
group
• Clinical Competency Committees
How the
residents
see us
Clinical Competency Committee
• ACGME definition force us to broaden evaluation
committee membership, change work process
–
–
–
–
Expand beyond Program Directors
PD is not chair but member of the committee
Informal review -> formal assignment of milestone levels
CCC meets prior to resident semi-annual performance
evaluation (twice yearly)
– Calendar allows submission of milestone data to ACGME
Prior Approach based on 6-CC
Interpersonal & Communications Skills
Below
Expectation
Growth Area
Meets Expectation
History taking (EM1) – focus, depth
X
Team member effectiveness (EM1)
X
Communication patients/families (EM1)
X
Empathy (EM1)
X
Interaction with nurses and ED staff (EM1)
X
Clinical Attitude/ Problem solving (EM1)
X
Dealing with difficult patients (EM3)
X
Effectively delivers difficult info (EM3)
X
Team leader effectiveness (EM4)
X
Medical Knowledge
Below
Expectation
Growth Area
Meets Expectation
General medical principles (EM1)
X
Intellectual curiosity (EM2) seeks new know
X
Fund of knowledge (EM2-4) in-train exam
X
Teaching – transfer of knowledge (EM3-4)
X
Application of know – clinical setting (EM3-4)
X
Not Applicable
Not Applicable
CCC Operationalize
• 8-12 faculty member (PDs, FDs, core faculty)
• It’s tons of work (48 residents takes 5+ hours)
– Identify true stakeholders
• Subcomm assigned to review each class the provide
overview to full CCC
– Class APD and 1-2 other faculty
– 12-16 hours; review data, discuss, create report
– Subgroup aware of class norms, follows individual
throughout training
• CCC ensured program norms between classes
Performance Dashboard
• Ideally pushes data to CCC members, residents in
organized one stop shop format
• Creating viable dashboard requires lots of IT
muscle (residents faculty looking for fault)
• Avoid getting trapped in the process - $$$
– Should there be a centralized resource?
Milestones with Comments
Comments (Core Competency):
1. Patient Care: Ahead of your peers, appropriate pace and number of patients seen (2.6/hour, class avg 2.14). Appears comfortable in physician role.
Runs EM2 like an attending.
2. Medical Knowledge: Above average In-service score 83% (mean 72%), clinical judgment is excellent
3. Interpersonal & Communication: great with staff, patients. Need nursing evals.
4. Practice-based Learning: Continue self directed learning (follow up cases, procedure log, DOTs) on track. Good job tracking procedures focus on
other procedures not just the RRC mandated core.
5. Professionalism: conf attendance great 100%, (8 hours of indep study) multiple compliments about bedside manner.
6. System-based Practice: Consider working on practice-based and quality improvement initiatives within the ED and hospital.
Administrative Issues:
360 degree evaluation - 2/2 patient evals, 3/2 nursing evals, peers due in April 2014.
8 of 8 DOTs (3 Hx/Dx, 1 Dispo/dx, 1 professionalism, 1 systems based practice) , Procedure skills ( 8/4 – 2 wound care, 3 airway, 1 pain management, 2
vascular access)
Need resuscitation DOTs (one for the semester) 1/1 resusc DOT
Transition of care 1/1
Follow up cases 8/8 for the year (two months)
EOS paper 17, electronic 12
------------------------------------------------------------------------------------------------------------------------------Areas of Strength: XXX has a calm mature demeanor. Applies medical knowledge well, displays outstanding judgment for level of training. She gets
along well with patients, staff and peers.
Uses technology to accomplish and document safe healthcare delivery
Uses the Electronic
Health Record (EHR) to order
tests, medications and document
notes, and respond to alerts
Reviews medications for patients
Ensures that medical records are
complete, with attention to preventing
confusion and error
Effectively and ethically uses technology for
patient care, medical communication and
learning
X
Comments: DOTs , FU cases (chart review) 8 of 8, faculty global rating
Recognizes the risk of
Uses decision support systems in
computer shortcuts and reliance upon
EHR (as applicable in institution)
computer information on accurate patient
care and documentation
X
Recommends systems re-design
for improved computerized processes
Gathering Data = Hassle Factor
• Mistrust of data by residents, faculty
• No good system to collect, lots of staff and
faculty time
• Residents see where data being applied
Final Milestone Rating Decisions
Preparing Residents for Milestones
• Annual Retreat – we’ve talked NAS for the past 3 years
• Self assessment – familiarize res w/ concepts, rankings
• They don’t care about it until they get tripped up by
the new rules
• Have to make Milestones relevant to them
• Include residents in plans & changes, this creates buy
in (even if only in token way)
• Make it clear this is moving target, it will change!
Residents more
invested than faculty
Milestones likely to be part of their
future as physicians
• Maintenance of certification for Board status
• Hospital privileging - ongoing CQI initiatives
• Performance data have many uses