Murat O. Arcasoy, MD, C. William Hargett, MD, Aimee K. Zaas, MDDuke University School of Medicine
Program Size: More than 101 residentsAcademic Setting: University-BasedClinical Setting: Inpatient wards
The General Medicine ward rotation is offered in each year of post-graduate training (Duke Internal Medicine Residency Program), providing an ideal vantage point for graduated performance assessment. Our approach focused on integrating ABIM/ACGME milestones into both our curriculum goals and objectives for this rotation and a new milestone-based evaluation tool. Each curricular and reporting milestone was discussed by our core educator panel and integrated into our curriculum in accordance with our programmatic and institutional priorities. Using our revised curriculum goals and objectives for each year of training, a comprehensive, summative evaluation form was generated based on graduated performance assessment during training, encompassing a total of 21 sub-competencies categorized according to one of six ACGME competency domains. Behavioral anchors (narratives) were articulated for each sub-competency describing the observable skills for each performance level and for each year of training. The focus was on the use of positive language in the narratives rather than emphasize the deficient aspects of performance. A five-tier evaluation scale was utilized, with the steepest earning curve anticipated during intern year. Four intermediate levels were incorporated into the scale for use in circumstances where the learner displayed features of two different levels of performance. Each skill was subsequently mapped to reporting milestones and 84 of the 142 curricular milestones. To generate a practical evaluation form, the views of our educators were assessed using Qsort methodology to select the most important elements of clinical competence. A video was created for faculty education on how to utilize the evaluation tool.
Download the Tool
We developed a video describing the milestones and the evaluation process that was embedded into our evaluation software for use as ‘just-in-time’ faculty development. We were able to track which faculty members viewed or chose not to view the video.
The milestones achieved can be viewed for an individual rotation as well as in aggregate for discussion during competency committee meeting. The progress over time as milestones are achieved can be displayed and reviewed to determine whether interns, junior or senior residents are on track.
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