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R ³P Project. Faculty Development. Question Themes: Day 1. Engagement of faculty (5) Recognizing faculty proficiency in assessment (3) Create value for clinician-educator (1) Evaluation process and small numbers (1) Training and giving feedback (1) Next “best” thing to face-to-face FD (1)
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R³P Project Faculty Development
Question Themes: Day 1 • Engagement of faculty (5) • Recognizing faculty proficiency in assessment (3) • Create value for clinician-educator (1) • Evaluation process and small numbers (1) • Training and giving feedback (1) • Next “best” thing to face-to-face FD (1) • Mass production of assessment tools (1)
Basic Principles • The assessment tool is only as good as the evaluator • There is no “holy grail” of assessment tools • Embed assessment in daily teaching activities • Lots of focused observation possible • Assessment should almost always be linked to feedback
Basic Principles • Need strong learning climate in program • Negative climate will undermine assessment • Evaluation should be something you do with trainees, NOT to them. • Trainees should be active participants • Residents can perform a lot of their own assessment • Self audit of medical records • Videotape review with structured tools • Actively seek feedback from others
Engaging Faculty Science and Professionalism • Use the evidence to demonstrate the known deficiencies in competence • 25 years of data demonstrating problems • Better supervision = better patient care • The “aha” moment • The “you will not believe what I saw today” experience
Push/Pull Forces on Faculty Evaluation Science (Push) • Evidence-based practice • Errors and competency gaps • Evidence-based medical education Professionalism (Push) • Culture of quality in education • Intolerant of incompetence • Professional commitment Science of Assessment • Build design support capability • Program analysis • Experience and competency in assessment • Patient and trainee focus • Teamwork in assessment • Program resources External Pull • Payers & government • Rewarding performance • Regulation • Patients/families/ advocacy groups • Accreditation • ACGME, LCME, NCQA, JCAHO • Certification • ABMS • ABP Increase number of training programs effectively measuring competence Increase number of trainees involved in effective self-assessment Based on Orleans CT, Anderson N and Gruman J Roadmaps for the next frontier: Getting evidence-based behavior medicine into practice: Society of Behavioral Medicine, Annual Meeting, San Diego, March 1999 Improved population health
Engaging Faculty Feasibility • Provide usable assessment tool • Don’t spend a lot of time developing local tools • Embed FD into routine activities where possible • Any standing meeting • “Longitudinal” faculty development • Attending rounds • Residents also benefit from same training • Focused “mini” workshops • Brief FD can have some, albeit modest, impact
Engaging Faculty Feasibility • Embed assessment into daily activities • Focused direct observation • 3-10 minute observations valuable! • Structured clinical observation (SCO) • First patient visit of outpatient clinic session • Pre-rounds • Part of an admission work-up • Work rounds • Chart stimulated recall • MRA to assess clinical judgment
Engaging Faculty Faculty Development as CPD • Combine CPD with assessment training • Performance dimension training for counseling skills • Skill workshops • Physical exam, QI science, etc. • Collaborative projects • Faculty and residents work together on QI • ABIM practice improvement modules (PIM)
Recognizing Proficiency • Reduction in rater errors • Less halo effect, etc. • Increase quality of written, descriptive evaluation • More behavioral, specific • Multiple observations • Videotape practice and feedback • Correlation with other assessments • Concurrent or construct validity • Resident assessment • Don’t underestimate value of evaluation of faculty
Training Methods That Work • Performance Dimension Training (PDT) • Frame of Reference Training (FoRT) • Behavioral Observation Training (BOT) • Direct Observation of Competence (DOC) Training
Faculty Deep knowledge, skills and attitudes about multiple modes of assessment: Need formal training 3-5 Core: PD’s, APD’s Faculty whose main focus is on education and clinical care Must possess strong observation, work-based assessment skills. Can train thru workshops, etc. Basic observation, descriptive skills +FB Use focused FD methods The 1-month per year attending
Other Questions • Create value for clinician-educator (1) • Evaluation process and small numbers (1) • Training and giving feedback (1) • Next “best” thing to face-to-face FD (1) • Mass production of assessment tools (1)