Skills Assessment. Monthly Neonatologist evaluation of the fellow s performance

Transcription

1 Patient Care Interviews patients The Y1 will be able to verbally obtain an accurate history on new NICU: Observation of Neonatologist evaluating a Goal: Practice patient care accurately and effectively admissions during regular hours and calls under the direct supervision patient during daily ward rounds that: of a Neonatologist. 1. Advocates for the whole patient 2. Is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health Performs routine physical exams effectively The Y1 will be able to conduct a thorough physical examination on new admissions during regular hours and calls under the direct supervision of a Neonatologist. NICU: Performing Physical Examination on a new admission and during ward rounds. Monthly Neonatologist evaluation of the fellow s performance Evaluation of Fellow s presentations w/neonatologist during new admissions NICU: Neonatologist evaluation of fellow s physical exam skills during new admissions Performs medical procedures effectively Makes informed diagnostic decisions The Y1 will be able to describe the indications, risks, procedural steps, and complications of a list of specific procedures. They will be able to demonstrate adequate technical skills in the performance of the procedures under direct supervision by a Neonatologist. The procedures include ECMO, oxygen administration by hood, CPAP or assisted ventilation, tracheal intubation, administration of surfactant; positive pressure ventilation and basic ventilator management, phototherapy, umbilical arterial and venous catheterization, central hyperalimentation and parenteral nutrition, enteral nutrition, analgesic, sedatives and paralytics, blood and blood product transfusions including exchange transfusion, vasoactive drugs (pressors and inotropes), judicious use of antibiotics, administration of medications specific to needs of newborn (Vitamin K), arterial puncture, venous access by peripheral vein, umbilical artery and vein catheterization, chest tube placement, paracentesis The Y1 will be able to utilize information obtained from the interview and physical examination to determine relevant diagnostic tests in the course of the evaluation and treatment of the patients Page 1 of 9 NICU: Skills Laboratory Pediatric Advanced Life Support Neonatal Resuscitation Course at the instructor level NICU: ECMO training and subsequent direct ECMO patient care under the direct supervision of the Neonatologist. evaluation of Fellow s NICU rotation NICU: Structured Review of Procedure Logs for content, quantity, and quality of performance. NICU: Direct Neonatologist s observations and formative evaluation Documentation of competency at conclusion of ECMO workshops NICU: Observation of Neonatologist during ward rounds as they identify relevant diagnostic tests. Clinical Case Conferences:

2 Medical Literature Search: Identify the evidence for the utility of specific diagnostic tests in the evaluation of specific clinical problems. Medical Knowledge Goal: Understand the scope of established and evolving biomedical, clinical, Epidemiological, and socialbehavior knowledge needed in neonatology; demonstrate the ability to acquire, critically interpret, and apply this knowledge in patient care. Develops and carries out patient management plans Thinks in an investigatory and analytical way The Y1 will be able to develop a plan of care on new admissions during regular hours and calls with substantial input from a Neonatologist. The Y1 will be able to conduct searches of and analyze the evidence within the medical literature. The Y1 will be able to list evidence-based methods available for the evaluation of medical information. The Y1 will be able to analyze their patient s presenting clinical problem and is able to investigate the differential of the case to develop a treatment plan based on the best available evidence. NICU: Observation during ward rounds Clinical Case Conference: Recognize appropriate patient management plans during presentation of clinical cases. NICU: Participation in Fellow-Neonatologists meetings in which Neonatologists, as a group, share their individual perspectives and experiences with the care of unique clinical conditions. Journal Club: Under the supervision of a Neonatologist, the Fellow will critically analyze a research report and present their findings to faculty and. Core Curriculum: Lecture on Evidence-Based Medicine NICU: Direct Neonatologist s observations and formative evaluation Clinical Case Conferences evaluation of Fellow s NICU rotation Journal Club: Evaluation by attendees Clinical Case Conferences: Has knowledge of and applies basic sciences The Y1 will be able to describe the pathophysiology of diseases affecting the fetus and newborn. Faculty and (F & F) Conference: Participate in F&F seminars where these topics are discussed. F&F: Evaluation of Fellow s presentation by attendees Has knowledge of and applies clinical knowledge The Y1 will be able to describe the clinical characteristics of diseases affecting the fetus and newborn and they are able to use this clinical Page 2 of 9 Clinical Case Conference: Participate in Clinical Case conference where these topics are discussed.

