Nine Hours with the CCC

Hi Everyone,

Last Friday, we completed a nine hour Clinical Competency Committee meeting, fueled by bagels, coffee, fruit salad, chocolate croissants, Panera sandwiches, potato chips, chocolate chip cookies, more coffee, brownies, more cookies, hazelnut coffee, hot chocolate and whipped cream. As the light faded outside the COE trailer, giddiness descended upon the assembled, but we kept focus. We evaluated 137 residents.

Iga Stepczynski chairs the CCC, which meets twice annually to review your progress. In addition to the APDs, the Chiefs and Brett Marks attend. When possible, clinic preceptors drop in. After the meeting, I submit reports to the ACGME, which we will share with you in the coming weeks.

Each resident is evaluated in six domains: Patient Care, Medical Knowledge, Systems-Based Practice, Practice-Based Learning and Improvement, Professionalism, and Interpersonal and Communication Skills. Based on your scores, we enter a final grade for Overall Clinical Competence: "Superior," "Satisfactory," "Conditional on Improvement," or "Unsatisfactory." We seldom grade residents as Superior ("Far exceeds the expected level of development for this year of training"), so most are Satisfactory ("Always meets and occasionally exceeds the expected level of development…"). Conditional on Improvement is rare ("Meets some developmental milestones but occasionally falls short…"), and we essentially never have to grade anyone as Unsatisfactory ("Consistently falls short…"). Grades are based on MedHub evaluations and verbal feedback from clinic preceptors and others familiar with your performance. Each resident is presented by an APD, who does extensive homework before the meeting. Most residents are thriving, so typical presentations take less than two minutes, which creates time to discuss the occasional struggling trainee.

For each ACGME competency, we grade on a spectrum from "Critical Deficiencies" (a performance we'd expect of someone who didn't attend medical school) to "Aspirational" (a performance rivaling our best attendings). Over the course of residency, we anticipate gradual progression from requiring major supervision (intern) to increasing independence (resident) to "Ready for Unsupervised Practice." Here are examples of assessments from the six domains:

1. Patient Care: evidence that you can gather and synthesize information, develop management plans, perform procedures (so log them!) and request appropriate consults.
2. Medical Knowledge: evidence of clinical knowledge as well as ability to obtain and interpret appropriate tests and procedures. ITE scores are not used to determine promotion, but they do inform our assessment of your medical knowledge.
3. Systems-Based Practice: your ability to work effectively within teams (including non-physicians), recognize system error and advocate for improvement, practice cost-effective care, and navigate transitions (i.e., signouts, transfer notes, and discharge summaries).
4. Practice-Based Learning and Improvement: your ability to learn and improve your practice by monitoring your performance and respond to feedback.
5. Professionalism: the quality of your interactions with patients, caregivers, and team members; to accept responsibility and follow through on tasks (e.g., review lab results, call patients back, empty your clinic inbox, complete MedHub evaluations on time, and respond to emails from program leadership); responsiveness to patients’ unique characteristics and needs; and evidence of integrity and ethical behavior.
6. Interpersonal and Communication Skills: your ability to communicate effectively with patients, caregivers, and team members, and to complete health records comprehensively, accurately, and promptly (i.e., clinic notes, discharge summaries, and other records).

Most of you score at or beyond the expected level in each domain. Less frequently, we find areas that lag behind, and when this happens, we initiate a coaching plan to work on with your advisers. The CCC day is exhausting but exhilarating when we recognize how talented you are. In the next few days, I'll submit final reports to the ACGME. When necessary, some of you will hear from your adviser about areas needing work. If they do call you, don't despair- we all need coaching sometimes and we're going to help you get the tools you need to succeed. The overall message emerging from this marathon meeting is that almost all of you are on track to graduate to stellar careers. The next big meeting will be in the Spring…

Enjoy your Sunday, everyone. Not that I need it, but I'm off to brunch...Also, enjoy the holiday party tonight- sorry I can’t make it!

Warmly,

Mark

PS Thank you to Barbara Wanciak, who has created a webpage for me to post these Program Director’s Notes: http://residency.med.yale.edu/programs/traditional/about/index.aspx