|
This one's for all of you Residency Directors. As a new director of a podiatric residency program (a little over a year), I am quickly learning just how hard this job actually is. I observed my Residency Director during my training, and he always seemed to have a handle on every part of residency training. For me, this is a learning process with a very rapid learning curve – out of necessity! But I'm finding that one of the most challenging parts of being a director is assessing resident competency.  Doing this right is a lot harder than it looks. In the section below, I'm "opening up the books" on the Chino Valley Medical Center residency program's  resident assessment methods. For those of you interested, I hope you find this thought provoking, and if nothing else, I hope this helps you to understand just how complicated this task can be.
Before I "show you mine," it's useful to understand the way in which the Council on Podiatric Medical Education (CPME) defines a residency program and what their general expectations are.
According to the CPME 320 document, a residency program is a "resource-based, competency-driven, assessment-validated model of training".1
"Competency-driven implies that the program director assures that the resident achieves the competencies identified by the Council for successful completion of the residency. Each of these specific competencies must be achieved by every resident identified by the sponsoring institution as having successfully completed the residency program.
"Assessment-validated implies that the serial acquisition and final achievement of the competencies are validated by assessments of the resident's knowledge, attitudes, and skills. To provide the most effective validation, assessment is conducted both internally (within the program) and externally (by outside organizations)."
If you think about what this actually means, it's a tall order. The CPME wants residencies to be "competency-driven" – residents become competent in various skills, rather than simply completing a certain number of procedures/skills – and to be "assessment-validated," rather than simply donating three years of time, regardless of quality on graduation. Happily, the CPME gives directors leeway as to how to assess their residents. Good for you CPME! General guidelines allow directors boundaries within which to function, while allowing the freedom for creativity and innovation.
With that said, here is how this one particular Residency Director assesses his residents for competency. Each of my residents receives a monthly rotation evaluation, a quarterly evaluation, and a yearly one. As an example of one of the rotation assessments, look at Figure 1. For purposes of space, I'm showing only the first page. Additionally, included in this podiatric rotation assessment are competencies for wound care, office and clinics, podiatric surgery, and sports medicine. You might also take note of the beginning section, in which the numbers correspond to levels of proficiency. These levels are based on the Dreyfus Developmental model of skill acquisition that is currently being adopted by the American College of Graduate Medical Education (ACGME), the body that accredits MD and, now, DO programs.2
Figure 1
Monthly rotation assessment example showing a portion of the evaluation of a podiatry rotation.
(Click image for PDF form) |
|
|
In order to gather a more complete assessment, I also like to survey the residents on their opinions of rotations. To do so, I use the Resident Assessment of Rotation Form in Figure 2. This gives me an opportunity to get a good feel for the quality of education during rotations, as perceived by the residents, especially the non-podiatric ones. To maintain some semblance of anonymity, I ask the residents to turn their forms in to our graduate medical education office. The administrators then de-identify these forms and send me a copy. Granted, I can probably figure out who's who (I currently have only four residents), but it's the best I can do for now.
Figure 2
Resident assessment of rotation using a Likert scale method.
(Click image for PDF form) |
|
|
For longer-term assessments, such as the quarterly and yearly assessments, I use the form partially shown in Figure 3. The form assesses the following criteria: skills, knowledge, interpersonal skills and professional conduct, teaching ability, clerical and managerial skills, research and publication productivity, and conference/meeting attendance. Along with each of these parameters is a verbal descriptor of an appropriately functioning resident (for each resident's level), comments that I make, and action items for resolution of deficiencies. This form allows me to have a guided conversation with each resident, while maintaining a paper trail for disciplinary purposes. I try to leave no ambiguity of expectations for the residents, since that leads to problems.
Figure 3
Sample portion of quarterly evaluation of resident.
(Click image for PDF form) |
|
|
What's In Store for the Future?
I'm always on the search for new assessment methods. To that end, I have a few more assessments in store for my residents. One method I'm about to beta test is a Surgical Competency Assessment Form, shown in Figure 4. The residents will carry a 5x7 inch card with the Dreyfus assessment model on one side and a comments section on the other. Immediately after completing procedures, the residents' attendings will use this form to both assess surgical skills and provide direct and immediate feedback in about two minutes. We'll see how this goes. The biggest hurdle is getting busy surgeons to provide feedback and complete the form.
Additionally, I have in store an OSATS examination (Objective Structured Assessment of Technical Skills) at the end of the year. The residents will have to complete various skills (for example, performing a running subcuticular suture or assessing a diabetic foot infection case) set up in stations. Each station will have an objective rubric to allow clear assessment of each resident. At the end of the examination, two things will occur. I will have an objective assessment of each resident's skills and the residents will receive feedback about their performance.
Figure 4
Surgical competency assessment form.
(Click image for PDF form) |
|
|
Everything I have described thus far are internal assessments of resident performance. Additionally, the residents are signed up for the ABPM In-Training examination during their second and third years to assess their medical knowledge base.
There you have it – a glimpse into one residency program's assessment. This is just one way to do it. There are likely as many methods as there are residency programs, and my way is likely not the best way. But of course, any assessment and focus on competencies instead of simply time to completion and minimum volume is better than none. For all you Residency Directors, I appreciate all you do, and you should give yourself a small pat on the back. But you'd better make it quick, because the next administrative hurdle is just around the corner.
Best wishes,
Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]
References
- Standards and Requirements for Approval of Podiatric Medicine and Surgery Residencies. Council on Podiatric Medical Education, December 2012.
- Carraccio C, et al. Academic Medicine. Aug 2008;83(8):761-767.
Get a steady stream of all the NEW PRESENT Podiatry
eLearning by becoming our Facebook Fan.
Effective eLearning and a Colleague Network await you. |
 |
This ezine was made possible through the support of our sponsors: |
|
Resident Assessment:
.jpg)