3 knowledge to effectively care for their patients. Clinical Case Conferences: Medical Ethics. Understand basic principles in bioethics and identify neonatalperinatal issues that frequently lead to ethical dilemmas The Y1 will be able to define key principles used in ethical decisionmaking The Y1 will be able to identify issues in the care of the neonate that frequently lead to ethical conflicts The Y1 will be able to identify situations when the Fellow s management goals for a patient are in conflict with the those of the family F&F: Didactic: Ethics seminars Core Curriculum: Lecture on Ethics Comprehensive rounds: Clinical discussion of a case referred to the CR because of ethical/moral distress of care providers NICU: Faculty-Fellow and family care meetings to discuss ethical concerns Pre-post tests and discussions : Faculty/family/social service evaluation of the Fellow Practice-Based Learning & Improvement Goal: Demonstrate knowledge, skills and attitudes needed for continuous self-assessment, using scientific methods and evidence to investigate, evaluate, and improve their own medical practice. Identifies strengths, deficiencies, and limitations in their own knowledge and expertise The Y1 will be able to present and evaluate their own strengths and weaknesses with respect to the six core competencies. Direct observation of conflict mediation by the Neonatologist. NICU: Monthly Fellow-Neonatologist pre-; mid-; and post- rotation meetings. Biannual self-evaluations: perform a structured self-evaluation exercise in preparation for biannual review. Program director s review of Fellow self-evaluation during biannual review Sets learning and improvement goals and identify and performs appropriate learning activities to achieve them The Y1 will be able to enumerate specific areas in need of improvement and identifies tools for making improvement. NICU: Monthly Fellow-Neonatologist pre-; mid-; and post- rotation meetings. Program: Biannual evaluations including direct feedback from Program Director Program director s review of Fellow during biannual review. Page 3 of 9

4 Morbidity and Mortality Conference (M&M): Fellow observes neonatology faculty defining their own deficiencies and limits during a morbidity and mortality conference. Systematically analyses The Y1 will be able to recognize systematic issues and describes M&M: Fellow will collaborate with a Neonatologist to practice using quality changes to improve outcomes. determine systemic problems that contribute to improvement methods and morbidity and mortality. implements changes with the goal of practice NICU: Participation in on-going NICU Quality improvement Improvement projects M&M: Feedback from neonatology faculty during M&M conference M&M: Active feedback from neonatology faculty during M&M conference. M&M: Direct feedback from collaborating Neonatologist during preparation for M&M conference. Incorporates formative evaluation feedback into daily practice The Y1 will be able to discuss with the Neonatologist how previous feedback has influenced their practice. NICU: Monthly Fellow-Neonatologist pre-; mid-; and post- rotation meetings. Program: Biannual evaluations Faculty Evaluation of Fellow s participation in on-going QI projects Program director s review of Fellow during biannual review. Locates, appraises, and assimilates evidence from scientific studies related to their patients health problems Uses information technology to optimize learning The Y1 will be able to access and correctly interpret scientific evidence from Internet sources and utilize this evidence to discuss the treatment plans of their patients during post-round discussion of complex/interesting patients in the NICU under the direct supervision of a Neonatologist. The Y1 will be able to perform an appropriately focused literature search on medical topics relevant to their patient s medical problems in the NICU with assistance from a librarian. The Y1 is able to enter procedures into the computerized procedure log and maintain this log with current, accurate information. Core Curriculum: Lectures on Effective Teaching and Interpreting the Medical Literature NICU: Journal Club; didactics; critically appraised topics. Core Curriculum: Training on Library Usage NICU: Journal Club; didactics; critically appraised topics. Critically appraised topics: NICU: Structured Review of Procedure Logs for content, quantity, and quality of performance. Journal Club; didactics; critically appraised topics: Attendees evaluations of Fellow presentation Page 4 of 9

