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EDUCATIONAL ISSUES IN GME |
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Core Curriculum
The ACGME has defined the following six areas as areas in which all physicians should have reference to and current information on.
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Professionalism--see Medical professionalism project, http://www.professionalism.org/ for current issues on medical professionalism
Medical Ethics: www.rcpsc.medical.org/english/ethics; eduserv.hscer.washington.edu/bioethics; http://www.va.gov/VHAETHICS/, Relationship to industry (drug companies)
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Socio-economics
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Medical / Legal
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Cost Containment
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Communications
Core Competencies
The ACGME has defined the following six areas as minimum competencies required for all physicians.
- Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health
- Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care
- Practice-Based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care
- Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families, and other health professionals
- Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population
- Systems-Based Practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value
This link is the competencies presentation Dr. Fabri presented at the June 2002 GME Retreat.
Evaluating the Core Competencies
The GME office has developed a secure relational database which can be accessed via the World Wide Web to assist each program director with the documentation related to the ACGME Outcomes Project. The relational database maintains the ratings for the six core competencies which all program directors assign to their residents. The data base is secure. Only program directors and key administrative staff can extract resident specific information from it. Instructions for using it follow:
Go to the website:
http://hscapps.hsc.usf.edu/panther/bin/prpweb.exe/drevalqscreen1.jam
If you print this page, and don't have a hyperlink, the easiest way to get to the website is to go to the HSC Home Page, select College of Medicine, then select Education, then select Graduate Medical Education, then select Competency Evaluation.
Enter the current year (2002)
Enter your HSCID. This is normally the first letter of your first name followed by the next 7 letters of your last name.
Enter your password. For security purposes, you should change it the first time you use the system.
Once the password is accepted, the resident search screen will appear. You may fill in the resident’s first name, last name, or click on the down arrow in the Program Box and select a program. Click on the SEARCH button. Residents meeting the criteria you selected will be displayed in a box below the SEARCH button. You may have to use the scroll bar on the right side of the screen to scroll down and find the resident's name.
Click on the name of the resident you wish to evaluate. An evaluation form with the resident’s first and last name will appear.
Select each one of the six tabs at the top of the form which correspond to each one of the six ACGME Core Competencies. Then rate each issue under each tab using the rating system described below.
Background for choosing the rating system: In the Dryfus model for evaluations, 1 is the rating for novice. It would probably be appropriate for an individual in medical school who has some limited knowledge or skill. 2 is the rating for an Advanced Beginner. This is generally defined, in the literature, as the level of knowledge, skill, or attitude expected of a new resident just completing medical school and just entering into a residency program. 3 is the rating for Competency. This is generally defined as the level of knowledge, skill, or attitude expected of a resident just completing Graduate Medical Education. This individual is ready to stand for the board exams in the medical specialty. According to some authors in the medical literature, the purpose of GME is to move the individual from the level of advanced beginner to the level of competency. 4 is the rating for Proficient. An individual who is proficient is generally one who has successfully completed the specialty's board certification process and who has several years of wide ranging experience in the medical specialty. 5 is the rating for expert. This rating would generally be reserved for the extremely proficient individual who is nationally recognized as a leader and a widely published scholar in the medical specialty.
The rating system: To work within the Dryfus model and maintain consistency among all of our programs, please use the following modification of the evaluation scale above to rate your observations of the resident's competency:
1. Advanced beginner. What you would expect from a new PGY-1
2. Below the peer group at the resident's current PGY level
3. On par with the peer group at the resident's current PGY level
4. Superior to the peer group at the resident's current PGY level
5. Competent. The level of knowledge, skill, and attitude expected of a resident completing Graduate Medical Education
6. Not Observed. This is counted as a null value and will not effect statistics.
Comments are optional, but encouraged. Comment field size is limited.
When
ALL of the ratings on the page have been filled in, click the SUBMIT
button. The page will not submit if one of the observations is left
blank. The number of
observations varies from tab to tab, but all must be completed or the system
will not let you move to the next one. If
you miss one of the evaluations and have to go back, be sure to page down to the
SUBMIT button when done. Remember,
It is OK to use number 6 (not observed). Once
all the observations in the section are complete and the SUBMIT button has been
selected, the page will be saved and you will be prompted to select another one
of the six tabs.
After the system has accepted each of the six parts, click on the button: SUBMIT FULL EVALUATION.
The system will respond: EVALUATION COMPLETE: YOUR EVALUATION HAS BEEN SAVED TO THE DATABASE. If you exit the program before doing this, the evaluation will not be saved. Once submitted, the evaluation cannot be changed. You may submit additional evaluations at any time.
You may select another resident to evaluate and continue as above or you may exit the program.
