Clinical Competency Committee Spring 2013 SemiAnnual Review OHSU

Clinical Competency Committee Spring 2013 Semi-Annual Review OHSU Nate Selden, PD Heidi Waldo, PC

Cast of Characters • [Also members of Milestones Group] – Rich Byrne – Bob Harbaugh – Tim Mapstone – Oren Sagher – Nate Selden (playing the PD) – Heidi Waldo (playing the PC) – Greg Zipfel • Moderator: Nick Barbaro

Resident: Dr. Alpha, PGY 4 3 months Functional/Vascular 3 months Pediatrics

Dr. Alpha: PGY 4 -Spring 2013 Dr. Alpha : Medical Knowledge Vascular Neurosurgery Surgical Treatment of Epilepsy & Movement Disorders Spinal Neurosurgery; Trauma, Tumor, Infection Spinal Neurosurgery; Degenerative Disease Pediatric Neurosurgery Pain & Peripheral Nerves Critical Care Brain Tumor 0 1 2 3 4 5

Dr. Alpha: PGY 4 -Spring 2013 Dr. Alpha: Patient Care Vascular Neurosurgery Traumatic Brain Injury Surgical Treatment of Epilepsy & Movement Disorders Spinal Neurosurgery Pediatric Neurosurgery Pain & Peripheral Nerves Critical Care Brain Tumor 0 1 2 3 4 5

Dr. Alpha: PGY 4 -Spring 2013 Dr. Alpha: General Competencies SBP - Safety & Systems SBP - Economics PRO - Compassion Sagher PRO - Accountability Zipfel PBLI - Research Mapstone Selden PBLI - Lifelong Learning IPC - Technology IPC - Relational 0 1 2 3 4 5

Dr. Alpha: PGY 4 -Spring 2013 • Dr. Alpha – Consensus • General competencies: Amongst observers • MK and PC competencies: Amongst specialties – Milestone levels appropriate for PGY 4 • MK • PC • General Competencies – Case minimums tracking well

Resident: Dr. Bravo, PGY 3 General service junior

Dr. Bravo: PGY 3 -Spring 2013 Dr. Bravo: Medical Knowledge Vascular Neurosurgery Surgical Treatment of Epilepsy & Movement Disorders Spinal Neurosurgery; Trauma, Tumor, Infection Spinal Neurosurgery; Degenerative Disease Pediatric Neurosurgery Pain & Peripheral Nerves Critical Care Brain Tumor 0 1 2 3 4 5

Dr. Bravo: PGY 3 -Spring 2013 Dr. Bravo: Patient Care Vascular Neurosurgery Traumatic Brain Injury Surgical Treatment of Epilepsy & Movement Disorders Spinal Neurosurgery Pediatric Neurosurgery Pain & Peripheral Nerves Critical Care Brain Tumor 0 1 2 3 4 5

Dr. Bravo: PGY 3 -Spring 2013 Dr. Bravo: Patient Care Low in all areas of Patient Care Vascular Neurosurgery Traumatic Brain Injury Surgical Treatment of Epilepsy & Movement Disorders Spinal Neurosurgery Pediatric Neurosurgery Pain & Peripheral Nerves Critical Care Brain Tumor 0 1 2 3 4 5

Dr. Bravo: PGY 3 -Spring 2013 Dr. Bravo: General Competencies SBP - Safety & Systems SBP - Economics PRO - Compassion Selden PRO - Accountability Mapstone PBLI - Research Zipfel Sagher PBLI - Lifelong Learning IPC - Technology IPC - Relational 0 1 2 3 4 5

Dr. Bravo: Career Trends Dr. Bravo: Medical Knowledge - Career Trends 5 Brain Tumor Critical Care 4 Pain & Peripheral Nerves 3 Pediatric Neurosurgery Spinal Neurosurgery; Degenerative Disease 2 Spinal Neurosurgery; Trauma, Tumor, Infection 1 Surgical Treatment of Epilepsy & Movement Disorders 0 PGY 1 A PGY 1 B PGY 2 A PGY 2 B PGY 3 A PGY 3 B Vascular Neurosurgery

Dr. Bravo: Career Trends Dr. Bravo: General Competencies - Career Trends 5 4 IPC - Relational IPC - Technology 3 PBLI - Lifelong Learning PBLI - Research PRO - Accountability 2 PRO - Compassion SBP - Economics 1 SBP - Safety & Systems 0 PGY 1 A PGY 1 B PGY 2 A PGY 2 B PGY 3 A PGY 3 B

