MILESTONES 1. Gathers and synthesizes essential and accurate information to define each patient s clinical problem(s). (PC1) 2. Develops and achieves comprehensive management plan for each patient. (PC2) 3. Manages patients with progressive responsibility and independence. (PC3) 4. Skill in performing procedures. (PC4) 5. Requests and provides consultative. (PC5) 6. Clinical knowledge (MK1) 7. Knowledge of diagnostic testing and procedures. (MK2) 8. Works effectively within an interprofessional team (e.g. peers, consultants, nursing, ancillary professionals and other support personnel). (SBP1) 9. Recognizes system error and advocates for system improvement. (SPB2) 10. Identifies forces that impact the cost of health, and advocates for, and practices cost-effective. (SBP3) 11. Transitions patients effectively within and across health delivery systems. (SBP4) 12. Monitors practice with a goal for improvement. (PBLI1) 13. Learns and improves via performance audit. (PBLI2) 14. Learns and improves via feedback. (PBLI3) 15. Learns and improves at the point of. (PBLI4) 16. Has professional and respectful interactions with patients, givers and members of the interprofessional team (e.g. peers, consultants, nursing, ancillary professionals and support personnel). (PROF1) 17. Accepts responsibility and follows through on tasks. (PROF2) 18. Responds to each patient s unique characteristics and needs. (PROF3) 19. Exhibits integrity and ethical behavior in professional conduct. (PROF4) 20. Communicates effectively with patients and givers. (ICS1) 21. Communicates effectively in interprofessional teams (e.g. peers, consultants, nursing, ancillary professionals and other support personnel). (ICS2) 22. Appropriate utilization and completion of health records. (ICS3)
INTERNAL MEDICINE MILESTONES SELF-ASSESSMENT NAME: PGY-level: DATE: Previous ratings in BLUE font Please highlight in yellow the behavioral anchors (descriptions) that best describe your current level of performance. For this list, you should be rating Peds practice only You can highlight descriptors in more than one column. Please give significant examples or a rationale for individual milestone ratings (not necessarily each bullet point). ---------------------------------- PD rating of elements different from resident - highlighted in pink PD and resident plan for next steps - highlighted in grey Final milestone determination - highlighted in green below each milestone # 01 02 Core Comp PC1 PC2 MILESTONES Critical Deficiencies ~1 ~2 ~3 Ready for unsupervised practice Does not collect accurate Consistently acquires accurate and historical data relevant histories from patients Gathers and synthesizes essential and accurate information to define each patient s clinical problem(s). Does not use physical exam to confirm history Relies exclusively on documentation of others to generate own database or differential diagnosis Fails to recognize patient s central clinical problems Fails to recognize potentially life threatening problems Inconsistently able to acquire accurate historical information in an organized fashion Does not perform an appropriately thorough physical exam or misses key physical exam findings Does not seek or is overly reliant on secondary data Inconsistently recognizes patients central clinical problem or develops limited differential diagnoses Consistently performs accurate and appropriately thorough physical exams Seeks and obtains data from secondary sources when needed Uses collected data to define a patient s central clinical problem(s) Acquires accurate histories from patients in an efficient, prioritized, and hypothesis-driven fashion Synthesizes data to generate a prioritized differential diagnosis and problem list Performs accurate physical exams that are targeted to the patient s complaints Effectively uses history and physical examination skills to minimize the need for further diagnostic testing FACULTY/ EVAL NOTES Develops and achieves Care plans are consistently Inconsistently develops an appropriate Consistently develops appropriate Appropriately modifies plans comprehensive inappropriate or inaccurate plan plan based on patient s clinical course, management plan for each additional data, and patient patient. preferences Recognizes disease presentations that deviate from common patterns and require complex decision- making Does not react to situations that require urgent or emergent Does not seek additional guidance when needed Inconsistently seeks additional guidance when needed Recognizes situations requiring urgent or emergent Seeks additional guidance and/or consultation as appropriate Manages complex acute and chronic diseases Aspirational
03 04 05 06 PC3 PC4 PC5 FACULTY/ EVAL NOTES Looking forward for remaining residency Manages patients with Requires direct supervision to ensure Requires indirect supervision to progressive responsibility patient safety and quality ensure patient safety and quality and independence. Cannot advance beyond the need for direct supervision in the delivery of patient Inconsistently manages simple ambulatory complaints or common chronic diseases Inconsistently provides preventive in the ambulatory setting Cannot manage patients who require urgent or emergent Does not assume responsibility for patient management decisions Inconsistently manages patients with straightforward diagnoses in the inpatient setting Unable to manage complex inpatients or patients requiring intensive Provides appropriate preventive and chronic disease management in the ambulatory setting Provides comprehensive for single or multiple diagnoses in the inpatient setting Under supervision, provides appropriate in the intensive unit Initiates management plans for urgent or emergent Cannot independently supervise provided by junior members of the physician-led team Independently manages patients across inpatient and ambulatory clinical settings who have a broad spectrum of clinical disorders including undifferentiated