2011 The International Conference on Residency Education La Conference Internationale sur la Formation de Residents

Transcription

1 2011 The International Conference on Residency Education La Conference Internationale sur la Formation de Residents Royal College of Physicians and Surgeons of Canada College Royale de Medecins et Chrurgiens du Canada

2 LEVELED & THREADED GRMEP CURRICULUM FRAMEWORK - Gayla Jewell, PhD, RNC, NP, Residency Programs Educator Ashraf Mansour, MD Program Director, Vascular Surgery Linda Youmans, MA, LPC Graduate Medical Education Advisor

3 Neither Gayla Jewell, Ashraf Mansour, nor Linda Youmans have any relevant financial relationships with commercial interests that pertain to the content of this presentation

4 Create an educationally sound curriculum framework Principles for framework construction Prepare/Engage Faculty Evaluate/Advance Residents

5 ACGME Medical Knowledge Patient Care Interpersonal & Communication Skills Practice-Based Learning Professionalism Systems-Based Practice CanMEDS Medical Expert Health Advocate Communicator; Collaborator Scholar Professional Manager

6 We believe we are already doing a good job So Why Change?

7 Lack of connection between written G&O and reality causes Disconnect for faculty and residents

8 Goals & Objectives dwell on the shelf look good but, are they relevant and useful?

9 Seems good enough, but. In-Training exam scores low average Tech skills behind Some complaints from attendings/staff M&M presentations lack depth Covers main points with families, does not check for understanding Could be more motivated Participates in a QI project

10 How do we know what to do about Pat?

11 Poorly articulated, unleveled G&O provide limited grounding for teaching, evaluation, and advancement decisions

12 Curriculum Framework as Guide to Educational Mindset

13 End of Program Goal Competence to be achieved by graduation

14 End of Program Goal PG Year Goal Minimal level of competence to be achieved by year end

15 End of Program Goal \ PG Year Goal PG Year Guiding Objective Used to generate specific rotation objectives for PG Year

16 End of Program Goal PG Year Goal PG Year Guiding Objective Rotation Objectives Gen Surg Endo Vasc Surg Surg Onc Behavioral expectations for each clinical experience

17 PGY 3 Goal Guiding Objective Rotation Objective Milestone Marker Facilitates collaborative & resource-based inter-professional teamwork in patient-centered, cost-effective care Works effectively in an inter-professional team and health care delivery system Negotiates pt-centered care with multiple care provider team. Assessment Method 36 mo Monthly evaluation; 360 evaluation Improves health care delivery: Recognizes system error and advocates for system improvement Engages in system-level quality improvement intervention 36 mo 360 evaluation Cost-effective care: Identifies forces that impact cost Incorporates cost-awareness principles into complex care scenarios 36 mo Monthly evaluation

18 Distinction between Goals & Objectives Verb Leveling Content Threading

19 GOALS Broadly stated General intentions OBJECTIVES Concrete, Specific Behaviorally stated Measureable

20 PGY 5 Goal Facilitates PGY 4 Goal Role Models PGY 3 Goal Assesses PGY 2 Goal Investigates PGY 1 Goal Identifies

21 PGY GOALS SYSTEMS- BASED PRACTICE Systems-Based Practice/Manager Attainment of each PGY goal is dependent on realization of previous PGY goals By the end of PGY 1 the Resident: Identifies issues related to error and cost Identifies need for multi-disciplinary and interprofessional collaboration in the delivery of health care By the end of PGY 2 the Resident: By the end of PGY 3 the Resident: END OF PROGRAM GOAL

22 PGY GOALS SYSTEMS- BASED PRACTICE Systems-Based Practice/Manager Attainment of each PGY goal is dependent on realization of previous PGY goals By the end of PGY 1 the Resident: Identifies issues related to error and cost Identifies need for multi-disciplinary and interprofessional collaboration in the delivery of health care By the end of PGY 2 the Resident: Role models cost awareness, riskbenefit analysis, and a systems approach in the provision of team based care By the end of PGY 3 the Resident: END OF PROGRAM GOAL

23 PGY GOALS SYSTEMS- BASED PRACTICE Systems-Based Practice/Manager Attainment of each PGY goal is dependent on realization of previous PGY goals By the end of PGY 1 the Resident: Identifies issues related to error and cost Identifies need for multi-disciplinary and interprofessional collaboration in the delivery of health care By the end of PGY 2 the Resident: Role models cost awareness, riskbenefit analysis, and a systems approach in the provision of team based care By the end of PGY 3 the Resident: Facilitates collaborative and resource based inter-professional team work in the delivery of patient centered, cost effective care END OF PROGRAM GOAL

