Michael S Beeson MD MBA Program Director Akron General Medical Center Amber Bradford DO Associate Program Director Akron General Medical Center Steven Warrington MD HAENOW Milestone ID: 490827
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End of Shift Milestone Evaluation Forms
Michael S. Beeson, M.D., MBAProgram Director, Akron General Medical CenterAmber Bradford, D.O.Associate Program Director, Akron General Medical CenterSteven Warrington, M.D.HAENOW Milestone Study GroupSlide2
HAENOW?
Hennepin- Danielle Hart, M.D.Akron General- Beeson, Bradford, WarringtonEinstein- (Beth Israel Albert Einstein College of Medicine) Saadia Akhtar, M.D.Nevada- Michael Epter, D.O.
Ohio State- Diane Gorgas, M.D.
Washington- Fiona
Gallahue
, M.D.Slide3
Objectives of Session
Introduce concept of End of Shift Milestone Evaluation FormsUnderstand advantages/drawbacks of this methodIntroduce elements of reliability and validity of this methodSlide4
Components of Session
Milestone assessment basicsDevelopment of End of Shift Milestone Evaluation FormsDescription of
End of Shift Milestone Evaluation Forms
Viewing of resident-patient interaction
Scoring of 1 of 8 EM1 End of Shift Evaluation Forms
Discussion of this Methodology
Concluding remarksSlide5
We Got Milestones, Now What?
AssessmentObjective rather than subjectiveSlide6
Core Competencies Introduction
Formative vs Summative assessmentSlide7
Milestone Assessment
Focus on Reliability and Validity of methods and toolsWill different faculty rate the same?Is the setting valid?Is the assessment instrument valid?How is bias controlled?Slide8
Emergency Medicine is Different
IM/Surgery rotations with same senior residents and rounding attending(s)EM shifts can be with a different attending EVERY shiftFor EM, difficult to do an end of month Milestone evaluationAn attending may have worked with a specific resident sparinglyAny assessment becomes a subjective global rating scale Slide9
General Milestone Assessment Basics
The farther from patient care (real or simulated) an assessment is made, the more it resembles a subjective global ratings scaleThe closer to direct patient care (real or simulated) assessment is made the more objectiveSlide10
Turning the EM
Milestones into Global Rating Scales
Bias exists from faculty matching PGY
level with expected proficiency levelSlide11
End of Shift Milestone Evaluation Forms
Struggled with how to make an efficient end of shift evaluation formSDOT useful, but could take 20-30 minutes to completeDesire to develop a brief end of shift assessment toolNovel concept- make it useful too!Slide12
Milestones to Exclude
Procedure-based (PC9- PC14)Medical Knowledge (MK)Milestones left:Milestone Number by Proficiency Level
Level
1
2
3
4
Total
23
26
40
31
120Slide13
Separate Forms for EM1 and EM2-4
EM1- Use Milestones from Proficiency levels 1-389 MilestonesEM2-4 Use Milestones from Proficiency levels 2-497 Milestones8 EM1 forms and 8 EM2-4 formsProficiency levels of each Milestone are NOT identifiedSlide14
Sample End of Shift Milestone FormSlide15
Sample End of Shift Milestone Form with AnchorsSlide16
Process
Milestone evaluation training with individual facultyA separate form is used on a weekly basisProgram Coordinator swaps them out weeklyWeekly email of that week’s End of Shift Evaluation Forms along with their anchors to faculty and residentsTowards end of shift a form is completed by the attending with the residentForm is then faxed to Residency Office by ED Unit ClerkSlide17
Let’s Score an Intern
View videoSlide18
Additional Case Points
Intern does not introduce himself to the patientIntern addresses patient by the wrong nameIntern was 10 minutes late to his shift and was told to wear his white coat to work the day beforeIntern does not perform a head or neck exam but communicates a normal examIntern does not communicate elevated blood pressure to his attendingSlide19
Case Points
Intern initially prescribes Percocet to a patient with a known alcohol problemIntern initially wants to place the patient in an air cast splint for a distal fibular fractureIntern initially refers the patient to the medicine clinic for follow-upSlide20
Score the End of Shift Evaluation FormSlide21
Data Input of Each Form
Each form is faxed to the residency officeProgram Coordinator inputs form into online databaseDemonstration of Form data inputSlide22
Reports from Data
Demonstration of Resident ReportSlide23
Issues to be Worked Out
Better balancing of each form in terms of Proficiency levelsWhich Milestones are just too difficult to evaluate using this methodCould procedural subcompetencies be evaluated this way?Airway, Wound Care, US, Central Line Forms?Form completion complianceBuy-in by residents and facultyUnknown Inter-Rater ReliabilitySlide24
State of This System
Available now!www.cordtests.orgForms can be downloaded as Word document, put your logo on it, whatever…iPad app is nearly completed