syndromes Seeks additional guidance and/or consultation as appropriate Appropriately manages situations requiring urgent or emergent Effectively supervises the management decisions of the team FACULTY/ EVAL NOTES Skill in performing Possesses insufficient technical skill for procedures. safe completion of common procedures Attempts to perform procedures without sufficient technical skill or supervision Unwilling to perform procedures when qualified and necessary for patient Possesses basic technical skill for the completion of some common procedures Possesses technical skill and has successfully performed all procedures required for certification FACULTY/ EVAL NOTES Requests and provides consultative. Is unresponsive to questions or concerns of others when acting as a consultant or utilizing consultant services Unwilling to utilize consultant services when appropriate for patient Inconsistently manages patients as a consultant to other physicians/health teams Inconsistently applies risk assessment principles to patients while acting as a consultant Inconsistently formulates a clinical question for a consultant to address Provides consultation services for patients with clinical problems requiring basic risk assessment Asks meaningful clinical questions that guide the input of consultants Provides consultation services for patients with basic and complex clinical problems requiring detailed risk assessment Appropriately weighs recommendations from consultants in order to effectively manage patient FACULTY/ EVAL NOTES Doing consultation lecture try to attend all of them MK1 Clinical knowledge Lacks the scientific, Possesses insufficient scientific, Possesses the scientific, Possesses the scientific, socioeconomic or socioeconomic and behavioral knowledge socioeconomic and behavioral socioeconomic and behavioral behavioral knowledge required to provide for common knowledge required to provide knowledge required to provide required to provide patient medical conditions and for common medical conditions and for complex medical conditions and basic preventive basic preventive comprehensive preventive FACULTY/ EVAL NOTES
07 MK2 Knowledge of diagnostic testing and procedures. Lacks foundational knowledge to apply diagnostic testing and procedures to patient Inconsistently interprets basic diagnostic tests accurately Does not understand the concepts of pretest probability and test performance characteristics Consistently interprets basic diagnostic tests accurately Needs assistance to understand the concepts of pre-test probability and test performance characteristics Interprets complex diagnostic tests accurately Understands the concepts of pretest probability and test performance characteristics 08 09 10 SBP1 SBP2 SBP3 Minimally understands the rationale and risks associated with common procedures Fully understands the rationale and risks associated with common procedures Teaches the rationale and risks associated with common procedures and anticipates potential complications when performing procedures FACULTY/ EVAL NOTES Works effectively within an Refuses to recognize the Identifies roles of other team members Understands the roles and Understands the roles and interprofessional team (e.g. contributions of other but does not recognize how/when to responsibilities of all team members responsibilities of and effectively peers, consultants, nursing, interprofessional team utilize them as resources but uses them ineffectively partners with, all members of the ancillary professionals and members team other support personnel). Frustrates team members with inefficiency and errors Frequently requires reminders from team to complete physician responsibilities (e.g. talk to family, enter orders Participates in team discussions when required but does not actively seek input from other team members Actively engages in team meetings and collaborative decision-making FACULTY/ EVAL NOTES Leadership Recognizes system error and Ignores a risk for error Does not recognize the potential for Recognizes the potential for error Identifies systemic causes of advocates for system within the system that may system error within the system medical error and navigates them improvement. impact the of a patient Identifies obvious or critical causes of to provide safe patient error and notifies supervisor accordingly Makes decisions that could lead to error which are otherwise corrected by the system or supervision Ignores feedback and is unwilling to change behavior in order to reduce the risk for error Resistant to feedback about decisions that may lead to error or otherwise cause harm Recognizes the potential risk for error in the immediate system and takes necessary steps to mitigate that risk Willing to receive feedback about decisions that may lead to error or otherwise cause harm Activates formal system resources to investigate and mitigate real or potential medical error Advocates for safe patient and optimal patient systems Reflects upon and learns from own critical incidents that may lead to medical error FACULTY/ EVAL NOTES Will have patient safety assignments as part of curriculum for all residents Identifies forces that impact the cost of health, and advocates for, and practices cost-effective. Ignores cost issues in the provision of Does not consider limited health resources when ordering diagnostic or therapeutic interventions Minimizes unnecessary diagnostic and therapeutic tests Possesses an incomplete understanding of cost-awareness principles for a population of patients (e.g. screening tests) Demonstrates no effort to overcome barriers to costeffective Lacks awareness of external factors (e.g. socio-economic, cultural, literacy, insurance status) that impact the cost of health and the role that external stakeholders (e.g. providers, suppliers, financers, purchasers) have on the cost of Recognizes that external factors influence a patient s utilization of health and may act as barriers to cost-effective Advocates for cost-conscious utilization of resources (i.e. emergency department visits, hospital readmissions) Incorporates cost-awareness principles into standard clinical judgments and decision-making, including screening tests Consistently works to address patient specific barriers to costeffective
