Presentation on theme: "Assigning Milestone Evaluations in Internal Medicine"— Presentation transcript:
1Assigning Milestone Evaluations in Internal Medicine Melvin Blanchard, MD, FACPProgram Director, Internal MedicineChief, Division of Medical EducationDepartment of Medicine
2Outline Internal Medicine program overview ACGME Charges re CompetenciesResponse by IM communityACGME counter responseOur program’s approach to evaluation
3Internal Medicine Overview Discipline encompassing the study and practice of health promotion, disease prevention, diagnosis, care and treatment of adults1 of 4 physicians in the USIM residentsOur program:151 trainees2/3 inpatient; 1/3 outpatientBJH, VA, community, international~50 rotationsCategoryPositionsNumber of training programs393Positions in match6177First year fellows4584
4ACGME Charge - 1 1999 – ACGME launched the Outcomes Project Required PDs to assess trainees in 6 competenciesPatient CareProfessionalismPractice-Based Learning and ImprovementInterpersonal and Communication skillsMedical KnowledgeSystems-Based PracticeCompetencies required of a physician to deliver competent medical care
5ACGME Charge - 22009 – ACGME charged specialties with identifying milestones of competency developmentObservable developmental stepsHow do we know that PGY-2 resident will be competent at graduation?How do we know that graduates from the 393 IM programs can deliver same quality of IM care?
6IM Community Response 2009-12: Published 142 Milestones Aka Curricular MilestonesPoint in development that facilitates assessment of progression from beginner to expected proficiency at end of trainingPublished 16 Entrustable Professional Activities (EPAs)KSAs critical to practice specialtyMilestones and EPAs categorized by 6 competencies
7EPAs Manage patients with diseases across multiple care settings. Provide age-appropriate screening and preventative care.Resuscitate, stabilize, and care for unstable or critically ill patients.Provide perioperative assessment and care. Manage transitions of care.Facilitate family meetings.Enhance patient safety.Improve the quality of health care at individual and systems levels.Demonstrate personal habits of lifelong learning.Demonstrate professional behavior.
8ACGME Counter Response 142 milestones is too numerousNot optimal format for reporting to the ACGMEACGME and ABIM combined forcesDeveloped milestones for reporting educational outcomesAka Reporting Milestones or MilestonesGrouped into 22 sub-competencesGrouped into 6 competenciesWith each competency associated with 2 – 5 sub-competencies
10CompetenciesCurricular milestonesReporting milestonesMilestonesEntrustable Professional ActivitiesNarrativesSub-competencies
11Competencies to Milestones MKPCPBLISBPWorks in teamsCost consciousTransition of careDisregards communicationInconsistentRecognizes importanceUses resourcesCoordinates careCompetenciesSub-competenciesMilestonesCurricular Milestones5 levels of milestones: Critical deficiency to AspirationalEPAsEntrustable Professional Activities
12What did we do? Broke 22 sub-competencies into sub-sub competencies Each sub-sub competency can be used as a question on a rotation evaluationRotations divided among 5 facultyEach faculty work with core faculty/rotation directors to select evaluation questions appropriate to rotationTracked assignment to assure each sub-competency measured multiple timesData from conference attendance, ITE, journal club participation, etc. also feed into evaluation system
131. Gathers and synthesizes essential and accurate information to define each patient’s clinical problem(s). (PC1)Critical DeficienciesReady for unsupervised practiceAspirationalDoes not collect accurate historical data.Inconsistently able to acquire accurate historical information in an organized fashion.Consistently acquires accurate and relevant histories from patients.Acquires accurate histories from patients in an efficient, prioritized, and hypothesis-driven fashion.Obtains relevant historical subtleties, including sensitive information that informs the differential diagnosis.Does not use physical exam to confirm history.Does not perform an appropriately thorough physical exam or misses key physical exam findings.Consistently performs accurate and appropriately thorough physical exams.Performs accurate physical exams that are targeted to the patient’s complaints.Identifies subtle or unusual physical exam findings.Relies exclusively on documentation of others to generate own database or differential diagnosis.Does not seek or is overly reliant on secondary data.Seeks and obtains data from secondary sources when needed.Fails to recognize patient’s central clinical problems.Fails to recognize potentially life threatening problems.Inconsistently recognizes patients’ central clinical problem or develops limited differential diagnoses.Uses collected data to define a patient’s central clinical problem(s).Synthesizes data to generate a prioritized differential diagnosis and problem list.Efficiently utilizes all sources of secondary data to inform differential diagnosis.Effectively uses history and physical examination skills to minimize the need for further diagnostic testing.Role models and teaches the effective use of history and physical examination skills to minimize the need for further diagnostic testing.
14Milestone distribution across Rotations Sub-competency12345678CompetencyPC1PC2PC3PC4PC5MK1MK2SBP1Inpt Gen MedRheumCAERNeuroGI consultNF