System of Evaluation

Residents are evaluated on core competencies delineated by the ACGME by their supervising faculty, co-residents, support staff (nurse practitioners, nursing, and social workers), students and patients while on clinical rotations as part of a 360-evaluation process.

The “Educational Milestones” method of resident evaluation and performance tracking will be implemented in the 2015 academic year.

The Educational Milestones

(The Milestones) are observable developmental steps, organized under the six competency areas, that describe a trajectory of progress on the competencies from novice (entering resident) to proficient (graduating resident) and, ultimately, to expert/master. They provide a framework for the assessment of the development of the physician in key dimensions of the elements of physician competency in the given specialty (Child Neurology).

Residents will undergo a structured evaluation of their expected and achieved milestones on a bi-annual basis. This will be done by a Clinical Competency Committee made up of various faculty members involved in resident education.

The following elements will be used for the purpose of evaluating residents’ Educational Milestones by the Clinical Competency Committees and providing feedback for the purpose of meeting future milestones.

1. Faculty evaluation and feedback of resident performance

   1. At the completion of each clinical rotation, faculty will complete written evaluations using the Medhub system. These evaluations measure a resident’s proficiency of the core competencies through the framework of the Educational Milestones.
   2. During clinical rotations, the attending will provide verbal feedback during clinical case presentations and review of neuroradiology studies.
   3. During clinical rotations, the attending will provide verbal evaluation and feedback during bedside history-taking and neurological exam.
   4. During clinical rotations, the attending will review resident notes – including admission and daily progress notes, procedures notes, as well as discharge summaries. He or she will evaluate notes for appropriate structure, thoughtful differential diagnosis, and formulation of appropriate management plan
   5. After completion of rotations where the resident acts as a supervisor (child neurology ward and consult services), outcomes will be presented at monthly morbidity and mortality conference, where they receive verbal and written feedback on performance by senior faculty.
   6. At the mid-point and completion of clinical rotations, faculty will provide verbal feedback to the resident, with a focus on strengths and areas with room for improvement. These evaluations will be modeled on the six core competencies as identified by the ACGME.
   7. During clinical rotations, the attending will provide a witnessed bedside history and neurological exam, with subsequent case discussion, in preparation for the clinical skills examination.

2. Peer evaluations

   1. Senior residents and clinical fellows evaluate the performance of junior residents with whom they work, particularly in the domains of medical knowledge, patient care, interpersonal skills and communication, and professionalism and will share this information with the faculty member responsible for providing written evaluation of the resident.
   2. Senior residents and faculty will evaluate competence in procedures, lumbar puncture and stroke thrombolysis, and document successful completion of 5 procedures on Medhub before the resident can perform them independently.
   3. Junior residents evaluate their senior residents and fellows, particularly addressing the domains of teaching, leadership and team organization and will share this information with the faculty member responsible for providing written evaluation of the resident.
   4. Residents will be evaluated by the ancillary/support staff on the inpatient services. Support staff will evaluate residents in particular on professionalism, interpersonal skills and communication, patient care, and systems-based practice. On a quarterly basis, the program directors will collect written evaluations from social workers, nurses, physician extenders, and hospital leadership.

3. Program director and chairman evaluations

   1. Every six months each resident will have a meeting with the program director and the department chairman will have a meeting, once with each during the course of the year.  During this meeting, the program director or program chairman will review written feedback.
   2. At the completion of the residency training the program director will complete a summary evaluation that confirms competency to begin practice without direct supervision. 

4. Nurse practitioner/hospitalist evaluations of residents

Where applicable the nurse practitioners or hospitalist who works with resident on the in the care of children on the inpatient pediatric neurology and pediatric neurosurgery service evaluate competency on a number of domains namely, interpersonal skills and communication, signing out of patients, practice-based learning and improvement, including time management skills, ability to work with others members of the health care team and share information with other providers at interdisciplinary rounds

5. Nursing and social work evaluation of residents

Nurses on the inpatient floors as well as social workers on the inpatient floors give written and verbal evaluation of each resident to the program director who will communicate this feedback to the residents