24 PGY GOALS SYSTEMS- BASED PRACTICE Systems-Based Practice/Manager Attainment of each PGY goal is dependent on realization of previous PGY goals By the end of PGY 1 the Resident: Identifies issues related to error and cost Identifies need for multi-disciplinary and interprofessional collaboration in the delivery of health care By the end of PGY 2 the Resident: Role models cost awareness, riskbenefit analysis, and a systems approach in the provision of team based care By the end of PGY 3 the Resident: Facilitates collaborative and resource based inter-professional team work in the delivery of patient centered, cost effective care END OF PROGRAM GOAL Appraises and collaboratively utilizes health care system resources in the pursuit of optimal patient care

25 Framework Prep Faculty Development Resident Evaluation

26 Create G&O template Plug in existing objectives Review with faculty/residents Identify & fill in gaps

27 G&O cannot be written by PD, PC, or Educator Must be based on realities of clinical rotations & assignments Must be co-composed by faculty & based on experience

28 3-hour Session Orient, Hone, & Approve 1-hour Sessions Verbal Feedback Written Feedback Working with Challenging Residents

29 Teach to PGY G&O Diagnose and guide performance Discuss at resident review sessions

30 Common language Consistent expectations Integrated Supervision requirements & Milestones Evaluation and advancement criteria Embedded Faculty Development

31 Gayla Jewell, Educator Ashraf Mansour, Program Director Linda Youmans, GME Advisor

32 Systems-Based Practice/Manager Attainment of each PGY goal is dependent on realization of previous PGY goals By the end of PGY 1 the Resident: By the end of PGY 2 the Resident: By the end of PGY 3 the Resident: By the end of PGY 4 the Resident: By the end of PGY 5 the Resident: The Vascular Surgery Residency Graduate: Identifies impact of key components of the health care system on patient care Investigates benefits and challenges of interprofessionally based patient care Assesses errors and patient outcomes from a systems perspective Role models cost awareness, risk-benefit analysis, and a systems approach in the provision of care Facilitates collaborative and resourcebased interprofessional team work in the provision of care Appraises and collaboratively utilizes health care system resources the pursuit of optimal patient care

33 PGY 1 Goal Guiding Objective Rotation Objective Identifies impact of key components of the health care system on patient care Collaboration: Maintains a flexible and adaptable attitude when practicing in various clinical settings Cost: Identifies how issues of reimbursement impact patient care Quality: Identifies knowledge base and unique skill sets of health care team members 1. Participates in conferences and follows assignments to various outpatient facilities 2. Participates in vascular quality assurance meetings 1. Becomes familiar with principles of coding and reimbursement, costs of medications and surgical technology 2. Discusses factors that impact choosing the most cost-effective tests and procedures 1. Participates in morbidity & mortality and surgical quality assurance meetings; becomes familiar with hospital QI to reduce infections 2. With faculty and other residents, participates in collecting and analyzing quality data from NSQIP; participates in forming an action plan to improve patient outcomes

34 PGY 3 Goal Guiding Objective Rotation Objective Assesses errors and patient outcomes from a system perspective Collaboration: Analyzes the impact of systems requirements on patient outcomes Cost: Performs a cost-benefit analysis from a population perspective Quality: Distinguishes differences between individual practice error and system error and impact on patient care 1. Identifies system failures and causal relationship affecting patient care 2. Discusses how 3 rd party reimbursement issues impact care 1. Discusses appreciation of financial cost of care in in-patient and outpatient settings 2. Understands implications of ordering imaging tests 3. Analyzed individual treatment decisions using population-based data 1. Participates in critical analysis of system failures, offers workable solutions 2. Participates in QI committees 3. Facilitates discussion with multidisciplinary/inter-professional group issues about patient morbidity or mortality

35 PGY 5 Goal Guiding Objective Rotation Objective Facilitates collaborative and resource-based inter-professional team work Collaboration: Demonstrates participative leadership in the provision of care 1. Assumes leadership of multidisciplinary and interprofessional team 2. Participates in teaching students and residents Cost: Demonstrates with others that carefully orchestrated, team-based care is effective use of resources 1. Demonstrates understanding of rational and judicious use of resources, including medical equipment, therapeutic drugs, imaging studies Quality Advocates for quality care in a variety of venues 1. Demonstrates leadership and initiative in surgical quality conferences, professional standards committee