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Internal Medicine
Evaluation of the ACGME Competencies
Practice-Based Learning
Practice-based learning includes ability of physicians to use information systems to maximize patient care and the degree to which we are able to learn from past cases and/or our errors.
1. Continuity Clinic Records Reviews - 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.
2. Attending Rounds - During daily Work and Teaching Attending Rounds, attending physicians note the degree to which trainees learn from previous cases and whether they use the medical literature to inform patient care.
3. The 6-Competency OSCE - Every other year, trainees perform an objective structured clinical examination (OSCE) comprised of 6 stations (one for each ACGME competency). The station for practice-based learning examines ability to access the medical literature to inform care of a patient case.
4. Quality-Assurance/Errors Management - In a program, since learning from medical errors is also an important facet of practice-based learning, a PGY-2 module includes 3 sessions spent at hospital quality management meetings, reading several chapters from the Institute of Medicine work on improving quality and reducing errors, and completion of a short quiz. These materials can be obtained in the Department of Medicine Program Director's office.
5. Regular Conferences (Morning Report, CPC) - In addition, Morning Report, which occurs every weekday, begins with a review of deaths and the degree to which medical decision-making and/or errors contributed. New cases are also "Q-A'ed" in similar fashion. Each month, at the Case Presentation Conference (CPC), the clinical course of a recently deceased patient is presented and discussed emphasizing medical decision-making and errors that may have contributed to death. A full-time Yale pathologist presents the (gross and microscopic) autopsy findings to examine the degree to which pre-mortem diagnoses are reflected in the post-mortem findings.
6. Journal Club and Scientific Methods Lecture Series - Each year, a series of lectures, for all residents, reviews scientific methods, statistical techniques and how to examine the validity of a published medical study. These skills are then practiced in monthly journal clubs and in smaller "break-out sessions" with a faculty member (once or twice/year).
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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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