End of Life Care


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  • End of Life Care

    1. 1. Resident to Resident: Using an educational framework to develop an ACGME competency based evaluation tool . Kimberly Painter, MD, MPH, Nicole, Kirchen, MD, MPH, Tara B. Stein, MD, Pablo Joo, MD, Edgar Figueroa, MD, MPH Carma Bylund, PhD New York-Presbyterian Family Medicine Program Columbia University’s Center for Family Medicine Society of Teachers in Family Medicine April 27, 2006
    2. 2. Context <ul><li>Shift to competency-based evaluation </li></ul><ul><li>Need to develop an evaluation tool for residents to evaluate other residents. </li></ul><ul><li>Review of the Literature: </li></ul><ul><ul><li>Few Tools </li></ul></ul><ul><ul><li>Not Valid (created by attendings in other residencies and not validated) </li></ul></ul><ul><ul><li>No Educational Framework Used </li></ul></ul><ul><ul><li>Not based on the ACGME Competencies </li></ul></ul>
    3. 3. Setting <ul><li>6-6-6 Inner city urban residency program </li></ul><ul><li>Dedicated inpatient Family Medicine Service </li></ul><ul><ul><li>4 residents on service every 4 weeks </li></ul></ul><ul><ul><li>Main venue where residents work with each other </li></ul></ul>
    4. 4. The Process <ul><li>Preparation (3 months) </li></ul><ul><li>Nominal Groups (6 months) </li></ul><ul><li>Tool Development (3 months) </li></ul><ul><ul><li>7 item instrument </li></ul></ul><ul><ul><li>6 items use the formative clinical competency scale </li></ul></ul><ul><ul><ul><li>Not evaluated added as selection </li></ul></ul></ul><ul><ul><li>1 open-ended section for comments </li></ul></ul><ul><li>Testing – currently ongoing </li></ul>
    5. 5. Stages of Clinical Competency 1 <ul><li>Novice </li></ul><ul><ul><li>Rule governed behavior </li></ul></ul><ul><li>Advanced Beginner </li></ul><ul><ul><li>Principles begin to formulate </li></ul></ul><ul><li>Competent </li></ul><ul><ul><li>Actions in terms of long-range goals or plans </li></ul></ul><ul><li>Proficient </li></ul><ul><ul><li>Increased speed and flexibility </li></ul></ul><ul><ul><li>Use maxims to appreciate the importance of nuances in a situation </li></ul></ul><ul><li>Expert </li></ul><ul><ul><li>Intuitive grasp of situations </li></ul></ul><ul><ul><li>Applies highly skilled analytic to unfamiliar situations. </li></ul></ul>1. Brenner, P. (1984). From Novice to Expert. Menlo Park: Addison-Wesley.
    6. 6. Nominal Group Technique <ul><li>Nominal Groups (Delbecq, 1975) </li></ul><ul><ul><li>efficient, structured process for problem solving and idea generation </li></ul></ul><ul><ul><li>serves to clarify, achieve consensus, and set priorities </li></ul></ul><ul><ul><li>all viewpoints are presented and all participants are involved equally </li></ul></ul><ul><li>Our small group brainstormed criteria to use for our tool based on ACGME competencies </li></ul><ul><li>The criteria were presented to groups of R1s, R2s, and R3s who then voted on the criteria's feasibility and importance in the tool </li></ul><ul><li>The small group then summed up the votes to determine the 6 most feasible and important criteria to be used in the tool </li></ul><ul><li>Delbecq, A.L., Van de Ven, A., & Gustafson, D.H. (1975) Group Techniques for Program Planning . Glenview, IL: Scott, Foresman. </li></ul>
    7. 7. Example <ul><li>ICS : Works effectively with others as member or leader of the team </li></ul><ul><ul><ul><li>1. Novice </li></ul></ul></ul><ul><ul><ul><ul><li>Attempts to complete assigned personal responsibilities. </li></ul></ul></ul></ul><ul><ul><ul><li>2. Advanced Beginner </li></ul></ul></ul><ul><ul><ul><ul><li>Effectively completes assigned personal responsibilities. </li></ul></ul></ul></ul><ul><ul><ul><li>3. Competent </li></ul></ul></ul><ul><ul><ul><ul><li>Assists other team members when requested. </li></ul></ul></ul></ul><ul><ul><ul><li>4. Proficient </li></ul></ul></ul><ul><ul><ul><ul><li>Proactively provides assistance to team members. </li></ul></ul></ul></ul><ul><ul><ul><li>5. Expert Competency </li></ul></ul></ul><ul><ul><ul><ul><li>Assesses team needs and facilitates team’s ability to work together effectively. </li></ul></ul></ul></ul><ul><ul><ul><li>Not Evaluated </li></ul></ul></ul>
    8. 8. Reliability Testing <ul><li>Tool completed twice (test-retest) </li></ul><ul><ul><li>At end of rotation </li></ul></ul><ul><ul><li>Two weeks after rotation </li></ul></ul><ul><li>Challenges to completion </li></ul><ul><ul><li>Resident time </li></ul></ul><ul><ul><li>Resident understanding of need </li></ul></ul><ul><li>Less difficult to overcome due to inclusive process </li></ul>
    9. 9. Preliminary Data <ul><li>Response rates </li></ul><ul><ul><li>83/128 (65%), representing 16/18 residents on initial test </li></ul></ul><ul><ul><li>51/128 (48%) on retest </li></ul></ul><ul><ul><li>50/83 (60%) with comments on initial test </li></ul></ul><ul><li>Means on initial test </li></ul><ul><ul><li>PGY-1=3.0 </li></ul></ul><ul><ul><li>PGY-2=3.7 </li></ul></ul><ul><ul><li>PGY-3=4.6 </li></ul></ul><ul><li>No significant difference between scores on initial test versus repeat test. </li></ul>
    10. 10. Future Directions <ul><li>Dissemination of data to residents </li></ul><ul><li>Identified limitations in tool </li></ul><ul><ul><li>Now being revised </li></ul></ul><ul><li>Integrating into formal resident evaluation process </li></ul>
    11. 11. Contact Information <ul><li>Pablo Joo, MD </li></ul><ul><li>Columbia University Center for Family Medicine </li></ul><ul><li>[email_address] </li></ul><ul><li>212-544-1880 </li></ul>