1. Douglas Char, MD – Emergency Medicine We think act like this group • Clinical Competency Committees How the residents see us

2. Clinical Competency Committee • ACGME definition force us to broaden evaluation committee membership, change work process • Expand beyond Program Directors • PD is not chair but member of the committee • Informal review -> formal assignment of milestone levels • CCC meets prior to resident semi-annual performance evaluation (twice yearly) • Calendar allows submission of milestone data to ACGME

3. Prior Approach based on 6-CC

4. CCC Operationalize • 8-12 faculty member (PDs, FDs, core faculty) • It’s tons of work (48 residents takes 5+ hours) • Identify true stakeholders • Subcomm assigned to review each class the provide overview to full CCC • Class APD and 1-2 other faculty • 12-16 hours; review data, discuss, create report • Subgroup aware of class norms, follows individual throughout training • CCC ensured program norms between classes

5. Performance Dashboard • Ideally pushes data to CCC members, residents in organized one stop shop format • Creating viable dashboard requires lots of IT muscle (residents faculty looking for fault) • Avoid getting trapped in the process - $$$ • Should there be a centralized resource?

6. Milestones with Comments Comments (Core Competency): 1. Patient Care: Ahead of your peers, appropriate pace and number of patients seen (2.6/hour, class avg 2.14). Appears comfortable in physician role. Runs EM2 like an attending. 2. Medical Knowledge: Above average In-service score 83% (mean 72%), clinical judgment is excellent 3. Interpersonal & Communication: great with staff, patients. Need nursing evals. 4. Practice-based Learning: Continue self directed learning (follow up cases, procedure log, DOTs) on track. Good job tracking procedures focus on other procedures not just the RRC mandated core. 5. Professionalism: conf attendance great 100%, (8 hours of indep study) multiple compliments about bedside manner. 6. System-based Practice: Consider working on practice-based and quality improvement initiatives within the ED and hospital. Administrative Issues: 360 degree evaluation - 2/2 patient evals, 3/2 nursing evals, peers due in April 2014. 8 of 8 DOTs (3 Hx/Dx, 1 Dispo/dx, 1 professionalism, 1 systems based practice) , Procedure skills ( 8/4 – 2 wound care, 3 airway, 1 pain management, 2 vascular access) Need resuscitation DOTs (one for the semester) 1/1 resusc DOT Transition of care 1/1 Follow up cases 8/8 for the year (two months) EOS paper 17, electronic 12 ------------------------------------------------------------------------------------------------------------------------------- Areas of Strength: XXX has a calm mature demeanor. Applies medical knowledge well, displays outstanding judgment for level of training. She gets along well with patients, staff and peers.

7. Gathering Data = Hassle Factor • Mistrust of data by residents, faculty • No good system to collect, lots of staff and faculty time • Residents see where data being applied

8. Final Milestone Rating Decisions

9. Preparing Residents for Milestones • Annual Retreat – we’ve talked NAS for the past 3 years • Self assessment – familiarize res w/ concepts, rankings • They don’t care about it until they get tripped up by the new rules • Have to make Milestones relevant to them • Include residents in plans & changes, this creates buy in (even if only in token way) • Make it clear this is moving target, it will change! Residents more invested than faculty

10. Milestones likely to be part of their future as physicians • Maintenance of certification for Board status • Hospital privileging - ongoing CQI initiatives • Performance data have many uses