ACGME Outcome Project: Patient Care

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ACGME Outcome ProjectPatient Care

• J. Craig Collins, MD, FACS
• Kaiser Permanente
• Los Angeles, California

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Acknowledgements

• Marvin R. Dunn, MD
• Patricia M. Surdyk, PhD
• Doris A. Stoll, PhD
• KP Center for Medical Education
• Joel C. Rosenfeld, MD
• ACGME webmaster
• MAJ Robert W. Letton, Jr., MD

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David Leach, MD, April 2003

• ACGME We invite you to respond to the challenge
  of assessing the competence of your residents.
• PDs What would you like us to do?
• ACGME We dont really know do something and
  well let you know if you did the right thing.
• PDs Youve got to be kidding.

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A paradigm shift

• Old way--focus on the process of surgical
  education
• Compliance with requirements
• Goals and objectives
• Evaluation of residents and program
• New way--focus on the evidence that the process
  works (or has worked)

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Dreyfus Model

• Novice
• Advanced beginner
• Competent
• Proficient
• Expert
• Master

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Elements of this competency

• Treatment plans
• Technical skills
• Data acquisition
• Judgment
• Problem formulation
• Operative outcomes

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Program requirements

• Common requirements--
• Programs must
• define knowledge, skills, behaviors, attitudes
• provide educational experience
• Residents must demonstrate patient care that is
  compassionate, appropriate, and effective for the
  treatment of health problems and the promotion of
  health.

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Program requirements

• Surgical residents must--
• Demonstrate manual dexterity
• Develop and execute patient care plans

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Implementation methods

• Clinical teaching (165)
• Departmental conference/lectures (156)
• Institutional core curriculum (94)
• Anatomic or animal models (58)
• Simulators/simulations (43)
• Computer modules (31)

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Other methods

• Performance feedback
• Clinical experience
• Patient evaluations
• Quizzes
• Self evaluation

• Mock oral exam
• Bedside rounds
• Case logs
• Role modeling
• VR simulator
• Operative outcome

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Assessment tools

• Faculty evaluations (166)
• ABSITE (148)
• Oral examinations (111)
• Resident evaluations of residents (95)
• Written examinations (89)
• 360 degree evaluations (83)

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Other assessment tools

• Rounds (patient, bedside, grand)

• Chief resident evaluations

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Grading care on a curve

• Dreyfus model of competence
• What are reasonable expectations for a particular
  PGY level?
• Measure actual performance
• Make PD and resident accountable
• Devise practical methods

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What to assess?

• High volume
• Potential for significant morbidity
• Treatable or preventable
• Questionable management
• Opportunities for improvement

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