Competencies for Resident Evaluations

USING THE EVALUATION FORM - STANDARDS FOR RATINGS

When evaluating residents, program directors and faculty should use the following definition as their standard - the level of knowledge, skills, and attitudes that is expected from a clearly satisfactory resident at this stage of training. Using a nine-point scale, a clearly satisfactory resident should receive a rating of "5". A rating of "4" should be considered "marginal."

PGY-1

At the conclusion of this year, the resident has demonstrated sufficient progress in the components of clinical competence that he/she is capable of functioning as a team leader. Specifically, the resident has the necessary skills in data gathering, medical knowledge, clinical insight, and critical thinking to assume a team leadership role. Core descriptors of performance milestones that may be useful to consider at the end of each rotation and include on the evaluation form are: Lacking in skills to function as a team leader . . . moving towards team leader role. . . capable of being a team leader

PGY-2

At the beginning of this year, the resident is capable of making independent decisions based on previous clinical experiences. As the resident progresses through PGY-2, he/she develops the ability to recognize and manage "new" clinical problems, those clinical scenarios not previously encountered. Core descriptors of performance milestones that may be useful to consider at the end of each rotation and include on the evaluation form are: Lacks insight and judgment in clinical situations. . .recognizes most new clinical situations and seeks appropriate consultation. . . recognizes and manages new clinical situations skillfully

PGY-3

At the conclusion of this year, the resident should demonstrate mastery of a large set of special skills and is prepared to practice independently. The resident now has the sufficient knowledge base, problem-solving skills, and clinical judgment that enable him/her to teach other residents and to evaluate the performance of junior residents. Core descriptors of performance milestones that may be useful to consider at the end of each rotation and include on the evaluation form are: Not yet capable of practicing as an independent physician. . .moving towards independent practice. . . practices as independent physician

WORKING DEFINITIONS FOR INTERNAL MEDICINE

Patient Care

Residents are expected to provide patient care that is compassionate, appropriate and effective for the promotion of health, prevention of illness, treatment of disease and at the end of life.

  • Gather accurate, essential information from all sources, including medical interviews, physical examinations, medical records and diagnostic/therapeutic procedures
  • Make informed recommendations about preventive, diagnostic and therapeutic options and interventions that are based on clinical judgment, scientific evidence, and patient preference
  • Develop, negotiate and implement effective patient management plans and integration of patient care
  • Perform competently the diagnostic and therapeutic procedures considered essential to the practice of internal medicine

Medical Knowledge:

Residents are expected to demonstrate knowledge of established and evolving biomedical, clinical and social sciences, and the application of their knowledge to patient care and the education of others.

  • Apply an open-minded, analytical approach to acquiring new knowledge
  • Access and critically evaluate current medical information and scientific evidence
  • Develop clinically applicable knowledge of the basic and clinical sciences that underlie the practice of internal medicine
  • Apply this knowledge to clinical problem-solving, clinical decision-making, and critical thinking

Practice-Based Learning and Improvement

Residents are expected to be able to use scientific evidence and methods to investigate, evaluate, and improve patient care practices.

  • Identify areas for improvement and implement strategies to enhance knowledge, skills, attitudes and processes of care
  • Analyze and evaluate practice experiences and implement strategies to continually improve the quality of patient practice
  • Develop and maintain a willingness to learn from errors and use errors to improve the system or processes of care
  • Use information technology or other available methodologies to access and manage information, support patient care decisions and enhance both patient and physician education

Interpersonal and Communication Skills

Residents are expected to demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families, and other members of health care teams.

  • Provide effective and professional consultation to other physicians and health care professionals and sustain therapeutic and ethically sound professional relationships with patients, their families, and colleagues.
  • Use effective listening, nonverbal, questioning, and narrative skills to communicate with patients and families
  • Interact with consultants in a respectful, appropriate manner
  • Maintain comprehensive, timely, and legible medical records

Professionalism

Residents are expected to demonstrate behaviors that reflect a commitment to continuous professional development, ethical practice, an understanding and sensitivity to diversity and a responsible attitude toward their patients, their profession, and society.

  • Demonstrate respect, compassion, integrity, and altruism in relationships with patients, families, and colleagues
  • Demonstrate sensitivity and responsiveness to the gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors and disabilities of patients and professional colleagues
  • Adhere to principles of confidentiality, scientific/academic integrity, and informed consent
  • Recognize and identify deficiencies in peer performance

Systems-Based Practice

Residents are expected to demonstrate both an understanding of the contexts and systems in which health care is provided, and the ability to apply this knowledge to improve and optimize health care.

