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ACGME Competency Measures

This perspective discusses the challenges and measures of competency in a large healthcare system with diverse patient populations and multiple facilities. It highlights the use of electronic systems and various evaluation methods.

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ACGME Competency Measures

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  1. ACGME Competency Measures Vu Q. C. Nguyen, MD, MBA Carolinas Medical Center Carolinas Rehabilitation Charlotte, North Carolina

  2. Perspective • Large healthcare system • 43 hospitals system • 2nd largest healthcare system in the nation • Carolinas Medical Center is flagship • Three education campuses • Charlotte: 15 residencies and 11 fellowships • Concord: 1 family medicine residency • Greenville: 1 family medicine residency • Large rehabilitation system • Carolinas Rehabilitation (CR): Main, Mt Holly, NE, Pineville • Levine Children’s • Charleston, Greensboro, Greenville, Lancaster, Wilmington

  3. Perspective • Geography • Facilities and physicians spread across 4 states • Challenges communication and processes • Diverse patient population • The variable composition of patients across facilities drives the type of care being delivered • CR Main: neurotrauma rehabilitation • Pineville Rehab: general rehabilitation • Unique medical staff culture • Charlotte, Concord, and Greenville are more education oriented • Faculty vs. practitioner • Facility vs. clinics

  4. System • Strong centrally-oriented leadership • Division of Medical Education drives processes • Heavy reliance on electronics • MedHub residency management system • Cerner EMR for all inpatient and outpatient interfaces • iPads and smartphones for clinical and communication • Virtual care for ICU, primary care, referral, and on-call • Video and audio conferencing for meetings and lectures

  5. PM&R Competency Measures • All measures are distributed in electronic and printed formats to faculty • MedHub End of Rotation Evaluations • ROCA • 360 Globals • Procedures Log • Diagnoses Log • PM&R-oriented Competencies

  6. MedHub • End of Rotation Eval measures the established ACGME competencies • Patient Care • General skills, physiatric skills, clinical judgment, patient care • Medical Knowledge • General knowledge, physiatric knowledge • Practice Based Learning and Improvement • Interpersonal and Communication Skills • Professionalism • Professional attitudes, humanistic qualities • Systems Based Practice

  7. MedHub • Modified MedHub End of Rotation Evaluation • Language and evaluation levels are more consistent with ACGME’s NAS

  8. 360s, Diagnoses, Procedures, and ROCA • 360 Globals • Patients, therapists, nurses, assistants, colleagues • Procedure Log • ACGME • ROCA • Diagnoses Log • All cases evaluated during the Consults Rotation are logged

  9. PM&R-oriented Competencies • 63 competencies based on 9 core subspecialties • TBI, SCI, Stroke, Peds, Cancer, Ortho-Amp, EDx, MSK, Sports • 7 competencies per core subspecialty • The competencies are the most pertinent conditions in PM&R • Creation of the Competencies • Core faculty in each subspecialty were surveyed as to the 7 most appropriate conditions that they felt all physiatrists should be able to manage comfortably • PD drafted all of the competencies and forwarded them to the subspecialized faculty to review and modify • PD then revised the competencies based on the cumulative feedback from faculty • Each batch of 7 competencies were debated and ratified at the monthly GME meetings

  10. Stroke Competencies • PC Stroke: Hemiplegic Shoulder Pain • PC Stroke: Spasticity • PC Stroke: Post-stroke Depression • PC Stroke: Botulinum Toxin Injection • MK Stroke: Scales – NIHSS, MMSE, Modified Rankin, Barthel Index, FIM, GOS, and Aphasia Tree • MK Stroke: Primary and Secondary Stroke Prevention • SBP Stroke: Assess caregiver support and resources available

  11. Stroke Competencies

  12. Stroke Competencies Overview of expectations for the resident: Patient Care Competency – Stroke: Hemiplegic Shoulder Pain (HSP) Resident must demonstrate an understanding of the pathophysiology of HSP and differentiate the condition from other painful disorders of the shoulder; outline an appropriate management plan that includes prevention of the condition, identification of the condition, initiation of therapy and modalities including oral pharmacotherapeutics and shoulder injections. Appropriately utilize imaging and other diagnostic testing modalities. The resident must be able to educate the patient and/or family members in regards to the condition and its management.

  13. Stroke Competencies Instruction for Faculty: The resident will hand you this form when they feel they have mastered any of the competency levels below. Please rate them according to the scale below by putting today’s date on the level that you feel they have achieved. Please recognize that a level 4 should only be given if you feel this resident is competent to manage this condition today, equivalent to that of a “graduate”. A level 5 is reserved for a resident who has shown competency level equivalent to that of an “expert”.

  14. Stroke Competencies

  15. Vu’s contact info: • 704-615-5214 (cell) • 704-355-9330 (office) • Vu.nguyen@carolinashealthcare.org

  16. Thank you 15

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