Jennifer Kesselheim, MD Nothing to - PowerPoint Presentation

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Jennifer Kesselheim, MD

Nothing to discloseDiscussion of off-label drug use: not applicable

56

th

ASH Annual Meeting

Disclosure Statement

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Milestone-based Assessment:

The Pediatric Hematology-Oncology ApproachJennifer Kesselheim, MD, EdMASH Program Directors’ WorkshopDecember 5, 2014

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51 sub competencies in pediatrics

15 EPAsClinical Competency CommitteesRequirement to report to ACGME on 21 milestones every 6 months for every fellow starting in this academic yearHow do we optimally support program directors???

The Next Accreditation System (NAS)

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Formed to provide guidance and resources to pediatric hematology-oncology (PHO) program directors

Subgroup of the Program Directors’ CommitteeApproximately 10 members, 1 fellowASPHO EPA/Milestones Task Force

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Tasks

Work on subspecialty-specific EPAsDevelop assessment instruments to measure the milestonesAvailable to any programAvoid reinventing the wheelDetermine how the sub competencies and EPAs relate to one anotherGather data to measure outcomes of transitionASPHO EPA/Milestones Task Force

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No current plans to require reporting on EPAs

Discussion about EPAs tabled for nowEntrustment is the subject of a research study happening in pediatric subspecialtiesMore on that below…

ASPHO EPA/Milestones Task Force

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Patient Care

: 135Medical knowledge: 21Interpersonal Communication: 6 3Practice-based Learning and Improvement:10 4Professionalism: 5 1Systems based Practice: 7

5

Personal and

P

rofessional Development

: 8

3

21 Sub competencies for Reporting

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The Task force identified 5 additional competencies (red) we believed essential to the training of a PHO, raising total number to 26.

PC-3

Transfers in care

PC6

Exhibits good clinical judgment

PC7

Construct a management plan

PC8

P

rocedures

PC12

R

ole

modeling

PC13

S

upervision

MK2

A

pplied

knowledge

PBLI1

Self-identify

deficiencies

PLBI4

QI, improve

practice

mgmt

PBLI7

Information technology

PBLI9

E

ducate patients

ICS-1

Communicate to patients

ICS3

Communicate in

profession

ICS4

L

ead

team

ICS5

C

onsult

P-conduct

Professional conduct

P-humanism

Humanism in

medicine

SBP1

H

ealth

care setting

SBP2

M

ed

home

SBp3

C

ost

/risk-benefit

SBP5

T

eam

safety/qi

SBP6

S

ystem

errors/

soln

PPD2

C

oping mechanisms

PPD5

Trustworthiness

PPD6

Leadership

PPD8

A

mbiguity

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No one wants to fill out an assessment form with 26 items!

Variable relevance of sub competenciesInpatient vs. outpatient settingsDifferent PGY levelsConducted survey of PHO program directorsSignificant overlap in rotations and curriculaThe Challenge of Implementation

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Distribute competencies among different rotations/ fellowship activities

InpatientOutpatient/ConsultsContinuity clinicTeaching conferencesResearchProcedures360 evaluationsAllow more advanced competencies to be assessed laterAllow crucial competencies to be assessed frequently

Spreading the Wealth

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Inpatient

Consult/Outpt

A

B

C

D

E

F

PC6

PC6

PC6

PC6

PC6

PC6

PC6

PBLI7

PC7

PC7

PC7

PC7

PC7

PC7

ICS5

PC3MK2PC12PBLI7PC13PC12P-conICS1PBLI1PC13PLBI9P-conICS4P-hum     PPD6Continuity Clinic360ConferencesABCDSBP1MK2MK2MK2MK2MK2SBP5PLBI4ICS1PBLI1ICS1P-humSPB6PBLI9ICS3PBLI9ICS3SBP2PPD2ICS3P-conP-humP-conPPD5PPD5  SBP3PPD8PPD6ProceduresPPD8PC8