You may complete an evaluation of a resident whenever you desire. You may complete as many evaluations on a resident as you desire. One evaluation, every six months, is the minimum number of evaluations expected. (per ACGME Common Program Requirements, section V.)
If you encounter any difficulties with the program or with access to it, contact John Clements by email or call 813-974-7746.
For your convenience, this link will take you to a Microsoft Word version of the core competencies.
For additional information about the core competencies, this link will take you to the competencies presentation Dr. Fabri presented at the June 2002 GME Retreat.
Accreditation Council for Graduate Medical Education (ACGME): www.acgme.org
American Medical Association (AMA): www.ama-assn.org
Board of Medicine (Click on Allopathic or Osteopathic Medicine at following): www.doh.state.fl.us/mqa
Educational Commission for Foreign Medical Graduates (ECFMG): www.ecfmg.org
Florida
Department of Health Medical Quality Assurance: www.doh.state.fl.us/mqa
Florida Medical Association (FMA): www.fmaonline.org
Medical Insurance Plan – Preferred Providers: www.phcs.com
Medical Professionalism Project, readings on medical professionalism: http://www.professionalism.org/
New England Journal of Medicine: www.nejm.org
US Health Science Centers and Medical Schools: medic.uth.tmc.edu/publ/00001170.htm
USF College of Medicine Home Page: http://health.usf.edu/medicine/home.html
USF College of Medicine Medical Informatics: www.hsc.usf.edu/CLASS
USF Health Compliance Program: http://www.research.usf.edu/cs/
Health Insurance Portability & Accountability Act (HIPAA) resources: www.olcsoft.com/hipaa_links.asp
How to Access Full Text, Online Medical Journals
Accessing Library Resources
1. Finding full text articles - This link provides four helpful steps on accessing full text articles:
http://www.health.usf.edu/library/How_to_Get_Journal_Article.pdf
2. Using the USF Catalog – This link provides a list of Frequently Asked Questions regarding the USF Library catalog:
http://sf.catalog.fcla.edu/sf.jsp?HLP=S&S=AEYDUDV8QMDKGY6C16XPICCVK53T2NF5ARTIEF9P1Q1BI6XV1P
3. Accessing Library Resources from home – This link provides you with instruction on how to access the USF library
resources off campus: http://www.lib.usf.edu/public/index.cfm?Pg=SignIn
Current articles related to the core curriculum
- Defining and Assessing Professional Competence
- Competence Is a Habit
- Quality Measurement of Outcome in General Surgery Revisited. Arch Surg. 2002; 137-52-54
- Prerequisite Objectives for Graduate Surgical Education: A Study of the Graduate Medical Education Committee American College of Surgeons. J Am Coll Surg 1998; 186:50-62
- Assessing the New General Competencies for Resident Education: A Model from an Emergency Medicine Program Acad. Med. 2001;76:753-757.
- Implementation of a College-wide GME Core Curriculum. Acad. Med. 2001;76:331-336
Education Issues, Theories, etc.
Websites:
Internet Resources for Higher Education Outcomes Assessment
Texts:
Kern, DE, Thomas, PA, Howard, DM, and Bass, EB "Curriculum Development for Medical Education A Six-Step Approach", The Johns Hopkins University Press, Baltimore, 1998
Worthen, BR, Sanders, JR, and Fitzpatrick, JL "Program Evaluation Alternative Approaches and Practical Guidelines, Second Edition" Addison Wesley Longman, New York, 1997
Rothwell WJ, Kazanas, HC "Mastering the Instructional Design Process", Jossey-Bass, San Francisco, 1998
Rotational Goals and Objectives
This section will be developed and added to as the various departments submit goals and objectives for their rotations.
There is a Template to assist in the development of goals and objectives for each rotation at this link. Additional suggestions for using the template are here. These documents can be downloaded for your convenience.
The following website allows 360 degree feedback for the formative evaluation of our resident's professionalism. The website will seek and record inputs from patients, former patients, friends and family of patients, staff, and other members of the health care team concerning the professionalism demonstrated by our residents. The site is confidential, individuals submitting observations do not have to give their name, (but they can if they wish). The information on the site can only be viewed by each resident's program director and is designed to give the program director additional information to assist with the formative evaluation process.
http://hscapps.hsc.usf.edu/panther/bin/prpweb.exe/profevalenter.jam
The USMLE is the only mechanism currently available for obtaining a license
to practice medicine in any state in the US. Although regulations vary slightly from state to state, all states now have a limitation on the time
frame over which all three parts of the USMLE must be taken. In Florida, Part III must be taken within 7 calendar years of having taken the first
part. Because of the limit on the number of years and the fact that the Part III exam is easier to take early after medical school, we highly
recommend that individuals take part III of the USMLE at the earliest opportunity, which is during the second half of the PGY1 year.