EFFECTIVE USE OF PORTFOLIO FOR COMPETENCY MEASUREMENT

1. EFFECTIVE USE OF PORTFOLIO FOR COMPETENCY MEASUREMENT Sandhya Samavedam

2. Measuring clinical competencies is a difficult task Students and residents should be able to track their own professional and personal growth. Self-reflective goals should be compared with outcomes in the form of evaluations, examination scores, personal experiences and acquisition of competencies.

3. We use electronic portfolio to track clinical competencies and residents’ learning experiences. The portfolio is constantly modified as the needs of the residency program changes.

4. Learner • Learners are typically PGY1 residents. • Portfolio helps in early identification of residents who are lagging in meeting the educational requirements through milestones tracking. • This is to accommodate varying learning needs among different residents.

5. Manager and Teachers • Typically PGY2s are managers. Learners become managers when the required competencies are achieved. • Managers become teachers when they acquire the confidence and competence to teach. • There may be teachers among PGY2s. Some may take time to become teachers. Those residents are left as managers till they become teachers.

6. To promote from learners to managers to teachers, we need effective tracking of evaluations, scholarly activities, personal experiences, scores, certifications etc. Hence electronic portfolio is a great platform to track ones own progress and also for mentoring purposes.

7. LEARNERS • EVALUATIONS • ATTENDANCE AT CONFERENCE • CASE REVIEWS FOR INPATIENT MODULES • NIGHT FLOAT - CASE REVIEWS, MINI-CEXs, DOCUMENTATION OF PROFESSIONALISM, DOCUMENTATION OF PARTICIPATION IN MORNING REPORTS. • SELF-EVALUATIONS AND REFLECTIONS. • MINI-CEXs

8. MANAGERS • EVALUATIONS FROM PEERS, ATTENDINGS, CHIEF RESIDENT • MORNING REPORT PARTICIPATION • ACTIVE INTERDISCIPLINARY MEETING CONTRIBUTION • GRAND ROUNDS AND M&M PRESENTATIONS. • JOURNAL CLUB PRESENTATION.

9. TEACHERS • RESIDENTS ARE PROMOTED AS TEACHERS BASED ON THEIR EVALUATIONS, ESPECIALLY IN INTERPERSONAL COMMUNICATION AND SKILLS AND TEACHING SKILLS.

10. MINI CEXS • NEED FOR DOCUMENTATION OF SKILLS (OTHER THAN PROCEDURES) • DIRECT SUPERVISION • ENTRUSTABLE PROFESSIONAL ACTIVITIES

11. MINI CEXs • HISTORY AND PHYSICAL EACH ROTATION • CONSULT MINI CEX EACH ROTATION • DISCHARGE CEX EACH ROTATION • ACUTE ABDOMEN CEX • TRANSFER CEX • ICU CEX • NEUROLOGICAL CEX • OUTPATIENT CEX EACH ROTATION • CHRONIC CARE CEX EACH ROTATION • CODE CEX

12. Learners need only the following mini-cexs • History and physical • Discharge CEX after 6 months of training • Chronic care CEX • Outpatient CEX • Neurological CEX • Acute abdomen CEX after atleast 6 months of training.

13. MINI CEX • PERFORMANCE IS DOCUMENTED WITH COMMENTS • BASED ON THESE, COMPETENCIES CAN BE MEASURED • EPAs CAN BE DETERMINED ESPECIALLY FOR LEARNERS

14. PROCEDURES • ACGME MANDATORY PROCEDURAL DOCUMENTATION • PROCEDURE MODULES AND TESTS • PERFORMANCE AND COMMENTS • MANDATORY ANESTHESIA ROTATION WITH PROCEDURAL EVALUATIONS

15. NIGHT FLOAT • CASE PRESENTATION IN THE MORNING WITH BEDSIDE TEACHING AT LEAST TWICE A WEEK • EVALUATIONS • DOCUMENTATION OF CASE REVIEWS • DOCUMENTATION OF DIFFICULT SITUATIONS • DOCUMENTATION OF PROFESSIONALISM • SELF REFELCTION • MINI-CEXs • MORNING REPORT ATTENDANCE • SUPERVISED SIGNOUTS ONCE A WEEK

16. EVALUATIONS • MINI CEXS • PEERS • ATTENDINGS • NURSES • CHIEF RESIDENTS • 360 DEGREE • MENTORS • PATIENTS • PROGRAM DIRECTOR

17. PATIENT FEEDBACK • OUTPATIENT SETTING • INPATIENT FEEDBACK • PATIENT SATISFACTION MEASURES • RESIDENTS PROBLEM LIST SHOULD MATCH WITH PATIENT’S AGENDA FOR THE CLINIC VISIT (AS MEASURED FROM THE PATIENT SATISFACTION SURVEY.)

18. EXAMS AND QUIZZES • ITE • QUIZZES BASED ON WEAK AREAS

19. SCHOLARLY ACTIVITIES • CASE REPORTS FOR PGY1 • QUALITY IMPROVEMENT FOR PGY2 • RESEARCH OR SYSTEMATIC REVIEWS FOR PGY3 (SENIOR PRESENTATION)

20. MENTOR - MENTEE EVALUATION • ASSESS STRESS LEVELS • CASE LOGS ENTRY • EVALUATIONS • PRESENTATIONS • EDUCATIONAL GOAL SETTING • CAREER PLANNING

21. PROPOSED ADDITIONAL ACGME COMPETENCY • COST-CONSCIOUS CARE • CURRENTLY PART OF SYSTEMS BASED PRACTICE. • TEAM WORKING ON EVALUATING RESIDENTS IN DECISIONS MAKING ABOUT IMAGING STUDIES, CONSULTS, DAILY BLOOD WORK ETC. • ALSO EVALUATE ABOUT KNOWLEDGE ABOUT COSTS INVOLVED IN VARIOUS PATIENT CARE ARENAS

22. References • www.acgme.org/acwebsite/RRC_280/280_corecomp.asp