A ROADMAP TO UNDERSTANDING AND ASSESSING AMBULATORY MILESTONES
Description: With the implementation of the ACGME Next Accreditation System (NAS), individual institutions and residency programs must develop frameworks to describe and assess trainee competency. Many interenists and training programs continue to struggle with the verbiage of milestones, EPAs, and narratives; which affects their understanding and ability to develop useful assessment tools. For the NAS to be feasible, reporting milestones need to be transformed into usable and reliable methods for the assessment of learners. To meet these goals, the assessment must be appropriate to the educational goal (knowledge, attitude, or skill) being assessed; be reasonable to implement; yield objective information to be used to enhance resident development; and capture data that is representative of the resident’s skills or ability. The continuity clinic setting is an ideal place to observe specific resident practice behaviors over time in order to assess their achievement of milestones for NAS.
This workshop will examine the relationship between milestones, EPA’s and ambulatory-specific activities and help clinician educators develop tools to be used to assess residents in their continuity clinic.
After a brief review of definitions and description of current challenges, attendees will break out in small groups using a novel Milestones worksheet designed by the presenters in collaboration with the Society of General Medicine (SGIM)’s Milestone Subcommittee of the Education Committee. This worksheet lists each reporting milestone, and asks the following questions:
1) How important is each milestone for residents’ competency in continuity clinic?
2) List assessment tools to best evaluate this milestone
3) Designate the person best able to observe and assess this milestone
4) Identify the location within the continuity clinic setting best suited to observe and asses this milestone
5) Rank the top 6 milestones uniquely assessable in residents’ continuity clinic
Participants will work collaboratively in small groups to answer these questions before reporting out for large group discussion, while considering potential assessment tools that are used in the ambulatory setting, potential clinic staff that can act as observers and assessors, and best locations suitable for observations. This process will frame the specific observers, tools and locations appropriate for the assessment of each milestone and provide participants with insight into methods to increase direct observation in the continuity clinic setting.
A facilitated group discussion of the process, its outcome, and how to apply this ambulatory assessment tool to their home institution will conclude the workshop. In particular, this discussion will address the anticipated barriers to change and the steps that one must take to create an assessment tool from the prioritized worksheet that incorporates existing assessment and direct observation methods, interfaces with online New Innovation evaluation forms and is easily disseminated amongst their teaching colleagues.
1. Define milestones, EPAs, and narratives and describe their relation to each other and resident competency assessment.
2. List NAS reporting milestones relevant to the ambulatory setting and how best to assess those milestones.
3. Develop a detailed action plan for creating a useful ambulatory assessment tool using the provided milestones worksheet.
Format: This is a 1.5 hour workshop which targets residency administrative faculty including program directors, associate program directors and residency clinic directors who are tasked with developing and implementing competency-based medical education assessments in the ambulatory setting. However, clinic preceptors and core faculty members who are heavily involved in teaching and assessing learners in the outpatient setting will find this workshop invaluable.
Contact: Margaret C. Lo, MD, FACP
Department of Medicine, Division of Internal Medicine
352-263-0239 Residency Office