Background:
With the roll out of ACGME outcomes-based milestones as a framework for determining resident and fellow performance within the six ACGME Core Competencies in 2013, residency training programs have been tasked to directly observe and evaluate learner progress. Competencies such as systems based practice, interpersonal and communication skills, and professionalism need to be directly observed. Patient- and family-centered rounding at the bedside presents an ideal opportunity to observe and provide formative feedback to resident and student trainees, including how the trainee works within the inter-professional team (systems based practice), shared decision making and goal-setting with patients and families, and adjusting treatment plans to meet the needs of the individual patient (communication skills and professionalism).
Purpose:
We have created an evaluative tool used in real-time by the attending physician to facilitate resident evaluation of the core competencies and sub-competencies frequently utilized during patient-and-family-centered rounding. This tool is additionally linked to family medicine milestones for progressively demonstrating progress over the course of training.
Description:
The Patient-and-Family Centered Rounding Direct Observation Form is an online tool used at the bedside. It contains six categories and can be completed in less than three minutes. The left hand column of the form contains a check list of activities that may be observed during rounds. This is completed by the faculty observer. The opposite column are some suggested behaviors and phrases to assist the trainee in cementing frequently used scripts to achieve mastery in each milestone. Upon completion the form is electronically delivered to the resident and his/her advisor. Faculty are encouraged to debrief with the resident face-to-face as well. Since the form is linked to milestones (PC-2, SBP 1, SBP-4, Prof-3, C1-3 for family medicine), progress of individual residents and for the program as a whole are tracked and monitored over time. Tool validation has been completed, and pilot testing is currently underway. In January 2016 the tool will be utilized for all residents on inpatient service. While the purpose of this presentation is to present our validated tool, we will additionally include data on tool utilization and milestone scores.
Conclusions:
To accurately assess resident competence and advancement along the milestones, educators need to spend more time directly observing resident interactions with patients and members of the inter-professional team. Our direct observation tool provides a way to give behavior-specific formative feedback to learners as well as tracking milestone progress over time. In the future we plan to gather learner reaction regarding the feedback and their ability to incorporate feedback into daily practice.