2011 the international conference on residency …2011 the international conference on residency...
TRANSCRIPT
2011 The International Conference on
Residency Education La Conference Internationale sur la
Formation de Residents Royal College of Physicians and
Surgeons of Canada College Royale de Medecins et
Chrurgiens du Canada
LEVELED & THREADED GRMEP CURRICULUM
FRAMEWORK -
Gayla Jewell, PhD, RNC, NP, Residency Programs Educator
Ashraf Mansour, MD Program Director, Vascular Surgery
Linda Youmans, MA, LPC Graduate Medical Education Advisor
Neither Gayla Jewell, Ashraf Mansour, nor Linda Youmans have any relevant financial relationships with commercial interests that pertain to the content of this presentation
Create an educationally sound curriculum framework
Principles for framework construction
Prepare/Engage Faculty
Evaluate/Advance Residents
ACGME CanMEDS Medical Knowledge Medical Expert Patient Care Health Advocate Interpersonal & Communication Skills
Communicator; Collaborator
Practice-Based Learning
Scholar
Professionalism Professional Systems-Based Practice
Manager
We believe we are already doing a good job… So … Why Change?
Lack of connection between written G&O and reality causes
Disconnect for faculty and residents
Goals & Objectives
• dwell on the shelf • look good … but, are they relevant and useful?
Seems good enough, but ….
• In-Training exam scores low average
• Tech skills behind
• Some complaints from attendings/staff
• M&M presentations lack depth
• Covers main points with families, does not check for understanding
• Could be more motivated
• Participates in a QI project
How do we know what to do about Pat?
Poorly articulated, unleveled G&O
provide limited grounding for teaching, evaluation,
and advancement decisions
Curriculum Framework as Guide to Educational Mindset
End of Program Goal
Competence to be achieved by graduation
End of Program Goal
PG Year Goal
Minimal level of competence to be achieved by year end
End of Program Goal \
PG Year Goal
PG Year Guiding Objective
Used to generate specific rotation objectives for PG Year
End of Program Goal
PG Year Goal
PG Year Guiding Objective
Rotation Objectives
Gen Surg Endo Vasc Surg Surg Onc Behavioral expectations for each clinical experience
PGY 3 Goal
Guiding Objective
Rotation Objective
Milestone Marker
Assess-ment Method
Facilitates collaborative & resource-based inter-professional teamwork in patient-centered, cost-effective care
Works effectively in an inter-professional team and health care delivery system
Negotiates pt-centered care with multiple care provider team.
36 mo Monthly evaluation; 360 evaluation
Improves health care delivery: Recognizes system error and advocates for system improvement
Engages in system-level quality improvement intervention
36 mo 360 evaluation
Cost-effective care: Identifies forces that impact cost
Incorporates cost-awareness principles into complex care scenarios
36 mo Monthly evaluation
Distinction between Goals & Objectives Verb Leveling
Content Threading
GOALS OBJECTIVES Broadly stated Concrete, Specific General intentions Behaviorally stated
Measureable
PGY 5 Goal Facilitates…
PGY 4 Goal Role Models…
PGY 3 Goal Assesses…
PGY 2 Goal Investigates… PGY 1 Goal Identifies…
Systems-Based Practice/Manager Attainment of each PGY goal is dependent on realization of previous PGY goals
PGY GOALS By the end of PGY 1
the Resident:
By the end of PGY 2
the Resident:
By the end of PGY 3
the Resident:
END OF PROGRAM GOAL
SYSTEMS-BASED PRACTICE
Identifies issues related to error and cost Identifies need for multi-disciplinary and inter-professional collaboration in the delivery of health care
Systems-Based Practice/Manager Attainment of each PGY goal is dependent on realization of previous PGY goals
PGY GOALS By the end of PGY 1
the Resident:
By the end of PGY 2
the Resident:
By the end of PGY 3
the Resident:
END OF PROGRAM GOAL
SYSTEMS-BASED PRACTICE
Identifies issues related to error and cost Identifies need for multi-disciplinary and inter-professional collaboration in the delivery of health care
Role models cost awareness, risk-benefit analysis, and a systems approach in the provision of team based care
Systems-Based Practice/Manager Attainment of each PGY goal is dependent on realization of previous PGY goals
PGY GOALS By the end of PGY 1
the Resident:
By the end of PGY 2
the Resident:
By the end of PGY 3
the Resident:
END OF PROGRAM GOAL
SYSTEMS-BASED PRACTICE
Identifies issues related to error and cost Identifies need for multi-disciplinary and inter-professional collaboration in the delivery of health care
Role models cost awareness, risk-benefit analysis, and a systems approach in the provision of team based care
Facilitates collaborative and resource based inter-professional team work in the delivery of patient centered, cost effective care
Systems-Based Practice/Manager Attainment of each PGY goal is dependent on realization of previous PGY goals
PGY GOALS By the end of PGY 1
the Resident:
By the end of PGY 2
the Resident:
By the end of PGY 3
the Resident:
END OF PROGRAM GOAL
SYSTEMS-BASED PRACTICE
Identifies issues related to error and cost Identifies need for multi-disciplinary and inter-professional collaboration in the delivery of health care
Role models cost awareness, risk-benefit analysis, and a systems approach in the provision of team based care
Facilitates collaborative and resource based inter-professional team work in the delivery of patient centered, cost effective care
Appraises and collaboratively utilizes health care system resources in the pursuit of optimal patient care
Framework Prep
Faculty Development
Resident Evaluation
Create G&O template Plug in existing objectives Review with faculty/residents Identify & fill in gaps
G&O cannot be written by PD, PC, or Educator Must be based on realities of clinical rotations & assignments Must be co-composed by faculty & based on experience
3-hour Session Orient, Hone, & Approve
1-hour Sessions Verbal Feedback Written Feedback Working with Challenging Residents
Teach to PGY G&O Diagnose and guide performance Discuss at resident review sessions
Common language Consistent expectations Integrated Supervision requirements & Milestones Evaluation and advancement criteria Embedded Faculty Development
Gayla Jewell, Educator [email protected] Ashraf Mansour, Program Director [email protected] Linda Youmans, GME Advisor [email protected]
Systems-Based Practice/Manager Attainment of each PGY goal is dependent on realization of previous PGY goals
By the end of PGY 1 the Resident:
By the end of PGY 2 the Resident:
By the end of PGY 3 the Resident:
By the end of PGY 4 the Resident:
By the end of PGY 5 the Resident:
The Vascular Surgery
Residency Graduate:
Identifies impact of key components of the health care system on patient care
Investigates benefits and challenges of interprofess-ionally based patient care
Assesses errors and patient outcomes from a systems perspective
Role models cost awareness, risk-benefit analysis, and a systems approach in the provision of care
Facilitates collaborative and resource-based interprofess-ional team work in the provision of care
Appraises and collabora-tively utilizes health care system resources the pursuit of optimal patient care
PGY 1 Goal Guiding Objective Rotation Objective
Identifies impact of key components of the health care system on patient care
Collaboration: Maintains a flexible and adaptable attitude when practicing in various clinical settings
1. Participates in conferences and follows assignments to various out-patient facilities
2. Participates in vascular quality assurance meetings
Cost: Identifies how issues of reimbursement impact patient care
1. Becomes familiar with principles of coding and reimbursement, costs of medications and surgical technology
2. Discusses factors that impact choosing the most cost-effective tests and procedures
Quality: Identifies knowledge base and unique skill sets of health care team members
1. Participates in morbidity & mortality and surgical quality assurance meetings; becomes familiar with hospital QI to reduce infections
2. With faculty and other residents, participates in collecting and analyzing quality data from NSQIP; participates in forming an action plan to improve patient outcomes
PGY 3 Goal Guiding Objective Rotation Objective
Assesses errors and patient outcomes from a system perspective
Collaboration: Analyzes the impact of systems requirements on patient outcomes
1. Identifies system failures and causal relationship affecting patient care
2. Discusses how 3rd party reim-bursement issues impact care
Cost: Performs a cost-benefit analysis from a population perspective
1. Discusses appreciation of financial cost of care in in-patient and out-patient settings
2. Understands implications of ordering imaging tests
3. Analyzed individual treatment decisions using population-based data
Quality: Distinguishes differences between individual practice error and system error and impact on patient care
1. Participates in critical analysis of system failures, offers workable solutions
2. Participates in QI committees 3. Facilitates discussion with multi-
disciplinary/inter-professional group issues about patient morbidity or mortality
PGY 5 Goal Guiding Objective Rotation Objective Facilitates collaborative and resource-based inter-professional team work
Collaboration: Demonstrates participative leadership in the provision of care
1. Assumes leadership of multi-disciplinary and interprofessional team
2. Participates in teaching students and residents
Cost: Demonstrates with others that carefully orchestrated, team-based care is effective use of resources
1. Demonstrates understanding of rational and judicious use of resources, including medical equipment, therapeutic drugs, imaging studies
Quality Advocates for quality care in a variety of venues
1. Demonstrates leadership and initiative in surgical quality conferences, professional standards committee