First-Year Evaluation Forms

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Continuity

360

Inpatient/Outpatient/Consult

A

B

ICS1

PC3

PC6

PC6

ICS3

PC8

PC7

PC12

SBP1

ICS4

PC13

MK2

SBP5

ICS5

P-con

P-hum

SPB6

SBP2

SBP3PPD2PPD6PPD8PPD5PPD6ResearchPPD8PLB1PLBI7ConferencesPBLI9MK2ICS3PLBI4P-conPBLI9PPD2ICS3Upper-Level Evaluation Forms

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Evaluation Source:

Inpatient

Continuity

Consult/Outpt

Procedures

Conferences

360

Research

CCC

 

Frequency:

qRotation

q3 month

qRotation

q6 mo

As appropriate

q6

mo

q6

mo

q6 mo

 

Minimumq2 moq3 mo q6 mo     Competency         PC3Transfer of careA       PC6Clinical judgmentAll X     PC7Management plansAll       PC8*Procedures   X    PC12Role modelingC,F       PC13*SupervisionC,E       MK2EBMB

All

 

X   PBLI1Self -knowledgeBB      PLBI4QI    X   PBLI7Information technologyD X     PBLI9Educate othersDB  X   ICS1*Communication: pts/publicAA.C      ICS3Communication:professional A,C  X   ICS4Team leadershipF       ICS5Consultant role  X     P-con Professional ConductEA,CX     P-hum*Humanism  B.DX     SBP1Work in health care system     X  SBP2Coordinate care D      SBP3Cost/risk-benefit analysis C      SBP5Interprofessional teams     X  SBP6ID and solve system errors     X  PPD2*Healthy coping mechanisms     X  PPD5Trustworthiness in pt care D   X  PPD6Leadership skillsF    X  PPD8Tolerance of ambiguity D   X 

First-Year Evaluation Matrix

* Not yet required for ACGME reporting

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Distilling Down to Essentials

Is reluctant to use information technology. Is unable to prioritize information retrieved.

Has basic EBM and EHR skills but is not able to use them with ease and facility.

Efficiently retrieves and utilizes information for medical decision making.

Habitually uses

information for medical decision making for patients and populations.

Contributes to development and improvement of information technology for patient care and/or professional learning.

Uses information technology to optimize learning and care delivery (PBLI 7)

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First-year

Fellow Evaluation Form: Inpatient

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How could you use the

Heme-Onc Milestones as an “item bank” to create meaningful evaluations aligned with the purpose of the curricular experience?Small Group Exercise

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At 2014 ASPHO annual meeting, we led a workshop open to program directors, associate program directors, and teaching faculty

Faculty Development

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Workshop Objectives

Describe the theory behind EPAs and CBME and the assessment instruments developed by the task forcePlan their own program’s implementation of CBME with guidance from a worksheet and task force membersBecome facile with faculty development modules, disseminated during the workshop, for use at home institution

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Hour 1

: Didactic presentationPrinciples of the Next Accreditation SystemStructure and function of the CCC Orientation to new assessment instruments created by task forceHour 2: Small group workHow will you implement new assessments in your program?Hour 3: Training the trainerStrategies for faculty development at homeReview of PowerPoint module created by task forceWorkshop Format

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Pre-test administered to registrants (N=37)

Repeated as post-test (N=38)Rate agreement with 6 different item stemsEvaluation Data

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Council of Pediatric Subspecialties

How are entrustment decisions being made?Measure program directors’ assessments of entrustment on each EPA (standard) Compare to CCC entrustment decisions derived from sub competencies and milestonesDetermine which sub competencies most influentialParticipation8 subspecialties, 15 PHO programs, ~500 fellowsIRB approval at hospital levelData collection in progressCollaborative Research

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Mark Atlas, MDTask Force members

ASPHO leadership and staffFunded 2 in-person meetingsAllocated time and space during annual meetingsConveyed fellowship training as major priorityAcknowledgments