  • Understand, access and utilize the resources, providers and systems necessary to provide optimal care
  • Understand the limitations and opportunities inherent in various practice types and delivery systems, and develop strategies to optimize care for the individual patient
  • Apply evidence-based, cost-conscious strategies to prevention, diagnosis, and disease management
  • Collaborate with other members of the health care team to assist patients in dealing effectively with complex systems and to improve systematic processes of care

Assessing Practice-Based Learning and System-Based Practice

Settings and Questions to Consider

Recognizing that the competencies of practice-based learning and improvement and systems-based practice are new concepts to most faculty responsible for evaluating residents, a short list of definitive questions is provided as a template from which faculty can observe a resident's proficiency in these areas.

Practice-Based Learning and Improvement

Inpatient Rotation

  1. Does the resident use information about self-errors to improve practice and change behavior?
  2. Does the resident voluntarily (without prompting or assignment) discuss and research relevant literature to support decision-making processes?
  3. Does the resident's ability to teach junior colleagues or peers demonstrate the level of research and preparation expected by the program?
  4. Does the resident's patient care reflect learning from previous experiences?
  5. Does the resident demonstrate understanding and use of an evidence-based approach in providing patient care?
  6. Does the resident effectively and efficiently use consulting services to improve both patient care and self-knowledge?

Ambulatory Rotation

  1. Does the resident assess patient compliance to ambulatory regimens and accordingly modify prescribing practices?
  2. Do the resident's educational discussions indicate a thorough, systematic review of the topic?
  3. Does the resident freely admit to and seek help in remedying errors?
  4. Does the resident readily seek formative feedback on performance?
  5. Does the resident use self-assessments of knowledge, skills and attitudes to develop plans for addressing areas for improvement?
  6. When presented with practice data, does the resident participate actively to improve practice?

Critical Care Rotation

  1. Does the resident appropriately differentiate care delivered in the unit from other venues?
  2. Does the resident quickly access appropriate reference material for current patients?
  3. Does the resident use interactions with nursing staff and other professionals as two-way educational opportunities?
  4. Does the resident participate actively in quality improvement practices pertaining to patient care (e.g., morbidity and mortality conferences)?
  5. Does the resident's response to critical problems reflect more than rote learning and protocol management? Does the resident suggest data-driven modification of protocols?
  6. Does the resident review autopsy findings to understand illness and the care of critically ill patients?
  7. Does the resident voluntarily plan instructional experiences in procedures not yet mastered?

Consultation Service

  1. Are the "non-internal medicine" patient care issues researched and learned by the team?
  2. Does the resident identify the questions and wishes of the physician who requested the consultation and evaluate the issues with these in mind?
  3. Does the resident spontaneously keep a log of unique cases? If such a log is required by the program, does the resident use it to self-assess performance patterns?
  4. Does the resident acquire appropriate evidence-based information for the consultation? Is the resident facile in using this information during consultations?

Systems-Based Practice

Inpatient Rotation

  1. Does the resident effectively utilize hospital resources to achieve appropriate patient care?
  2. Does the resident recognize and surmount obstacles to appropriate patient care?
  3. Does the resident provide appropriate patient care follow-up?
  4. Does the resident use practice guidelines when appropriate?
  5. Does the resident provide attention to discharge planning beginning at admission?

Ambulatory Rotation

  1. Does the resident utilize community and clinic resources for successful patient care?
  2. Does the resident access clinical information systems to enhance patient care?
  3. Does the resident collaborate with payers to ensure that patients receive required care?
  4. Does the resident use practice guidelines when appropriate?

Critical Care Rotation

  1. Does the resident work effectively with nursing staff and ancillary health care personnel?
  2. Is the resident aware of resource utilization in critically ill patients?
  3. Does the resident use alternate care venues (stepdown units, etc.) appropriately

Consultation Service

  1. Does the resident appropriately delineate relationships between the consulting service and the primary service?
  2. Does the resident understand coordination of current inpatient and subsequent outpatient care?

composite

Contact Us

Internal Medicine Residency Program

956 Court Avenue, Room H314
Memphis, Tennessee 38163
Phone: 901-448-5814
Fax: 901-448-7836
Bran Upchurch, Coordinator

Verifications

Daniece Mackie
Phone: 901-448-5720
Fax: 901-448-7836

Please expect a two week turnaround time.