EFFECTIVE USE OF PORTFOLIO FOR COMPETENCY MEASUREMENT

Sandhya Samavedam

• 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.

• 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.

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.

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.

• 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.

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

MANAGERS

• EVALUATIONS FROM PEERS, ATTENDINGS, CHIEF RESIDENT

• MORNING REPORT PARTICIPATION• ACTIVE INTERDISCIPLINARY MEETING

CONTRIBUTION• GRAND ROUNDS AND M&M PRESENTATIONS.• JOURNAL CLUB PRESENTATION.

TEACHERS

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

MINI CEXS

• NEED FOR DOCUMENTATION OF SKILLS (OTHER THAN PROCEDURES)

• DIRECT SUPERVISION• ENTRUSTABLE PROFESSIONAL ACTIVITIES

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

• 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.

MINI CEX

• PERFORMANCE IS DOCUMENTED WITH COMMENTS

• BASED ON THESE, COMPETENCIES CAN BE MEASURED

• EPAs CAN BE DETERMINED ESPECIALLY FOR LEARNERS

PROCEDURES

• ACGME MANDATORY PROCEDURAL DOCUMENTATION

• PROCEDURE MODULES AND TESTS• PERFORMANCE AND COMMENTS• MANDATORY ANESTHESIA ROTATION WITH

PROCEDURAL EVALUATIONS

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

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

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.)

EXAMS AND QUIZZES

• ITE• QUIZZES BASED ON WEAK AREAS

SCHOLARLY ACTIVITIES

• CASE REPORTS FOR PGY1• QUALITY IMPROVEMENT FOR PGY2• RESEARCH OR SYSTEMATIC REVIEWS FOR

PGY3 (SENIOR PRESENTATION)

MENTOR - MENTEE EVALUATION

• ASSESS STRESS LEVELS• CASE LOGS ENTRY• EVALUATIONS• PRESENTATIONS• EDUCATIONAL GOAL SETTING• CAREER PLANNING

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

References

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