The process for evaluating residents is dynamic and complex, and requires multiple assessment tools. At the Internal Medicine Residency Program at Morristown Medical Center, our approach is designed to provide each participant with individualized feedback for skills improvement. All evaluations faculty complete on trainees are not anonymous; however, peer-to-peer evaluations are always anonymous.
New Innovations, Inc., an electronic data system, tracks standard evaluations of residents, attendings and rotations. The system also keeps track of procedures, duty hours and conferences. New Innovations evaluations can be done privately online.
Throughout various rotations, residents have random charts reviewed by faculty and/or the chief resident. Instructive feedback is provided to individual residents to help improve note writing skills.
360 Degree Evaluations
Patients and staff periodically assess each resident during several inpatient and outpatient rotations throughout the three-year training period. Feedback is designed to improve the Accreditation Council of Graduate Medical Education (ACGME) competency of interpersonal skills and communication.
Portfolios are used for rotations for which standard evaluations would not provide an accurate assessment of resident performance. Multiple assessment tools are used to compile an accurate picture of performance and may include case summaries, chart audits, peer evaluations and narratives of a stressful event. Residents also submit "scholarly" work to their scholarly activity portfolio on New Innovations.
Evaluation of Oral Presentation
Several times throughout training, residents are required to give an oral presentation. Faculty members in attendance use this assessment tool to provide feedback to residents to assist them in improving their skills in this area.
Morning Report Evaluation
A brief summary form is completed regularly by faculty present at Morning Report to provide feedback on performance in this forum. Information gathered is relayed to residents during the semi-annual evaluation.
Each fall, our categorical residents take the American Board of Internal Medicine (ABIM)-sponsored exam to assess their strengths and weaknesses. In January, the in-training exam scores are released and our residents sit individually with our program director or associate program director to review performances and develop personalized learning plans.
Praise and Concern Cards
On occasion, there are specific events or resident behaviors that warrant special attention, but do not fall in the parameters of the usual evaluation process. For this reason, we have an “on-the-fly” reporting system of “praise” and “concern” cards that can be submitted by attendings, residents, nurses or other staff. This system alerts us to noteworthy developments as they occur and gives each resident the recognition or special help she or he deserves.
Observed Clinical Skills Exercise (OCSE)
Interns will have the opportunity to attend the Icahn School of Medicine at Mount Sinai’s Institute for Medical Education for an OCSE session during the summer of their internship. Each resident will receive scores and videos to review his or her performance and make personal improvements.
Directly Observed Exercise (DOE)
Faculty members observe and provide feedback to residents on their performance of specific aspects of residency training. This may include history, examination, communication or counseling skills during a patient encounter; bedside presentation skills; sign-out rounds performance, etc. These can be done in both inpatient, outpatient and academic settings.
The Bioskills Rotation uses a portfolio-based system. Residents complete computerized video and testing modules on the web-based program called Procedures Consult. They also have the opportunity to practice procedures on various models and mannequins at our simulation center.
Early Academic Year Meeting
Interns meet with our program director early in the academic year to become acquainted with one another and develop first-year training goals. As reflected by our trademark "open door" policy, residents are always able to meet with the directors throughout the year to discuss any concerns or questions they have; no appointment is needed.
Longitudinal Ambulatory Advisor
Categorical residents meet with the assigned advisor for a portfolio review twice per year. The advisor may also meet with residents on his/her team at various times, depending on needs and performance.
Residents meet with our program director or associate program directors several times per year to review individual resident goals and performance. Since instructive feedback is a two-way street, directors always welcome suggestions for program improvement.
Clinical Competency Committee (CCC)
The CCC meets multiple times per year to review resident performance as it relates to the ACGME milestones. The CCC is composed of 17 faculty who have close resident contact, and review the records of a subset of residents. Information about resident performance provided by the CCC is used by the Program Director to submit twice annually to the ACGME, as required. Through New Innovations, residents receive instructive feedback about the CCC’s assessment after each meeting.