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Program Directors Survey How are we evaluating our fellows

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Program Directors Survey How are we evaluating our fellows

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    1. Program Directors Survey How are we evaluating our fellows? Ann Zimrin, MD University of Maryland Greenebaum Cancer Center

    3. Why do the survey?

    4. Original survey SHARING BEST PRACTICES SURVEY   General Information Name of program: Name of program director: Number of fellows per year: Number of months clinical work on average (out of 24 or 36) during fellowship:   Strategy for assessing competencies CompetencyMethods Used Patient Care Medical Knowledge Practice-based Learning Interpersonal and Communication Skills Professionalism Systems-based Practice   How do you assess a fellow’s capacity for analytic thinking and its application to patient problems?

    5. Modified survey What evaluation methods are you currently using? Mini-CEXs Faculty global ratings 360 degree evaluations Faculty feedback on presentations (such as journal club, grand rounds, research presentations) Portfolios Procedure logs In-service exams (ASH, ASCO) QOPI Simulation center (patient interviews, physical exams) Simulation center (procedures) Case review conferences Anything else? How do you assess a fellow’s capacity for analytic thinking (optional)?

    6. Who responded? Adult programs Hematology/Oncology combined 69/126 (55%) Hematology 3/7 (43%) Oncology 4/16 (25%) Pediatric Hematology/Oncology29/65 (45%) overalloverall

    7. Adult programs Combined heme/onc,onc and hemeCombined heme/onc,onc and heme

    8. Pediatric programs Combined heme/onc,onc and hemeCombined heme/onc,onc and heme

    9. Responses by Region Combined heme/onc,onc and hemeCombined heme/onc,onc and heme

    10. Evaluation Methods

    11. Evaluation Methods

    12. Evaluation Methods

    13. Other Methods (Adults) A set of cases for which the fellows provide “consultation” report with critical analysis of the issues and relevant literature (q 6 mos) Written test and demonstration of manual competency in administrating chemotherapy Chart reviews by the faculty of the fellows’ notes; review of fellows’ overnight triage log Chart stimulated recall oral exams

    14. Other Methods (Peds) Individualized Learning Plans Scholastic Oversight Committee presentations “Pretending” month as third year One thing stands out, at least in my mind, after reviewing the responses. It seems that the biggest component of most if not all of our assessment methods revolves around observing the fellows in clinical situations. This might seem obvious to everyone in the room, and not particularly problematic. My concern is that outside of the 360 degree evals, faculty are doing the observations, and it has been documented that we are not particularly good observers. One thing stands out, at least in my mind, after reviewing the responses. It seems that the biggest component of most if not all of our assessment methods revolves around observing the fellows in clinical situations. This might seem obvious to everyone in the room, and not particularly problematic. My concern is that outside of the 360 degree evals, faculty are doing the observations, and it has been documented that we are not particularly good observers.

    15. Wish List On-line teaching modules concerning ethics, delivery of bad news, cultural sensitivity Better ways to mentor and assess research aspect of fellowship Simulation models for bone marrow biopsies

    16. New ACGME Requirement “Fellows must have access to training using simulation.” “The committee does NOT expect each program to use a simulator or have a simulation center. Simulation means that learning about patient care occurs in a setting that does not include actual patients. This could include OSCEs, standardized patients, patient simulators, or electronic simulation of codes, procedures, and other clinical scenarios.” One PD (Ira Wollner at the Henry Ford Hospital pfogram) is doing OSCEs (one per fellow per year). One PD (Ira Wollner at the Henry Ford Hospital pfogram) is doing OSCEs (one per fellow per year).

    17. Simulation – OSCE Objective Structured Clinical Examination Students rotate from station to station Interview patients, interpret lab findings and imaging Observed by examiners and performance scored Useful way to test students’ grasp of common topics (“Approach to the Patient with Chest Pain”, for example) 2 programs responded that they were doing OSCEs. 2 programs responded that they were doing OSCEs.

    18. OSCE - Application to Heme/Onc Possible topics Approach to the patient with thrombocytopenia Approach to the patient with anemia Approach to the patient with a mediastinal mass Gerontology issues Disadvantages Expensive Time-consuming to set up Questionable utility

    19. Computer-Based Simulation Schick and Burke (The Internet Journal of Hematology 2010 : Volume 7 Number 1) Computer-based tutorial on the topic of bleeding disorders After reading history, residents and fellows were asked to order tests from a menu and make recommendations for treatment Authors noted that selection of diagnostic tests was the weakest area FromLankanau Hospital in Pennsylvania Novel Teaching Methods and Innovative Fellow Evaluation Tools Alexandra Wolanskyj, Mayo Clinic FromLankanau Hospital in Pennsylvania Novel Teaching Methods and Innovative Fellow Evaluation Tools Alexandra Wolanskyj, Mayo Clinic

    20. Lab-based Simulation Insertion of CVP catheters Administration of intrathecal chemotherapy Bone marrow biopsy simulation Sternal aspirate More on simulation in upcoming breakout session

    21. Tools: Where to Look for Help ASH Website http://www.hematology.org/Training Presentations from previous TPDWs Grants Clearinghouse Hematology curriculum Case studies for fellows (board-type questions with answers and references) Image Bank (slides to download or print) Teaching Cases for Medical Students Medical Student Hematology Course Learning Objectives Presentations available include Ensuring Fellows Productive Research Experiences, Teaching and Evaluating Competency in Procedures, Developing and Evaluating Program Improvement ProcessesPresentations available include Ensuring Fellows Productive Research Experiences, Teaching and Evaluating Competency in Procedures, Developing and Evaluating Program Improvement Processes

    22. Tools: Where to Look for Help ASCO Website www.asco.org Training Program Director sessions from previous annual meetings Oncology Training Program Directors Retreat – presentations and extra material submitted by PDs Medical Oncology Core Curriculum Communication Skills “Works for Me” ASCO Tumor Boards Presentations available on the website include Systems-Based Practice Curriculum Development, Legal Issues in GME, Administration of Chemotherapy: Responsibilities and Competencies, How to Monitor Fatigue, Common Citations and How to Avoid Them, How to Prepare for a Site Visit. The “Works for Me” site has a chemotherapy certification coursePresentations available on the website include Systems-Based Practice Curriculum Development, Legal Issues in GME, Administration of Chemotherapy: Responsibilities and Competencies, How to Monitor Fatigue, Common Citations and How to Avoid Them, How to Prepare for a Site Visit. The “Works for Me” site has a chemotherapy certification course

    23. Tools: Where to Look for Help The American Society of Pediatric Hematology/Oncology Site for training program directors (for sharing information, documents, links and files in an organized, searchable library) – password protected

    24. Tools: Where to Look for Help European Hematology Organization (www.ehaweb.org) Passport (a hematology curriculum) On-line cases ACGME Outcomes Project Toolbox Educating Physicians for the 21st Century RSVP (Recognize Success Via imPlementation) Educating Physicians for the 21st Century is a collection of 4 powerpoint presentations and facilitator notes that you could use for “faculty development”, and include topics such as Developing an Assessment System and Developing a Competency-Based Curriculum. Educational Quality Improvement is coming soon. Educating Physicians for the 21st Century is a collection of 4 powerpoint presentations and facilitator notes that you could use for “faculty development”, and include topics such as Developing an Assessment System and Developing a Competency-Based Curriculum. Educational Quality Improvement is coming soon.

    25. My Conclusions Although many evaluation methods are used, faculty feedback is the cornerstone of the evaluation in essentially all programs surveyed Faculty development to make faculty better observers would be useful Simulation not yet incorporated into most programs Resources are available on-line

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