5 Participates in the education The Y1 will be able to present and discuss the evidence-based NICU: Case presentation at Clinical Case of patients, families, diagnosis and management of a case they have managed in Conferences. students, residents, and conjunction with a Neonatologist at a weekly conference attended by other health professionals other health professionals. NICU: Resident lecture series NICU: Participation in bedside conversations with families Clinical Case Conference: Resident lecture series: evaluation of by residents Interpersonal & Communication Skills Goal: Demonstrate interpersonal and communications skills that result in information exchange and partnering with professional associates, patients, and their families Communicates effectively with patients, families, and the public across a broad range of SES and cultural backgrounds Communicates effectively with physicians, other health professionals and health related agencies The Y1 will be able to organize clinical information and generate an oral report with respect to a broad range of SES patients, parents and public. The Y1 will be able to relate relevant clinical information using the SBAR. The Y1 will be able to relate a patient s clinical course and care plans to the patient s primary care physician. NICU: Observe Neonatologists as they counsel families of NICU infants during rounds and family meetings Core Curriculum: Lecture on Communication NICU: Observation of Neonatologist communication using the SBAR format. NICU: Observation of Neonatologist as they update primary care physicians.. Structured Assessment of Fellow s medical documentation Core Curriculum: Lecture on Communication NICU: Fellow s update of referring physicians NICU: Fellow evaluation of faculty Works effectively as a member or leader of a health care team or other The Y1 will be able to organize the care provided by the transport team to patients in outlying community hospitals. Page 5 of 9 NICU: Observe Neonatologist and participate in discussions on providing medical control of transport team. NICU: Feedback from community referring physician

6 professional group The Y1 will be able to formulate a plan of care in collaboration with other members of the medical team during night calls. NICU: Observation of the Neonatologist as they lead health care team during rounds. NICU: Conduct of medical control between 2 PM and 5 PM and during night calls. Acts in consultative role to other physicians and health professionals, as appropriate The Y1 will be able to evaluate and determine appropriate plan of care for sick infants on whom consultation is requested by the pediatric, surgical or general pediatric services. NICU: Lead the on-call team during night rounds NICU: Observe Neonatologist and participate in the evaluation of sick infants referred by other services (pediatric, surgical or general pediatric). Professionalism Goal: Demonstrate a commitment to carrying out professional responsibilities, including adherence to ethical Principles and sensitivity to diversity. Maintains comprehensive, timely, and legible medical records Is compassionate, respectful, and shows integrity towards others Is responsive to patient needs that supersedes selfinterest The Y1 will be able to write pertinent admission and incidental notes on patients in the NICU. The Y1 will be able to offer emotional, social, and culturally sensitive verbal support to families of NICU infants with prompting from a Neonatologist. The Y1 will be able to predict patient s needs and choose appropriate responses without regard to personal interests and provide selfless interventions The Y1 will be able to identify conflicts between professional and personal responsibilities, and develop a plan for self-improvement NICU: Incorporate feedback from Neonatologist s review of Fellow s notes. NICU: Observe Neonatologists as they counsel families of NICU infants Core Curriculum: Lecture on Communication NICU: Demonstrates to Neonatologist and social worker their understanding of patients needs. Comprehensive Care Rounds: Participates in discussions of selected patients with complex medical and psychosocial circumstances. evaluation of Family Care Conference Family Care Conference: Directly engages family in identifying and addressing patients needs. Page 6 of 9 NICU: Evaluation of Fellow by social work/chaplaincy

