New ‘Competencies’ Model: A Better Way to Evaluate Residents

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Children's Doctor

I’ ll admit it. I dreaded the old way we evaluated residents. For residents, it was subjective and judgmental. For faculty, it was burdensome and confusing.

I’m happy to say those days are over. Since July 2013, the Accreditation Council for Graduate Medical Education (ACGME) has required pediatric residency programs to report the performance of their residents along six core competencies and the 21 subcompetencies into which they are subdivided. Each resident’s progress is tracked as he or she successfully reaches and surpasses predetermined “milestones” along the 21 subcompetencies.

Think of it as the Denver Developmental Screening Test for trainees, but instead of competencies such as fine or gross motor skills, faculty evaluate trainees along competencies such as patient care, medical knowledge, and interpersonal/ communication skills. But like the Denver Test, there are markers of acceptable performance, and the accumulation of skills and development can be charted—making it easy to see where a resident might be lagging or excelling. Then that resident can be coached or challenged to keep him or her on the path toward being a fully competent pediatrician, one we’d want to send our own children to.

The Children’s Hospital of Philadelphia is co-leading a group of 20 top pediatric residency programs that is adopting a new system called MiBEST: Milestones-Based Evaluation Strategies. We feel it’s a way to maximize feedback to residents while making it easy for the attendings who will be evaluating them.

Faculty members evaluate residents using an online form with short explanations of the skills, or milestones, appropriate for each level of training. For example, for the subcompetency “Organize and prioritize responsibilities to provide patient care that is safe, effective, and efficient,” the intern-level milestone is “ Able to organize responsibilities for a panel of patients with some prioritization skills. Interruptions sometimes lead to prolonged or permanent disruption of task completions.” The late-senior-resident-level milestone is “Demonstrates efficient and thorough patient care by optimizing organization and anticipating some future needs. Interruptions are handled easily.” Evaluators just click the milestone description that most closely matches the resident’s actual performance and add additional text comments if they choose.

Residents don’t get a final grade. Instead, they receive evaluations that are more objective and show how they are developing as physicians along several different parameters. Are they right on target? If they are low achieving in some areas, they can see what specific skills to work on. High achievers can see what’s next.

In addition to the valuable information that residents and educators receive, the ACGME will be evaluating residency programs based on how well residents perform along the competencies. This outcomes-based approach has a simplicity and transparency that is satisfying to all.

Lisa Zaoutis, MD, has been director of CHOP’s Pediatric Residency Program since August 2012.