Sample Documents and Forms
ACGME Competency
Time-Line for Development of Core Competencies (Word document) Provided by Joel Spear,
MD at St. Joseph Hospital
Promotion Criteria based on General Competencies (Excel document) The
Internal Medicine Residency Program at Christiana Care has developed this competency based grid for promotion of
residents and has been using it for the past two years. It has been well received and will be submitted for a poster
publication in the next month. Developed by Drs. Virginia Collier, Brian Aboff, Neil Farber and Allen Friedland.
Feedback is greatly appreciated.
Making the New ACGME Competencies Work In and For Your Residency Program-
Workshop presentation by Donald Bordley, MD
at the 2002 Spring Plenary
New! University of Rochester Internal Medicine Residency Program Competency-Based Curriculum--Created by Donald R. Bordley, MD, these curricular documents are organized around the ACGME Core Competencies.
Results of the ACGME Competencies Workshop- presentation of the comments
and suggestions from the workshop participants
Greenwich Hospital Competency Plan- a system to help track the
resident evaluation process.
Portfolio for Internal Medicine Residency Programs- Evaluating Your
Residents: New Competencies, New Forms
Mentoring
Mentoring program description at Hurley Medical Center/Michigan State University
Mentoring program contract for Hurley Medical Center/Michigan State University
Mentoring program evaluation form for Hurley Medical Center/Michigan State University
Credentialing
Summative credentialling forms provided by Virginia Collier, MD
Surveys, Questionnaires, and Forms
Graduate Survey Provided by Virginia Collier, MD
Resident Satisfaction Questionnaire (Excel document) and
Questionnaire scales Provided by Charles Seelig, MD
A short (33 item) resident questionnaire (see citations below) that is used anonymously on a twice yearly basis to asses Workload
Satisfaction, Emotional Distress and Learning Environment Satisfaction. The Word attachment provides the three factor
analysis derived scales for use with the questionnaire: ED = emotional distress scale - validated against the profile of mood states
instrument WS = workload satisfaction scale - validated with a separate workload questionnaire completed by chief residents
LES = Learning Environment Satisfaction scale - not specifically validated but clearly distinct from the other two scales.
Seelig, CB: Changes in Residents' Attitudes in Response to Residency Program Modifications: A Prospective Study.
South Med J 1992;85:972-975
Seelig CB: Quantitating Qualitative Issues in Residency Training: Development and Testing of a Program Evaluation Questionnaire.
J Gen Intern Med 1993;8:610-613
Seelig CB, DuPre CT and Adelman HM: Development and Validation of a Scaled Residency Program Evaluation Questionnaire.
South Med J 1995;88:745-750
Sample Letter of Agreement for Away Rotations Provided by Virginia U. Collier,
MD
Resident request to Moonlight form Provided by Wilhelmine
Wiese, MD
Chart Audit Collation- a collection of chart audit forms
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