Dr. Bravo: Career Trends Dr. Bravo: Patient Care - Career Trends 5 Brain Tumor Critical Care 4 Pain & Peripheral Nerves 3 Pediatric Neurosurgery 2 Spinal Neurosurgery 1 Surgical Treatment of Epilepsy & Movement Disorders Traumatic Brain Injury 0 PGY 1 A PGY 1 B PGY 2 A PGY 2 B PGY 3 A PGY 3 B Vascular Neurosurgery

Dr. Bravo: Career Trends Dr. Bravo: Patient Care - Career Trends 5 Patient Care Milestones have not increased over time Brain Tumor Critical Care 4 Pain & Peripheral Nerves 3 Pediatric Neurosurgery 2 Spinal Neurosurgery 1 Surgical Treatment of Epilepsy & Movement Disorders Traumatic Brain Injury 0 PGY 1 A PGY 1 B PGY 2 A PGY 2 B PGY 3 A PGY 3 B Vascular Neurosurgery

Dr. Bravo: PGY 3 -Spring 2013 • Patient Care Milestones are low across all specialties • Comments from Evaluations: – PC summative evaluations • “Bravo is still experiencing the wood/trees problem. He needs to focus on what is important. Needs counseling. ” – Procedural on-the-fly • “Tentative. Will not make progress on simple approaches without faculty hovering, and even then indecisive and slow. ” – Clinical on-the-fly • “Decision-making is a problem. ”

Dr. Bravo: PGY 3 -Spring 2013 • Dr. Bravo – Low Patient Care Milestone levels for Spring 2013 – Patient Care levels ‘stalled out’ last three reporting periods – Discussion

Dr. Bravo: PGY 3 -Spring 2013 • Dr. Bravo – Plan of action: • Program director counseling • 3 month fall elective replaced with additional University service junior rotation • Additional dissection curriculum • Written remediation plan, including submission to GME • Interim review in 3 months – Consider probation if no progress

Resident: Dr. Charlie, PGY 3 General service junior

Dr. Charlie: PGY 3 -Spring 2013 Dr. Charlie: Medical Knowledge Vascular Neurosurgery Surgical Treatment of Epilepsy & Movement Disorders Spinal Neurosurgery; Trauma, Tumor, Infection Spinal Neurosurgery; Degenerative Disease Pediatric Neurosurgery Pain & Peripheral Nerves Critical Care Brain Tumor 0 1 2 3 4 5

Dr. Charlie: PGY 3 -Spring 2013 Dr. Charlie: Patient Care Vascular Neurosurgery Traumatic Brain Injury Surgical Treatment of Epilepsy & Movement Disorders Spinal Neurosurgery Pediatric Neurosurgery Pain & Peripheral Nerves Critical Care Brain Tumor 0 1 2 3 4 5

Dr. Charlie: PGY 3 -Spring 2013 Dr. Charlie: General Competencies SBP - Safety & Systems SBP - Economics PRO - Compassion Selden PRO - Accountability Mapstone PBLI - Research Zipfel Sagher PBLI - Lifelong Learning IPC - Technology IPC - Relational 0 1 2 3 4 5

Dr. Charlie: PGY 3 -Spring 2013 Dr. Charlie: General Competencies SBP - Safety & Systems SBP - Economics PRO - Compassion Selden PRO - Accountability Mapstone PBLI - Research Zipfel Sagher PBLI - Lifelong Learning IPC - Technology IPC - Relational 0 1 Discrepancy between Sagher and other faculty members on all measures 2 3 4 5

Dr. Charlie: PGY 3 -Spring 2013 • Dr. Sagher’s comments: – “Manner in speaking with patients sometimes conveys arrogance” – “I do not see him taking ownership” – “Does not teach; spends only the minimal time necessary with younger residents on rounds” • Discussion

Dr. Charlie: PGY 3 -Spring 2013 • Concerning areas

Dr. Charlie: PGY 3 -Spring 2013 • Concerning areas

Dr. Charlie: PGY 3 -Spring 2013 Dr. Charlie: General Competencies - FINAL SBP - Safety & Systems SBP - Economics PRO - Compassion PRO - Accountability Consensus PBLI - Research PBLI - Lifelong Learning IPC - Technology IPC - Relational 0 1 2 3 4 5

Dr. Charlie: PGY 3 -Spring 2013 Dr. Charlie: General Competencies - FINAL SBP - Safety & Systems SBP - Economics PRO - Compassion PRO - Accountability Consensus PBLI - Research PBLI - Lifelong Learning IPC - Technology IPC - Relational 0 1 Consensus of faculty is generally positive, but accepts Dr. Sagher’s criticism about teaching (PBLI LLL) 2 3 4 5

