One Resident One Competency An Outpatient Competency Tool

One Resident One Competency An Outpatient Competency Tool Rob Mc. Donald MD Spartanburg Family Medicine Residency Program March 6 -7 2009

The Core Competencies • • • Patient Care Medical Knowledge Interpersonal and Communication skills Professionalism Practice-based Learning and Improvement • Systems-based Practice

ACGME Outcome Project • Vision • Enhance residency education • Process • Educational outcome assessment

ACGME Outcome Project • Principles • • • What we measure we improve. More flexibility to be creative. Enhances public accountability. • Activities • • • Identify Competencies Develop Measurement Tools Develop Support Network

The Outpatient Setting • Our primary site of care • In practice we will spend 75 -100% of our time in our offices • Therefore we should have a tool to evaluate our residents’ performance, as it pertains to the 6 Core Competencies, in this setting

Faculty Retreat • May 2005 • Recognized that we didn’t have a useful tool to evaluate residents in the outpatient setting (#1 priority? ) • Created “OUR” One Resident One Competency tool

One Resident One Competency • Single out one resident (from a pool of 2 -4) during a half day of precepting • Focus on one competency • Focus on specific outpatient aspects of that competency

One Resident One Competency • Create a simple check-list of outpatient specific goals • Make these goals PGY specific • Create a system that automatically demonstrates growth over 3 years

Daily Precepting Form for Patient Care Resident: Attending: PGY Level: Direct observation Standard precepting Video observation Date: PGY - 1 1. Adequate information gathering PM ME EE 2. Completes and documents a systems based exam PM ME EE 3. Demonstrates organized thinking in presentation, patient care and documenting PM ME EE 1. Develops and carries out a diff dx and management plan PM ME EE 2. Demonstrates awareness of family dynamics on patient’s health and management of disease PM ME EE 1. Counsels and educates patient and families PM ME EE 2. Skillfully performs medical procedures PM ME EE 3. Provides environment that maximizes continuity of care PM ME EE PGY - 2 PGY - 3

Additional Attending Comments: Resident Reflective Comments: How does this affect my education, etc? What am I going to do based on this information? Attending Signature Resident Signature

Professionalism PGY 1 Altruism • Shows concerns and compassion Accountability • Appropriate dress • Arrives on time • Timely completion of EMR Integrity • Maintains confidentiality • Admits errors • Truthful documentation Respect For Others • Treats patients as individuals • Respect for staff, peers, and faculty • F I S H principle

Professionalism PGY 2 Altruism • Offers to help Respect For Others • Does not show or encourage disruptive behavior Excellence • Actively seeks precepting • Openness and willingness to learn

Professionalism PGY 3 Excellence • Actively teaches Duty (Responsibility) • Shares team workload fairly • Positively perceives responsibilities • Reports errors or inappropriate behaviors

Evaluation • All areas evaluated as either: • • • Partially met the expectation Met the expectation Exceeded the expectation • Forms are reviewed prior to the start of clinic • Forms are reviewed and marked at the end of the clinic time

Reflection • Space for the following: • • Faculty comments Resident Reflective Comments: • How does this affect my education, etc? • What am I going to do based on this information? • Signatures • Placed in advancement folder

Scheduling sample CLASS MEDICAL KNOWLEDGE INTERNS SUR A 1 ST MON AM SUR B 1 ST TUE PM PHAB 1/EMA 1 ST WED AM PGY 2 PED D 2 ND MON AM ER B/PMG A 1 3 RD MON AM ER B 1/PMG A 2 4 TH MON AM PGY 3 OPH/ENT 4 TH MON AM ELE B 5 TH MON AM CAR 5 TH THUR AM

Dirty Laundry?

Meeting our Goals – completed competency forms in folders Resident Class of 2008 Med Know Patient Profes. Care Com. Skills Systemsbased Practicebased Learning Resident 1 2 0 0 1 Resident 2 0 0 4 1 0 0 Resident 3 1 1 0 1 Resident 4 0 0 4 2 0 1 Resident 5 0 0 0 Resident 6 2 7 3 2 1 2 Resident 7 0 0 0 Resident 8 3 2 0 0 1 4 Resident 9 4 4 1 0 0 1 Resident 10 2 1 0 0 Resident 11 0 2 0 0 1 1

Meeting our Goals – completed competency forms in folder Resident Total of all 6 competencies Resident 1 4 – 11% Resident 2 5 – 14% Resident 3 5 – 15% Resident 4 7 – 19% Resident 5 0 – 0% Resident 6 17 – 46% Resident 7 0 – 0% Resident 8 10 – 27% Resident 9 10 – 27% Resident 10 5 – 15% Resident 11 4 – 11% Maximum exposure per resident 37 – 100% TOTAL 67 – 16%

Positives • Residents awareness of evaluation process and need for one-on-one attention from attending • Residents become better educated about the 6 core competencies • Out patient specific • Automatically tracks growth • Meets RRC guidelines

Obstacles • Very busy clinic • Faculty forgetting to check schedule • Faculty and resident starting process then forgetting • Resident not turning in completed form with reflective comments to coordinator • Difficult to find forms in folder for study purposes

Future • Rework the forms to improve completion and better reflect our outpatient teaching and evaluation • Create a better system for reminding faculty to perform the 1 R 1 C evaluation • Empower the resident to look for assigned and other opportunities to be evaluated – happening already! • Color code the forms so we can retrieve the information for future studies! • Electronic format

Future • Link resident performance with other tools to test for reliability and validity • Will most likely have to change to lickert scale to accomplish

Questions?