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Resources Relevant to the Implementation
of Core ACGME-Required Competencies
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Resources Relevant to the Implementation
of Core ACGME-Required Competencies
Module V Patient care Assessment |
| Commentary on the use of SP-based assessment & OSCEs |
In its table of toolbox methods, the ACGME suggests that standardized patient-based assessment and OSCEs are desirable ways to assess patient care. While these methods are very useful, the cost and time required to implement them means that they are not very practical for most A/I training programs. One possibility for programs that wish to avail themselves of these types of assessment is to partner with other GME programs in the institution to create cases, scenarios, or stations that can be used across specialty areas. Observation by faculty of an actual patient encounter, especially if conducted on an unannounced basis, is likely to provide a more realistic snapshot of resident behavior than scheduled time with a standardized patient. |
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| Assessment of fellow by faculty or self | ||
| Record review: Comparison to guidelines |
The asthma chart review and its accompanying summary and the allergic rhinitis/conjunctivitis and its accompanying summary were designed by Stephen McGeady at Jefferson Medical College. These tools were designed to compare care actually delivered to practice guidelines or standards. The diagnosis-specific chart reviews and summaries were chosen for the AAAAI toolbox because they represent examples of measures that can be used to assess a number of components of appropriate and effective patient care, including performance of procedures, clinical decision making, preventive health services, and development and carrying out of patient management plans. It is anticipated that similar measures could be created for other diagnoses. The diagnosis-specific chart reviews and summaries were originally designed for fellows to use for self-evaluation. Used in this way, they can relate to a learning plan. They can also be used as for assessment of fellow by faculty. The diagnosis-specific chart review and summaries are examples of assessment via record review. The ACGME, in its draft Toolbox of Assessment Measures, provides some information about the properties and uses of record review for assessment. |
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| Assessment of fellow by faculty | ||
| Global rating: American Board of Internal Medicine (ABIM) Mini-CEX |
The ABIM’s Mini-CEX project is a work-in-progress designed to study the feasibility and measurement characteristics of this assessment measure. The mini-CEX is designed to provide a brief snapshot of resident attitudes, behaviors, and skills. The mini-CEX was chosen for the AAAAI toolbox for a number of reasons. First, it was designed to assess aspects of multiple competencies (patient care, professionalism, medical knowledge, interpersonal and communication skills, and practice-based learning and improvement) in a single brief measure. The project’s pilot information indicates that, “the mini-CEX provides a valid, reliable measure of clinical performance based on multiple encounters (four per year) by different examiners.” Although the mini-CEX was originally designed for use with PGY-1 internal medicine residents, the focus of the assessment is useful across years of training and specialties. One caveat is that the descriptors of competencies provided ask the rater to consider multiple behaviors in her or his assessment. Research has shown that when multiple behaviors are assessed in one question, neither those doing the assessment nor those being assessed can be sure which components are being measured. When one of the purposes of assessment is to provide feedback to learners, it is important to be able to provide specific information aimed at enhancing performance. The ABIM has granted permission for use of its core competencies by A/I training programs. The mini-CEX is an example of assessment via global rating. The ACGME, in its draft Toolbox of Assessment Measures, provides some information about the properties and uses of global rating for assessment. |
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| Assessment of fellow by patients | ||
| Patient survey: American Board of Internal Medicine (ABIM) [adapted] |
The ABIM‘s Continuous Professional Development Program uses patient assessment as one measure of physician skill. Designed to be completed by patients who have been contacted by mail some time after the visit, the ten-item instrument focuses on the physician-patient interaction that occurred during the medical encounter. Because caring and respectful behavior and counselling and educating patients and families are demonstrated to a great degree during physician-patient interaction, assessment measures that are useful for evaluating interpersonal and communication skills may also be used to evaluate these components of patient care. An adaptation of the ABIM instrument was chosen for the AAAAI toolbox for a number of reasons. First, the questions focus solely on aspects of the physician-patient interaction. Instruments that look at the concept of satisfaction more globally often include questions about other aspects of the medical visit, such as access to appointments, wait time, and convenience of parking. While this information is useful, a more targeted assessment of caring and respectful behavior and counselling and educating patients and families is needed both to assure compliance with the ACGME mandate and also to provide useful, targeted formative feedback to fellows. Ten questions are enough to provide information about important specific components of the medical interaction, but are few enough not to be onerous for the patient to complete. Two adaptations to the instrument are suggested. First, the items should be shortened so that each reflects a single behavior. Research has shown that when multiple behaviors are assessed in one question, neither those doing the assessment nor those being assessed can be sure which components are being measured. The University of Pennsylvania Health System, in conjunction with Independence Blue Cross, created truncated single items from the ABIM instrument for reporting purposes. This adapted version of the items is suggested for use by A/I training programs. The second recommendation concerns how the instrument is administered. Since response to mailed surveys is low and may tend to reflect the evaluation of patients who are either very happy or very unhappy with their care, we suggest that the questions be handed out to patients by clinic staff at the end of the visit and completed on the spot. Having all of a fellow’s patients complete the forms during some period of time—one week every six months, for example— is likely to provide more complete and useful information. Care should be taken to ensure that the time period used is representative. The ABIM has granted permission for use of its core competencies by A/I training programs. The adapted ABIM form is an example of assessment via patient survey. The ACGME, in its draft Toolbox of Assessment Methods, provides some information about the properties and uses of patient surveys for assessment. |
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| Return to Table of Contents | ||
| Return to Assessment Overview | ||
| Return to Patient care Overview | ||
| Move forward to Patient care Resources | ||
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©Copyright 2002 American Academy of Allergy, Asthma,& Immunology All Rights Reserved
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