Altru Family Medicine Residency

EVALUATION

Overview
The Family Medicine Residency Program is committed to early, continuing, progressive evaluation of resident competencies using a framework of developmental steps that relies upon clinical faculty to collect data, supplemented by academic faculty members' own observations, while charging academic faculty with the responsibility of evaluation through the Clinical Competency Committee.

The milestone evaluation is explicit and understanding the developmental stages is stressed during residents' orientation, and is also available on-line at the residency program's website and at E-value.net.

Methodology
The program provides objective assessments of competence in patient care and procedural skills, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice based on the "milestones" through multiple forms of evaluation. On-line data collection instruments further map the evaluations to the milestones to simplify clinical faculty data collection and improve consistency. These completed evaluations are available online to residents. The use allows each resident to measure personal strengths and weaknesses together with indicating a path toward remediation or advancement. In addition, assessment includes direct observation of resident patient encounters, six observations in PGY I, four in PGY II, and three in PGY III.

Process
An early evaluation of all incoming residents is carried out to assess performance within the six-core competency areas. This evaluation involves core faculty, select behavioral science faculty and nursing, together with self-evaluation by the resident.  A simulated patient may be used, using a presentation of sufficient complexity to permit recognition of more advanced skills, and using the observation capabilities of the simulation laboratory of the School of Medicine and Health Sciences. Upon successful completion of orientation, the resident will progress into the core curriculum.  Evaluation forms assessing the six core competencies as well as skill sets identified on the milestones will be completed by appropriate personnel (i.e. physicians, nursing staff, etc.) at the completion of each scheduled rotation.  Separately, the educational experience is evaluated by the resident.  Resident will be further evaluated by peers, residency clinic nursing staff, patients, and additional members of the health care team throughout all years of training.  Additionally, self-evaluation is encouraged as a continuous process throughout training to foster the development of skills necessary to become a family physician. This form of evaluation requires maturation throughout training and, while felt to be a daily exercise, will also be formally completed at least twice yearly at required resident evaluation meetings with a core faculty member. All evaluations are maintained within the resident’s written file as well as through an online secure database that is accessible for review.  Evaluations are reviewed by the Clinical Competency Committee to document progressive resident performance through the utilization of family medicine specific milestones.  Evaluations and milestone assessment will be reviewed with the resident at least twice yearly at required resident evaluation meetings.  Resident evaluation meeting schedule is as follows: PGY I - every three months, PGY II and PGY III - every six months, and prior remediation - every three months.

Performance Improvement
Formative evaluations, sentinel or “near-miss” event, concern from teaching faculty, peers, nursing staff or patients, regarding resident’s performance, and/or inadequate performance in general measures (In-training Exam, Boards) will be used to identify possible resident deficiency in the core competencies. If a concern is identified, the resident will be referred to the Resident Progress Committee (RPC).  If a deficiency is noted in one of the competency areas, it will be stated explicitly and focused correction implemented.  An academic action plan will be initiated and reviewed until appropriate advancement in the core competencies is obtained.  A written record of the academic action plan will be completed and signed by the RPC chair and resident.  An initial period of one to three months for correction of deficiencies, at the discretion of the RPC, will be allotted.

At the discretion of the faculty, and provided that progress has been demonstrated, one further period of remediation not to exceed three months may be provided.  Failure to reach explicit goals at that stage is considered academic failure and dismissal proceedings may be initiated.

On any occasion when action that could affect a resident's academic standing is contemplated, discussed, or implemented, an academic action plan will be placed in the resident's academic record.  Further, such discussion will be noted in the minutes of the faculty meeting and that minute will be reviewed and approved or amended by the faculty no later than the following faculty meeting.

A blank copy of the academic action plan is available for review at gfresidency.com as well as in this document following description of residency requirements.

Professionalism
Residents are understandably focused on content and breaches of professionalism may not be recognized.  However, professional breaches may escalate.  Consequently, questionable breaches of professionalism are reviewed by faculty on a monthly basis. Such breaches may include, but are not limited to:

  • Unpunctuality - this is inefficient, disruptive to clinical services, and discourteous to patients and clinical faculty who may have made special preparation to teach;
  • Failure to report duty hours in a timely fashion;
  • Failure to complete clinical records, including progress notes and discharge summaries, in a timely fashion;
  • Unusual patterns of sick leave; Repeated rescheduling of clinic appointments.

If a suspected lapse of professionalism occurs, it will be referred to the RPC.

Program Director's Final Evaluation

Towards the completion of training, the resident will meet with the program director for a summative evaluation.  It is a review of the resident's performance throughout residency.  Family medicine specific milestones will be used as one of the tools to ensure that the resident is able to practice core professional activities without supervision upon completion of the program.  This written evaluation will be part of the resident's permanent record, maintained by Altru Health System, and accessible for review by the resident.