360˚ Evaluation

1. 360˚ Evaluation A new era of comprehensive review Written by: the ACGME

2. The concept of 360: a full spectrum of evaluation • Our Patients • Nurses • Colleagues (Peer) • Faculty

3. Why do we have to do this? Formative Evaluation The program must: V.A.1.b). (1) provide objective assessments of competence in patient care, medical knowledge, practice-based learning, interpersonal and communication skills, professionalism, and systems-based practice;

4. ACGME: core competencies • Patient Care is the compassionate, appropriate, and effective treatment of health problems • Medical Knowledge about established and evolving biomedical, clinical, and cognate sciences • Practice-Based Learning and improvement that involves investigation and evaluation of their own patient care and assimilation of scientific evidence in patient care. • Interpersonal and Communication Skillsthat result in effective information exchange • Professionalism as manifested through a commitment to carrying out professional responsibilities • Systems-Based Practice as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care

5. Why do we have to do this? • V.A.1.b).(2) use multiple evaluators (e.g., faculty, peers, patients, self, and other professional staff); Common Program Requirements 9 by ACGME

6. Patient 360˚ Evaluation • A minimum of 10 evaluations per year • Self-distribution to clinic patients at the end of the clinic visit • “Anonymous” • The patient returns the survey to the front desk along with check out sheet • Paper

8. Nurse 360˚ Evaluation • A minimum of 10 per year • “Anonymous” • Electronic ISD survey • Distributed monthly by Nurse Managers • Evaluating night float, ward residents and interns in close proximity to nurses station • Wake Med nurses possibly included

9. Peer 360 Evaluation • A minimum of 10 per year • Evalue • Your colleagues will be assigned to you • Encouraged to submit “on the fly” evals • ACGME core competencies

10. Peer 360 Evaluations • Respects staff and peers • Works as a team player • Is prompt and present for rounds and sign out • Promptly return pages and emails • Shows respect and empathy to patients and families • Keep current and effective communication to main aspects of patient care • Maintains a positive and supportive attitude

11. Thank you for your attention

12. Evalue • RRC Rules • 80h work week over 4 week average • 1 day off in 4 over 4 week average • 10h between shifts • 24+6 call cycle

13. Log Accurately • If you worked >30h, we want to know about it • If you had <10h off between shifts, we want to know about it • At same time • You should structure your call to prioritize these mandates • You should sign-out procedures, labs, and other outstanding issues • This fits into the ‘team approach’ to inpatient care

14. E-Value Mistakes • Always tell us your shift • Lunches are part of your work hours • Pay attention to AM/PM, start/end dates for overnight inpatient duties • In ED, chart your patients as your shift is coming to a close, staying after can break the <10h rule

15. E-Value Demonstration

16. Med U and Med W Teaching • Each Tuesday at 1:15 in 8 BT Conference Room • Residents, Interns, Students expected to attend

17. Admissions Protocol

18. Our Priorities for Admissions • The Patient takes all priority • On-call interns meet their admissions cap • Patient are admitted to appropriate services • All services are ‘general medicie’ first, specialty second • This usually is not an issue • Team equity and fairness amongst teams

19. Friday and Saturday Nights • Hard intern on-call cap at 11pm • If 5 day admissions are not reached by 11pm, that team will not cap for the day • Non specialty patients might be assigned to a specialty service • Pre-Call Floats begin once on-call cap has completed • We want our interns to have more opportunities to go independently complete the admissions process

20. Sunday – Thursday Nights • No hard 11pm cap • Admissions and patient placement returns to our priorities • If all on-call teams will cap, patients admitted early in the night [e.g. 8pm] can be floated to the next team; patients admitted in the middle of the night [e.g. 2am] can go to the on-call team • Night Floats should not modify/reassign the now post-call assignments after any team member could have woken and reviewed WebCIS from home.

21. During the Day • Fact: some teams cap earlier than others • Fact: most residents also function as a mini-MAO for their team or beyond • Fact: no one likes doing this; particularly if you are trying to find a spot for our patient • On-call residents together work as a team of MAOs • If patients are called for admission from ED or arrive to floor to direct admit, they take priority over any other ‘potential’ patient. • Do not ‘save spots’ • Please let us help you if resident/attending tension arises

22. 2010-2011 Education Committee Members • R4: Andrew Smitherman • R3: Lindsay Kruska, Nicole Tintera • R2: Ed Barnes, John Rommel • Interns: soon-ish