Resident Credentialing Project: From Procedures to Portfolios

Ruth H. Nawotniak, MS Program Coordinator - Surgery

University at Buffalo State University of New York

A Retrospective Look at One Answer to the Management of Physician Education

Definition of Terms

• Portfolio - a factual description of strengths and achievements that includes materials which collectively suggest the scope and quality of performance

• Resident Portfolio - a factual description of a resident’s credentials that meet procedural criteria and accreditation standards

Definition of Terms (Con’t)

• Credential - something that gives a title to credit or confidence given

• Procedure - a series of steps followed in a regular definite order

• Procedural Criteria - level of performance required to be eligible for credentials

• Accreditation Standards - level of performance required to meet the goals and objectives of the monitoring agency

Background - ACGME

• Before 2000: focus on the program and its ability to teach residents; adequacy of tools and resources

• Since 2000: focus on the physician-in-training

Background - ACGME (Con’t)

• Change in Focus: How do we know we are training competent physicians?

• Six core competencies

– The need to redefine the educational component of residency training

– The need to redefine the evaluation process– Continue to maintain the appropriate procedural

goals for Board requirements

Background - Education

• Used in Canada (Teaching Dossier) for the past 20 years

• Widely used by the Royal College of Physicians (Physician Training), the concept has long been vetted in the United Kingdom

• Considered by the educational system in the United States some years ago, but rarely used

• Since 1990, a substantial increase in the number of institutions in the United States using teaching portfolios

UB-SUNYDepartment of Surgery Resident Credentialing Project

• Phase 1 - 1997 - 2000

• Phase 2 - 2000 - 2003

• Phase 3 - 2003 and Beyond

Phase 1 - 1997 - 2000

• Developed management techniques for successful completion of clinical assignments

• Reviewed existing credentialing program - procedural activity: ABS Index Case Standard - bedside procedures - Internal Standard

• Established Benchmarks - Inservice Exam and American Board of Surgery standard

Phase 1 - 1997 - 2000Management techniques used for successful completion of clinical assignments• Controlled clinical experiences to manage work hours

regulations

• Monitored procedural activity to insure consistency

• Identification of venues and faculty for content areas

• Development of an ABSITE-based grand rounds experience

• Development of a criterion-based credential for content areas

Phase 2 - 2000 - 2002• Initial development of standards-based portfolio to

include all components of the credentialing program

• Inclusion of documentation of supervision and communication

• Development and use of web-based evaluation system

• Resident assignments modified to meet procedural needs

• Development of a surgical skills laboratory

Phase 2 - 2000 - 2002

• Educational programming expanded - certificate programs in compliance and conscious sedation - requirements of the ACGME competencies project - experiences in palliative care - development of communication skills component using standardized patients

Resident Portfolio

• 6 section folder

• Section 1 - General Information

• Section 2 - Credentialing Documentation

• Section 3 - Department Credentials

• Section 4 - Examination Scores

• Section 5 - Publications / Presentations

• Section 6 - Evaluations

Section 1 - General Information

• Table of Contents• Composite Picture• American Board of Surgery Application• Completion of Training Certificate• Residency Application, Medical School

Diploma, ECFMG Certificate (if applicable)

Section 2 - Credentialing Documentation

• Resident Record

• Case List on Disk

• Case List on Printout

• University Bedside Credentialing Report

• ACLS, ATLS, BLS (as required)

• Rotation Schedule

Section 3 - Department Credentials• Department Certificates of Mastery

• Core Curriculum Master Session Statement of Completion

• Certificates of Completion for Courses/Seminars -Conscious Sedation; Fraud Awareness / Professional Compliance; Quality Assurance/Improvement; Cultural Diversity; Coding/Billing; Risk Management, etc.

Section 4 - Examination Scores

• USMLE Scores

• Inservice Scores

Section 5 - Publications / Presentations / Posters

• PGY5 Grand Rounds Presentation

• PGY3 Grand Rounds Presentation

• Evidence-Based Medicine Conference Presentations

• Presentations / Publications / Posters

Section 6 - Evaluations

• Exit Interview

• Resident File Reviews

• Resident Yearly Self-Assessments

• Chief Resident Peer Evaluation

Phase 2 - 2000 - 2002 Currently Under Consideration for Inclusion

• Initial plans for consideration of specific experiences in the off-line training of specific skills

• Initial consideration of including an educational session on sleep deprivation and its potential effects on residents and patient care

Phase 3 - 2003 and Beyond

• Focus on resident’s successful career development • Focus on insuring success by setting standards and

monitoring progress• Constant process of engineering the program to

meet specific goals• Identification of content area mastery procedures

and development of faculty raters and testing standards

Phase 3 - 2003 and Beyond

• Continued development and use of on-line interactive educational tools

• Continued development of self-evaluation and personal goals setting tools

• Inclusion and development of educational sessions on risk management, NYPORTS reporting, quality assurance and management practices, cultural diversity

Phase 3 - 2003 and Beyond

• Continual development and management of the portfolio for use as a 1) description of resident activity toward successful completion of all resident requirements 2) support for request for hospital privileges

• Formal credentialing package of resident training presented upon completion of the program

Challenges• Changing residents from passive learners to active learners

- The responsibility for learning has shifted from the program to the resident

• Creating more opportunities for residents to choose examples of best personal work for inclusion

• Making more efficient use of time and resources to promote active learning

• Training the trainers to be better teachers and evaluators

• Meeting the increasing requirements of regulatory agencies while continuing to foster a vibrant educational environment