Douglas Char, MD – Emergency Medicine

• Clinical Competency Committees

We think act like

this group

How the residents

see us

Clinical Competency Committee • ACGME definition force us to broaden evaluation

committee membership, change work process– Expand beyond Program Directors– PD is not chair but member of the committee– Informal review -> formal assignment of milestone levels– CCC meets prior to resident semi-annual performance

evaluation (twice yearly)– Calendar allows submission of milestone data to ACGME

Prior Approach based on 6-CC

Medical Knowledge Below Expectation

Growth Area Meets Expectation Not Applicable

General medical principles (EM1) X

Intellectual curiosity (EM2) seeks new know X

Fund of knowledge (EM2-4) in-train exam X

Teaching – transfer of knowledge (EM3-4) X

Application of know – clinical setting (EM3-4) X

Interpersonal & Communications Skills Below Expectation

Growth Area Meets Expectation Not Applicable

History taking (EM1) – focus, depth X

Team member effectiveness (EM1) X

Communication patients/families (EM1) X

Empathy (EM1) X

Interaction with nurses and ED staff (EM1) X

Clinical Attitude/ Problem solving (EM1) X

Dealing with difficult patients (EM3) X

Effectively delivers difficult info (EM3) X

Team leader effectiveness (EM4) X

CCC Operationalize• 8-12 faculty member (PDs, FDs, core faculty)• It’s tons of work (48 residents takes 5+ hours)– Identify true stakeholders

• Subcomm assigned to review each class the provide overview to full CCC – Class APD and 1-2 other faculty– 12-16 hours; review data, discuss, create report – Subgroup aware of class norms, follows individual

throughout training • CCC ensured program norms between classes

Performance Dashboard • Ideally pushes data to CCC members, residents in

organized one stop shop format• Creating viable dashboard requires lots of IT

muscle (residents faculty looking for fault)• Avoid getting trapped in the process - $$$– Should there be a centralized resource?

Uses technology to accomplish and document safe healthcare delivery

Uses the ElectronicHealth Record (EHR) to order tests, medications and document notes, and respond to alertsReviews medications for patients

Ensures that medical records arecomplete, with attention to preventing confusion and errorEffectively and ethically uses technology for patient care, medical communication and learning

Recognizes the risk ofcomputer shortcuts and reliance upon computer information on accurate patient care and documentation

Uses decision support systems inEHR (as applicable in institution)

Recommends systems re-designfor improved computerized processes

X XComments: DOTs , FU cases (chart review) 8 of 8, faculty global rating

Comments (Core Competency):1. Patient Care: Ahead of your peers, appropriate pace and number of patients seen (2.6/hour, class avg 2.14). Appears comfortable in physician role. Runs EM2 like an attending.2. Medical Knowledge: Above average In-service score 83% (mean 72%), clinical judgment is excellent3. Interpersonal & Communication: great with staff, patients. Need nursing evals.4. Practice-based Learning: Continue self directed learning (follow up cases, procedure log, DOTs) on track. Good job tracking procedures focus on other procedures not just the RRC mandated core.5. Professionalism: conf attendance great 100%, (8 hours of indep study) multiple compliments about bedside manner.6. System-based Practice: Consider working on practice-based and quality improvement initiatives within the ED and hospital.Administrative Issues:360 degree evaluation - 2/2 patient evals, 3/2 nursing evals, peers due in April 2014. 8 of 8 DOTs (3 Hx/Dx, 1 Dispo/dx, 1 professionalism, 1 systems based practice) , Procedure skills ( 8/4 – 2 wound care, 3 airway, 1 pain management, 2 vascular access)Need resuscitation DOTs (one for the semester) 1/1 resusc DOTTransition of care 1/1Follow up cases 8/8 for the year (two months)EOS paper 17, electronic 12-------------------------------------------------------------------------------------------------------------------------------Areas of Strength: XXX has a calm mature demeanor. Applies medical knowledge well, displays outstanding judgment for level of training. She gets along well with patients, staff and peers.

Milestones with Comments

Gathering Data = Hassle Factor

• Mistrust of data by residents, faculty• No good system to collect, lots of staff and

faculty time• Residents see where data being applied

Final Milestone Rating Decisions

Preparing Residents for Milestones• Annual Retreat – we’ve talked NAS for the past 3 years• Self assessment – familiarize res w/ concepts, rankings• They don’t care about it until they get tripped up by

the new rules• Have to make Milestones relevant to them• Include residents in plans & changes, this creates buy

in (even if only in token way)• Make it clear this is moving target, it will change!

Residents more invested than faculty

Milestones likely to be part of their future as physicians

• Maintenance of certification for Board status• Hospital privileging - ongoing CQI initiatives• Performance data have many uses