7 Is respectful of patient The Y1 will be able to demonstrate discretion with regard to place and Core Curriculum: Lecture on Professionalism privacy and autonomy time when discussing patient s medical and / or psychosocial Is accountable to patients, society, and the medical profession circumstances. The Y1 will be able to explain their professional responsibilities to patients, society and the medical team. The Y1 will maintain certifications of competency (NRP, medical licensure, DEA license) NICU: Work with Neonatologist to educate families about treatment options/complications and medical errors. NICU: Correspondence with community physicians NICU: Feedback from community referring physician Is sensitive and responsive to gender, age, culture, race, religious, disability, and sexual orientation issues The Y1 will comply with duty hour regulations and ensure that changes to schedule do not conflict with regulations The Y1 will notify program director of absences and ensure appropriate coverage where necessary The Y1 will maintain a complete and accurate record of scholarship activities The Y1 will identify personal attributes that compromise work habits effectiveness and professional responsibilities, and develops a plan for self-improvement The Y1 will be able to offer culturally sensitive support to families of NICU infants with prompting from a Neonatologist. Core Curriculum: Lecture on Professionalism Core Curriculum: Lecture on Safety License renewal process Record duty hours in new innovations Verbal/written notices Scholarship oversight meetings Biannual self-evaluations: perform a structured self-evaluation exercise in preparation for biannual review Reflections for biannual review NICU: Observe Neonatologists as they counsel families of NICU infants Core Curriculum: Lecture on Communication NPM Program Coordinator records Duty-hour reviewed weekly Review of attendance records for SOC meetings/announcements Biannual PD review Systems-Based Practice Goal: Understand how to practice high quality health care and advocate for Works effectively in various health care delivery settings and systems The Y1 will be able to direct the care of sick infants in the NICU, SCC and medical transport. Hospital Wide Training: Cultural sensitivity NICU: Under the supervision of the Neonatologist directs the care of the sick infant. Transport: In collaboration with the Neonatologist provides medical control during transport of sick NICU: Feedback from community referring physician Page 7 of 9

8 patients within the infant. context of the health care system, and demonstrate Special Care Clinic (SCC): Works with the SCC commitment to working for attending to provide care to sick outpatient improvement in healthcare Coordinates patient care within the health care system relevant to their clinical specialty Incorporates considerations of cost awareness and riskbenefit analysis in patient and/or population-based care The Y1 will be able to coordinate the care provided by various specialties and community agencies that is required for the patient with complex medical and psychosocial issues. The Y1 will be able to analyze and enumerate the costs and risks associated with various treatment options in the NICU outpatient The Y1 will be able to enumerate the legal implications of health care decision-making NICU: Discharge planning SCC: Review w/ SCC attending the multiple institutional support needs of outpatients with complex medical issues. Southern Medical Association Conference: Practice management workshop offered at UMKC School of Medicine. Core Curriculum: Lecture on Safety SCC: Evaluation of Fellow by SCC attending staff NICU: Evaluation of Fellow by discharge planner IHI: Assessment at completion of modules UR evaluation of Fellow The Y1 will be able to demonstrate understanding of the utilization review process Institute of Health Initiatives: On line required didactics Advocates for quality patient care and optimal patient care systems Works in interprofessional teams to enhance patient safety The Y1 will be able to identify evidence-based approaches to the care and treatment of the sick infant. The Y1 will be able to design and implement a quality improvement project that directly affects patient outcomes The Y1 will be able to facilitate multidisciplinary discussions of patient care issues. Page 8 of 9 NICU: Participate in utilization review (UR) of patient care F&F Conference: Participate in F&F seminars where these topics are discussed. Journal Club: Under the supervision of a Neonatologist, the Fellow will critically analyze a research report and present their findings to faculty and at conference. Clinical Case Conference: Participate in Clinical Case conference where these topics are discussed. NICU: Participates in multidisciplinary team discussions at patient bedside and during Family care conferences. F&F: Evaluation of Fellow s presentation by attendees Journal Club: Evaluation of by attendees Clinical Case Conference: Evaluation of Fellow by attendees Participates in identifying The Y1 will be able to critique the care of cases that result in morbidity M&M Conference: Fellow observes neonatology M&M: Feedback from

9 system errors and and / or mortality faculty defining their own deficiencies and limits implementing potential during the M&M conf. systems solutions The Y1 will be able to describe the components of a QI process Clinical Case Conferences: Work collaboratively with Neonatologist to identify learning opportunities presented by unique clinical cases in the NICU. neonatology faculty during M&M conference Clinical Case Conference: Evaluation of Fellow by attendees Page 9 of 9