6. Peer evaluations

   1. Senior residents and clinical fellows evaluate the performance of junior residents with whom they work, particularly in the domains of medical knowledge, patient care, interpersonal skills, communication, and professionalism.  Feedback may be either verbal or via the MedHub system
   2. Senior residents and fellows evaluate competence in procedures, including lumbar puncture, peripheral nerve blocks, and BOTOX injections.
   3. Junior residents evaluate their senior residents and fellows, particularly addressing the domains of teaching, leadership and team organization.
   4. Any resident may offer verbal or written feedback to their peer-resident. The MedHub system may be used to providence written evaluation

7. Self-assessment evaluation

Residents will evaluate themselves, and use these self-assessments of their own knowledge and skills as a way to address practice-based learning and improvement and foster thoughtful reflection on their own career progress and plans.

8. Clinical skills evaluation

   1. As part of the American Board of Psychiatry and Neurology (ABPN) requirements to demonstrate competency in basic clinical skills, residents complete at least five observed history and physicals for which they are evaluated using the ABPN forms (see appendix 2).
      1. Residents are evaluated for competency in medical interviewing skills, neurological examination skills, and humanistic qualities, professionalism and counseling skills.
      2. The five required patient scenarios are in critical care, ambulatory (headache, seizures, etc.), neuromuscular, neurodegenerative, and child neurology (or adult neurology for the child neurology residents).
      3. Completion of these evaluations by faculty is additionally an opportunity for feedback and teaching.
      4. Two forms used for evaluation of this clinical skills exam are included as an appendix to this packet

9. Medical student evaluations

Following the completion of their clinical neurology rotations, medical students will give written feedback about their junior and senior residents in terms of their quality as a resident role model, teaching, and professionalism. This written medical student feedback will be reviewed with residents at semi-annual meetings with the program director.

10. Residency In-service Training Exam (RITE)

    1. The RITE is sponsored by the American Academy of Neurology to:
       1. Provide an opportunity for residents to assess their knowledge in neurology and neuroscience;
       2. Identify areas for further study;
       3. Serve as a tool for further education by providing references and discussion of each item.
    2. The test contains approximately 480 multiple choice questions in a single day test, usually administered in late February.

Scores are reported back to the resident and the department about 6 weeks after the exam, and will be included in review meetings.

11. Feedback

At the end of each rotation, CN residents should seek verbal feedback from the respective Consult and Ward attending they have worked with.  Evaluations are performed at the end of each 2-week rotation module.  In addition, beginning in 2012, residents are evaluated quarterly by the program director.   

12. Attendance at Conferences

    1. Attendance at conferences will be used as one way of assessing medical knowledge, professionalism, and practice-based learning and improvement.
    2. Residents are expected to attend all conferences unless exempted because of urgent patient care responsibilities, Bell Commission requirements, or permission from the Chief Residents or faculty member. Conferences include:
       1. Neuroradiology Conference (Wednesday Noon: HP5)
       2. Monday, Chief of service lectures
       3. Tuesday Child Neurology Didactics Lecture Series
       4. Evidence Based Neurology Sessions/CPC: 3^rd Wednesday HP5 at 4pm
       5. Tuesday Morning Report
       6. Child Neurology Division Rounds Friday 9 am HP 5^th Floor Conference Room
       7. Neurology Grand Rounds: Friday 1:15 pm NI-1
       8. Morbidity and Mortality: 2^nd Friday of the month
       9. Journal Club: 3^rd Friday of the month
       10. Pediatric Neurosurgery Conference: Weekly Thursday 1pm NI2

Attendance will be monitored by requiring residents and attending faculty to sign attendance sheets for all conferences with the exception of work rounds.

13. Resident Evaluation of Program

    • All residents will have the opportunity to evaluate the program confidentially and in writing at least annually, and the program will use this feedback to make improvements to the training experience.
    • The following mechanisms will be used to evaluate the program:
      1. Online feedback of the program in a written format through the MedHub system
      2. Annual meeting of all residents to discuss weaknesses and items of deficiency in the program
      3. Annual written feedback and evaluation of the residency program
         • Items identified through the annual resident meetings and written evaluations will be used to develop an action plan in conjunction with the program director and department chairman
      4. Individual in-person meetings between each resident and the program director to give verbal evaluation and feedback on the residency program strengths and weaknesses.  This is done quarterly when the program director meets with each resident.