11 12 13 14 15 SBP4 PBLI1 PBLI2 PBLI3 PBLI4 FACULTY/ EVAL NOTES Transitions patients effectively within and across health delivery systems. Disregards need for communication at time of transition Does not respond to requests of givers in other delivery systems Inconsistently utilizes available resources to coordinate and ensure safe and effective patient within and across delivery systems Written and verbal plans during times of transition are incomplete or absent Inefficient transitions of lead to unnecessary expense or risk to a patient (e.g. duplication of tests readmission) Recognizes the importance of communication during times of transition Communication with future givers is present but with lapses in pertinent or timely information Appropriately utilizes available resources to coordinate and ensures safe and effective patient within and across delivery systems Proactively communicates with past and future givers to ensure continuity of FACULTY/ EVAL NOTES Good Monitors practice with a goal Unable to self-reflect upon one s practice for improvement. or performance Unwilling to self-reflect upon one s practice or performance Not concerned with opportunities for learning and self-improvement Misses opportunities for learning and selfimprovement Inconsistently self-reflects upon one s practice or performance and inconsistently acts upon those reflections Inconsistently acts upon opportunities for learning and self-improvement Regularly self-reflects upon one s practice or performance and consistently acts upon those reflections to improve practice Recognizes sub-optimal practice or performance as an opportunity for learning and self-improvement consistently acts upon those reflections to improve practice FACULTY/ EVAL NOTES Works hard to fix things that others have identified Learns and improves via Disregards own clinical Limited awareness of or desire to analyze Analyzes own clinical performance Analyzes own clinical performance performance audit. performance data own clinical performance data data and identifies opportunities for data and actively works to improve improvement performance Demonstrates no inclination to participate in or even consider the results of quality improvement efforts Nominally participates in a quality improvement projects Not familiar with the principles, techniques or importance of quality improvement Effectively participates in a quality improvement project Understands common principles and techniques of quality improvement and appreciates the responsibility to assess and improve for a panel of patients Actively engages in quality improvement initiatives Demonstrates the ability to apply common principles and techniques of quality improvement to improve for a panel of patients FACULTY/ EVAL NOTES Finish IHI modules Learns and improves via Never solicits feedback Rarely seeks feedback Solicits feedback only from supervisors Solicits feedback from all members feedback. of the interprofessional team and patients Actively resists feedback Responds to unsolicited feedback in a Is open to unsolicited feedback Welcomes unsolicited feedback from others defensive fashion Temporarily or superficially adjusts Inconsistently incorporates feedback Consistently incorporates feedback performance based on feedback FACULTY/ EVAL NOTES Learns and improves at the point of. Fails to acknowledge uncertainty and reverts to a reflexive patterned response even when inaccurate Rarely slows down to reconsider an approach to a problem, ask for help, or seek new information Can translate medical information needs into well-formed clinical questions with assistance Inconsistently slows down to reconsider an approach to a problem, ask for help, or seek new information Can translate medical information needs into well-formed clinical questions independently Routinely slows down to reconsider an approach to a problem, ask for help, or seek new information Routinely translates new medical information needs into wellformed clinical questions
16 17 18 19 PROF1 PROF2 PROF3 PROF4 Fails to seek or apply evidence when necessary Unfamiliar with strengths and weaknesses of the medical literature Has limited awareness of or ability to use information technology Accepts the findings of clinical research studies without critical appraisal Aware of the strengths and weaknesses of medical information resources but utilizes information technology without sophistication With assistance, appraises clinical research reports, based on accepted criteria Utilizes information technology with sophistication Independently appraises clinical research reports based on accepted criteria FACULTY/ EVAL NOTES Has professional and Lacks empathy and Inconsistently demonstrates empathy, Consistently respectful in interactions Demonstrates empathy, respectful interactions with compassion for patients compassion and respect for patients and with patients, givers and compassion and respect to patients patients, givers and and givers givers members of the interprofessional and givers in all situations members of the Disrespectful in interactions team, even in challenging situations Positively acknowledges input of interprofessional team (e.g. with patients, givers members of the interprofessional peers, consultants, nursing, and members of the team and incorporates that input ancillary professionals and interprofessional team into plan of as appropriate support personnel). Sacrifices patient needs in favor of own self-interest Blatantly disregards respect for patient privacy and autonomy Inconsistently demonstrates responsiveness to patients and givers needs in an appropriate fashion Inconsistently considers patient privacy and autonomy Is