Hi everyone,
Twice a year, our Clinical Competency Committee (CCC) meets to evaluate each traditional resident. At two half-day meetings in the fall and two in the spring, we assess your performance in the key ACGME milestones: Patient Care, Medical Knowledge, Systems-Based Practice, Practice-Based Learning and Improvement, Professionalism, and Interpersonal and Communication Skills. In the fall, we determine if you’re progressing on schedule; in the spring, we decide if you’re ready for promotion or graduation. Last Friday we discussed 80 residents and on December 5, we’ll discuss the remaining 77.
Dr. Cindy McNamara chairs the CCC, which includes the APDs, Chiefs, and additional clinical faculty. At the meetings, we sit around a conference table with some members and clinic preceptors joining on Zoom. We review MedHub evaluations, ITE scores, preceptor reports, and any performance-related information that comes to our attention (e.g., special recognitions). The meetings last about five hours, and we break them up with soundtracks (The Beatles), stretching and breathing exercises (Navy Seals), and food (salads, sandwiches, pink lemonade, hot chocolate, coffee, and donuts).
We presume most residents progress at a roughly similar rate from early learners needing direct supervision to internists ready for independent practice. Many of you are ahead of schedule while a few lag in specific areas. CCC discussions identify who needs extra support to get back on track.
Through years of experience, we know where most residents score on their milestones based on their PGY level and time of year, so, for efficiency’s sake, we pre-populate the forms and move residents up or down (more accurately, forward or back) if they’re outliers. Here’s an abbreviated summary of the factors considered:
Patient Care: We consider note writing (accurate, concise, up to date), presentations (crisp, targeted), response to emergencies, ability to distinguish sick from not sick, clinical reasoning, interpretation of test results, and timely task completion (signing notes, responding to inbox messages).
Medical Knowledge: We consider ITE scores* and references to clinic knowledge in MedHub. Here’s where reading, teaching, attending conferences, and using MKSAP pays off.
Systems-Based Practice: We consider participation in quality improvement projects, submitting SAFER and JPSR reports, working with care coordinators and social workers, patient advocacy, service on committees, and being a helpful teammate.
Practice-Based Learning and Improvement: We consider use of clinical guidelines and Care Signature Pathways, seeking and responding to feedback, and learning from mistakes. Clinic preceptors assess how you manage your patient panels and grow over successive ambulatory blocks.
Professionalism: We consider adherence to ethical principles such as honesty, honoring patients’ preferences, behaving professionally in stressful situations, recognizing your limitations, and knowing when to seek help. We also consider whether you come to work on time (nearly everyone does), respond promptly to emails from program leadership, attend mandatory teaching sessions, report duty hours consistently, keep up with your clinic inbox, complete MedHub evaluations on time, and respond promptly to ChOC calls when you’re on jeopardy. Professionalism also includes caring for yourself and those around you (be an upstander!) and seeking physical and mental health care when needed.
Interpersonal and Communication Skills: We consider whether you establish therapeutic relationships with patients, communicate compassionately, engage in shared decision making, work collaboratively with colleagues and staff, and provide meaningful feedback to peers and program leadership.
CCC meetings are exhausting, but more importantly, they’re inspiring. Throughout the day, we have to remind each other to hold our praise and suppress our adoration so we can finish the list. Your APD will contact you if there are skills to work on, but the main message is that you should be proud, and we’re immensely proud of you.
Take care and enjoy your Sunday, everyone. I’ll be going for a bike ride before leaving this afternoon for a dear friend’s wedding.
Mark
*ITE scores are used to assess medical knowledge but not to determine readiness for promotion or graduation.
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