NOTES FROM
SEPTEMBER 19, 2013 NETWORK WORKSHOP
Lake Washington Rowing Club
Wading Knee-Deep into the Next Accreditation System (NAS): Tackling the
Clinical Competency Committees (CCC’s) and Milestones at Your Program
GOAL
Teams from Network Programs will leave the workshop informed about managing the Family
Medicine Milestones and CCC’s with an action plan for your program
OBJECTIVES
1. Discuss approaches to form a functional CCC
2. Identify curricular areas your program needs to augment to teach and evaluate Milestones
which are not currently addressed
3. Identify mechanisms for an efficient system to organize data for resident Milestones
assessment (such as New Innovations)
4. Review Faculty Development strategies for a functioning CCC and Milestones assessment
5.
Leave with an action plan for your program’s team which includes assessment of
administrative resources needed for implementation by July 2014
EVALUATION FORMS
Resident Self-evaluations and Portfolios - Rae Wright
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Resident Self-evaluations:
o What can be adapted from current self-evals vs new evaluations using the
milestones?
 Use current evaluation questions and map to milestones
 See which milestones might be best reflected in a resident self-eval, then
rewrite evaluations using milestones language
 Combine some/all current eval questions with new questions based on
milestones
Why use resident self-evaluations
o Milestones self-evals can prime/educate residents for the actual milestone based
evaluations to come, with greater familiarity with language and priorties.
o Self-evals should set resident driven goals as well
o Self-evals may provide a more accurate picture of resident performance, as part
of a 360 evaluation process

Portfolios:
o Traditionally a collection of written and printed material about a residents
progress placed in a file or binder of some sort
o Gradually moving toward all or mostly electronic format
o New Innovations (NI) has a Portfolio function built in that can collect information
from multiple sources
 Need knowledgeable admin staff to set up
 Best if a faculty point person involved as well, to advise on content most
needed
 Evaluations need consistent grading scale to create accurate data and
graphs
 In addition to aggregate data from evaluations, can also attach files
created outside NI
 Additional information from NI portfolio function:
 Duty hour compliance
 Conference attendance
 Procedure report
 Some others
Direct Observation Checklists and Field Notes – Lisa Johnson
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Strategies for direct observationo Target 1st pt. of the day using a regularly assigned preceptor
o Entire clinic session with an advisor or assigned faculty
o Every clinic session, preceptor should do 1 one-on-one active precepting session
(Vancouver is developing a check list)
o Can use NP/PA faculty for observation in clinic, as long as the residents precept
with FP faculty too
o Quarterly or semi-annually all residents do simulations; train faculty to teach and
evaluate the sessions (Madigan sessions for faculty are scheduled regularly)
o Use behavioral health faculty for direct observation sessions; completing
appropriate target milestones eval.
o Can use a check list or field note to give feedback and inform the CCC.
o Observe while rounding in hospital, during deliveries, write a field note on
observations.
Field Notes: Brief, specific written feedback on a form that is put in resident’s file.
Field notes may be best if tied to a Milestone or Competency, feed into the NI system if
done on-line.
Must keep it simple to get faculty to do them regularly. Preceptors can do them toward
the end of the clinic session.
----------------------------------17 procedures may be required (NOTE: there are no specific requirements in the new
ACGME FM requirements- each program must have their own requirements stated.).
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BSQ = basic skills qualification to document procedural competency
o Providence St. Peter’s are on UW NDRL
o BSQ checklists usually brief
Consider adding to your core curriculum:
o ACLS, NALS, PALS, ALSO, (?) ATLS
There is interest in ICU skills BSQs development
----------------------------------Need a list of procedures residents are capable of doing independently after they have
achieved competency.
Guidelines differ between residencies in regards to procedures and supervision, must
still follow Medicare/Medicaid rules
What happens when they finish residency w/o completing all of the BSQ’s?
o Milestones aren’t a requirement of graduation
o Final PD letter should reflect what the program knows the graduate can do
independently
o Do what you say you do in terms of requirements!
o Doesn't always have to be done on humans
 OSCE
 Sim lab
 Certification classes