available and responsive to needs and concerns of patients, givers and members of the interprofessional team to ensure safe and effective Emphasizes patient privacy and autonomy in all interactions Anticipates, advocates for, and proactively works to meet the needs of patients and givers Demonstrates a responsiveness to patient needs that supersedes selfinterest FACULTY/ EVAL NOTES Give examples of interprofessional teamwork Accepts responsibility and follows through on tasks. Is consistently unreliable in completing patient responsibilities or assigned administrative tasks Shuns responsibilities expected of a physician professional Completes most assigned tasks in a timely manner but may need multiple reminders or other support Accepts professional responsibility only when assigned or mandatory Completes administrative and patient tasks in a timely manner in accordance with local practice and/or policy Completes assigned professional responsibilities without questioning or the need for reminders Prioritizes multiple competing demands in order to complete tasks and responsibilities in a timely and effective manner Willingness to assume professional responsibility regardless of the situation FACULTY/ EVAL NOTES He will fix this Responds to each patient s Recognizes and accounts for the unique characteristics and unique characteristics and needs of needs. the patient/ giver Is insensitive to differences related to culture, ethnicity, gender, race, age, and religion in the patient/giver encounter Is unwilling to modify plan to account for a patient s unique characteristics and needs Is sensitive to and has basic awareness of differences related to culture, ethnicity, gender, race, age and religion in the patient/giver encounter Requires assistance to modify plan to account for a patient s unique characteristics and needs Seeks to fully understand each patient s unique characteristics and needs based upon culture, ethnicity, gender, religion, and personal preference Modifies plan to account for a patient s unique characteristics and needs with partial success Appropriately modifies plan to account for a patient s unique characteristics and needs FACULTY/ EVAL NOTES Exhibits integrity and ethical Demonstrates integrity, honesty, behavior in professional and accountability to patients, conduct. society and the profession Dishonest in clinical interactions, documentation, research, or scholarly activity Refuses to be accountable for personal actions Honest in clinical interactions, documentation, research, and scholarly activity. Requires oversight for professional actions Honest and forthright in clinical interactions, documentation, research, and scholarly activity Demonstrates accountability for the of patients
20 21 22 ICS1 ICS2 ICS3 Does not adhere to basic ethical principles Blatantly disregards formal policies or procedures. Has a basic understanding of ethical principles, formal policies and procedures, and does not intentionally disregard them Adheres to ethical principles for documentation, follows formal policies and procedures, acknowledges and limits conflict of interest, and upholds ethical expectations of research and scholarly activity Actively manages challenging ethical dilemmas and conflicts of interest Identifies and responds appropriately to lapses of professional conduct among peer group FACULTY/ EVAL NOTES Communicates effectively Makes no attempt to Engages patients in discussions of Engages patients in shared decision Identifies and incorporates patient with patients and engage patient in shared plans and respects patient preferences making in uncomplicated preference in shared decision givers. decision-making when offered by the patient, but does not conversations making across a wide variety of actively solicit preferences. patient conversations Ignores patient preferences Incorporates patient-specific for plan of preferences into plan of Routinely engages in antagonistic or countertherapeutic relationships with patients and givers Attempts to develop therapeutic relationships with patients and givers but is often unsuccessful Defers difficult or ambiguous conversations to others Requires assistance facilitating discussions in difficult or ambiguous conversations Requires guidance or assistance to engage in communication with persons of different socioeconomic and cultural backgrounds Quickly establishes a therapeutic relationship with patients and givers, including persons of different socioeconomic and cultural backgrounds FACULTY/ EVAL NOTES I will send "Bad News" video Communicates effectively in Utilizes communication Uses unidirectional communication that Inconsistently engages in Consistently and actively engages interprofessional teams strategies that hamper fails to utilize the wisdom of the team collaborative communication with in collaborative communication (e.g. peers, consultants, collaboration and Resists offers of collaborative input appropriate members of the team with all members of the team nursing, ancillary teamwork Inconsistently employs verbal, nonverbal, Verbal, non-verbal and written professionals and other Verbal and/or non-verbal and written communication communication consistently acts to support personnel). behaviors disrupt effective strategies that facilitate collaborative facilitate collaboration with the collaboration with team team to enhance patient members FACULTY/ EVAL NOTES Appropriate utilization and completion of health records. Health records are absent or missing significant portions of important clinical data Health records are disorganized and inaccurate Health records are organized and accurate but are superficial and miss key data or fail to communicate clinical reasoning Health records are organized, accurate, comprehensive, and effectively communicate clinical reasoning Health records are succinct, relevant, and patient specific FACULTY/ EVAL NOTES yes STRENGTHS AREAS FOR DEVELOPMENT GOALS/PLAN CCC NOTES Program Director Residents