Dr. Charlie: PGY 3 -Spring 2013 • Dr. Charlie – Teaching skills are a concern – Lifelong Learning, level 1. 5 consensus – Plan of Action: • PD Counseling session with resident • Released from service for GME teaching workshop

Resident: Dr. Delta, PGY 2 General service junior, 3 months Neuro critical care, 3 months

Dr. Delta: PGY 2 -Spring 2013 Dr. Delta: Medical Knowledge Vascular Neurosurgery Surgical Treatment of Epilepsy & Movement Disorders Spinal Neurosurgery; Trauma, Tumor, Infection Spinal Neurosurgery; Degenerative Disease Pediatric Neurosurgery Pain & Peripheral Nerves Critical Care Brain Tumor 0 1 2 3 4 5

Dr. Delta: PGY 2 -Spring 2013 Dr. Delta: Patient Care Vascular Neurosurgery Traumatic Brain Injury Surgical Treatment of Epilepsy & Movement Disorders Spinal Neurosurgery Pediatric Neurosurgery Pain & Peripheral Nerves Critical Care Brain Tumor 0 1 2 3 4 5

Dr. Delta: PGY 2 -Spring 2013 Dr. Delta: General Competencies SBP - Safety & Systems SBP - Economics PRO - Compassion PRO - Accountability PBLI - Research PBLI - Lifelong Learning IPC - Technology IPC - Relational 0 1 2 3 4 5

Dr. Delta: PGY 2 -Spring 2013 Dr. Delta: General Competencies SBP - Safety & Systems SBP - Economics ! PRO - Compassion PRO - Accountability PBLI - Research PBLI - Lifelong Learning IPC - Technology IPC - Relational 0 1 2 3 4 5

Dr. Delta: PGY 2 -Spring 2013 • Program Coordinator Input – Timeliness of duty hour logging – Conference attendance record

Dr. Delta: PGY 2 -Spring 2013

Dr. Delta: PGY 2 -Spring 2013 • Faculty Evaluation Comments – “Resident is extremely devoted to patient care, but often stays on ward or in ICU and is late for morning teaching conference” – “Dedicated resident but I am concerned about fatigue and burn-out. ” • Discussion

Dr. Delta: PGY 2 -Spring 2013

Dr. Delta: PGY 2 -Spring 2013 Dr. Delta: General Competencies SBP - Safety & Systems SBP - Economics Unable to follow duty hours requirements. Time off and shift length violations. Does not meet Level 1. PRO - Compassion PRO - Accountability PBLI - Research PBLI - Lifelong Learning IPC - Technology IPC - Relational 0 1 2 3 4 5

Dr. Delta: PGY 2 -Spring 2013 • Dr. Delta – Compassionate resident with good patient care skills – Trouble with duty hours compliance – Comments from faculty suggest trouble with fatigue and time-management – Action Plan: • • Program Director counseling meeting Intentional mentoring from Chief Resident Faculty awareness 3 month interim review with PD and PC

Resident: Dr. Epsilon, PGY 7 Chief University Service

Dr. Epsilon: PGY 7 -Spring 2013 Dr. Epsilon: Medical Knowledge Vascular Neurosurgery Surgical Treatment of Epilepsy & Movement Disorders Spinal Neurosurgery; Trauma, Tumor, Infection Spinal Neurosurgery; Degenerative Disease Pediatric Neurosurgery Pain & Peripheral Nerves Critical Care Brain Tumor 0 1 2 3 4 5

Dr. Epsilon: PGY 7 -Spring 2013 Dr. Epsilon: Patient Care Vascular Neurosurgery Traumatic Brain Injury Surgical Treatment of Epilepsy & Movement Disorders Spinal Neurosurgery Pediatric Neurosurgery Pain & Peripheral Nerves Critical Care Brain Tumor 0 1 2 3 4 5

Dr. Epsilon: PGY 7 -Spring 2013 Dr. Epsilon: General Competencies SBP - Safety & Systems SBP - Economics PRO - Compassion Selden PRO - Accountability Mapstone PBLI - Research Zipfel Sagher PBLI - Lifelong Learning IPC - Technology IPC - Relational 0 1 2 3 4 5

Dr. Epsilon: PGY 7 -Spring 2013 • Dr. Epsilon – At or above appropriate level for graduation (4)