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Internal Medicine
Evaluation of the ACGME Competencies
Patient Care
Patient care has always been an area emphasized in evaluation of trainees. Various "rounds" are predicated on the opportunity of senior teachers to share information and also to observe trainees caring for patients.
1. Attending Work Rounds - Daily rounds on the teaching services (wards and intensive care units) provide opportunities for attending physicians to observe the quality of patient care provided by trainees. These are assessed through the standard end-of-month evaluation process.
2. Teaching Attending Rounds - Trainees present 1-2 cases each session then go to the bedside with the Teaching Attending to focus on one domain of performance. In some instances, a trainee is chosen to interview the patient with the group observing. The Teaching Attending then models optimal techniques for the entire team and later provides the "tested" trainee with oral and written feed-back. Similarly, if patients have excellent physical examination findings, a trainee might be asked to perform a focused examination with the team in attendance. In this manner, every-day patient care skills can be "fine-tuned" by senior teachers.
3. Program Director's Rounds - Once each month, the Program Director meets with trainees assigned to the Ward services to examine their oral presentation and medical reasoning skills and examine documentation in chart-stimulated recall exercises.
4. Practice-based Learning Exercises - A program instituted by Dr. Paramanathan in our clinics, each resident performs a review of his/her own medical records for documentation of interventions/measures that are proven to enhance patient outcomes for a number of illnesses. Examples include screening for the 8 elements of diabetes longitudinal care and maintenance of comprehensive problem lists in the ambulatory record. Trainees examine medical records of 5 of their patients for these elements using the attached worksheets. They repeat the exercise after 6 months to determine the degree to which they learned from their previous performance.
Diabetes Management Checklist
Comprehensive Problem Checklist
This system provides real-time evaluation of the quality of patient care in the chosen areas. Each year, new evidence-based measures will be added to the areas of assessment.
5. 6-Competency OSCE - This exam, testing all 6 domains of medical competency, is given every other year to all trainees. A Boards-style case is presented at one the stations of the objective clinical skills evaluation (OSCE). The trainees then answer a series of questions that examine the care that would be provided to the hypothetical case.
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A summary of all six ACGME competencies may be downloaded from the following link.
NOTE: These documents are in Adobe Acrobat® (PDF) format. If you are unable to open them, please download and install Acrobat Reader by clicking on the following button.
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