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Implementing Clinical Competency Milestones in Neurosurgery Training at UCLA

The UCLA Neurosurgery Clinical Competency Committee, led by Dr. Marvin Bergsneider, emphasizes the significance of achieving defined milestones in resident competency. These milestones respond to societal demands and guidelines from organizations like CMS and payors, defining competencies distinct from mere proficiency. The measured evaluations will be integrated into MedHub and involve extensive effort and institutional support. A detailed six-step plan outlines assurance of competent assessments, linking evaluations to reportable milestones, ultimately fulfilling ACGME requirements for semi-annual reporting.

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Implementing Clinical Competency Milestones in Neurosurgery Training at UCLA

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  1. NASPearls Marvin Bergsneider, M.D. Program Director UCLA Neurosurgery

  2. Clinical Competency Committee

  3. Milestones

  4. Competent • Demanded by society, CMS, payors • Definition • Just good enough • Different from proficiency • An objective sampling of abilities: not all

  5. CCC Assessment Form

  6. End of Rotation Evaluation

  7. End of Rotation Evaluation

  8. Procedural Competency

  9. Other Evaluations • Mock oral boards • Outpatient assessment competency • Implementation into MedHub • Will be very labor intensive • Will need institutional support

  10. CCC Example

  11. Internal Medicine One approach to reporting milestones Darryl Sue, Harbor-UCLA

  12. Six step plan • Find the (reportable) milestones • Evaluate trainees in context of milestones • Modify or add milestones to evaluations • Change evaluation scales to reflect performance relative to milestones • Collect evaluation data • Review “provisional” scores from evaluations • Finalize the semi-annual milestones (CCC) • Report to ACGME by December 31 and June 30 each year.

  13. Milestone Reporting: ACGME and ABIM

  14. Target, not requirement Scale reflects performance relative to milestones; PGY added to assist evaluators

  15. Target, not requirement Consistently acquires accurate and relevant histories from patients Seeks and obtains data from secondary sources when needed Consistently performs accurate and appropriately thorough physical exams Uses collected data to define a patient's central clinical problem(s) Independently manages patients across inpatient and ambulatory clinical settings who have a broad spectrum of clinical disorders including undifferentiated syndromes Seeks additional guidance and/or consultation as appropriate Appropriately manages situations requiring urgent or emergent care Effectively supervises the management decisions of the team

  16. Verinform Provisional Performance Final Performance

  17. Verinform

  18. Repetitive stress injury? • 55 residents x 22 milestones = 1,210 semi-annual assessments x 2/year = 2,420 • So, someone will “click” 2,420 radio buttons per year for ACGME reporting (unless…) • Note: Verinform assessment system has same number of clicks, so double the number to 4,840 individual clicks?

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