2011 the international conference on residency …2011 the international conference on residency...

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 gayla.jewell@grmep.org Ashraf Mansour, Program Director ashmans2@aol.com Linda Youmans, GME Advisor linda.youmans@grmep.org

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