Ability to link signs/symptoms of current patient to previous clinical encounters; allows filtering of info to produce broad. differential.

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Joseph Bridges
6 years ago
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1 Patient Care Novice Advanced Information gathering Organization of responsibilities Transfer of Care Physical Examination Decision Making Development and execution of plans Gathers too much/little info; limited ability to organize, filter info relative to patient s complaint Struggles to organize patient care responsibilities; unable to multi-task Variability of transfer of from one patient to the next; frequent errors Performs many skills incorrectly; head-to-toe regardless of age or stage Broad and unfocused diagnosis; difficulty in developing a plan of care plans based on Ability to link signs/symptoms of current patient to previous clinical encounters; allows filtering of info to produce broad diagnosis Organizes care of a few patients with efficiency; occasionally able to multi-task Uses a standard template for the provided during the handoff; unable to deviate from template to adapt to more complex situations; some errors Performs basic maneuvers correctly but does not regularly elicit abnormal findings; sometimes alters appropriate to age and stage Some synthesis of gathered but inexperience often results in a myriad of tests and therapies and unclear plan of care plans based on one s Advanced pattern recognition leads to development of illness scripts; allows real-time development of diagnosis Organizes care of many patients with efficiency; ability to multi-task only affected when patient volume is high Reliably adapts and applies standardized template relevant to individual patients; minimal errors Performs basic maneuvers correctly and usually recognizes abnormal findings; developmentally appropriate Experience allows elicited clinical findings to be compared to previous cases; often results in a well-synthesized diagnosis and plan of care plans based on both Well-developed illness scripts allow precise diagnosis for most pediatric problems Provides care to large volume of patients with efficiency; anticipates interruptions in work flow and deals with them proactively Adapts and applies a standardized template to increasingly complex situations in a broad variety of settings and disciplines Performs, elicits, recognizes, and interprets the findings of most maneuvers correctly; successful in using a developmentally appropriate Early directed diagnostic hypothesis testing; effective and efficient diagnostic work-up and plan of care carries out plans based on experience; Robust illness scripts; efficient gathering of pertinent allows accurate diagnosis in all but most complex, rare cases Serves as a role model of efficiency; safe and effective multitasking of responsibilities in all situations Adapts and applies the template without error and regardless of setting or complexity Performs, elicits, recognizes, and interprets the findings of even special testing maneuvers correctly plans even for

2 Medical Knowledge Medical Knowledge Evidence-Based Medicine Practice Based Learning and Improvement Self-evaluation Learning attitudes/activities directives from others; unable to alter plan based on patient preferences theoretical /or directives from others; one s own assumptions/values form basis of plan some experience; begins to incorporate patients assumptions/values effectively and efficiently focuses on key to arrive at a plan; incorporates patients complicated or rare situations; can filter out one s own values and assumptions and assumptions/values focus on with little patient/family interference from personal biases Beginning Novice Developing Near Mastery Mastery Does not know, remember the basic content knowledge of common pediatric problems and illnesses Explains basic principles of EBM; limited by lack of clinical exposure Novice Acknowledges external assessments but understanding of performance is superficial and limited to the overall grade or bottom line Sets learning activities based on readily available Understands the basic content knowledge of pediatrics, but is still learning to apply it to clinical situations Recognizes the importance of using current to care for patients and responds to external prompts to do so; able to formulate questions with some difficulty Advanced Assessment of performance is seen as being able to do or not do the task at hand without appreciation for how well it is done and whether there is a need to improve the outcome Well-defined goals are mapped to appropriate learning activities Understands the basic content knowledge of pediatric practice, and is able to synthesize and apply it in a clinical situation Able to analyze and categorize knowledge in a way that allows the generation of a meaningful diagnosis Able to evaluate use it appropriately in any given clinical encounter to develop meaningful clinical plans Teaches critical appraisal of topics to others; strives for change at the organizational level Able to identify knowledge gaps as learning opportunities; makes an effort to ask answerable questions on a regular basis; Self-motivated to learn more and regularly formulates answerable questions; incorporates use of clinical evidence in rounds understands varying levels of evidence Prompts for understanding specifics of level of performance are internal and may be identified in response to uncertainty in completing clinical duties Learning resources are sought based on analysis of learning needs Prompted by anticipation or contemplation of potential clinical problems, the learner self-identifies gaps in performance through reflection Consideration of choice of activities is based on instructional Prompted by a self-directed goal of improving the self, the practitioner anticipates hypothetical clinical scenarios and addresses identified gaps Seeking resources to learn is undertaken with

3 Quality Improvement Incorporate feedback Interpersonal and Communications Skills Relates to patients/families Insight into human emotion curricular materials, irrespective of learning style, appropriateness of activity Unable to gain insight from encounters due to a lack of reflection on practice; limited understanding of quality Defensiveness and inability to receive feedback and/or avoidance of feedback; limited incorporation of formative feedback into daily practice Novice Uses standard medical interview template and does not vary based on a patient s unique needs Does not accurately anticipate or read others and resources based on assigned curriculum Able to gain insight from reflection on individual patient encounters, but potential s limited by lack of systematic strategies Beginning to acknowledge other points of view, but reinterprets feedback in a way that serves her own need for praise or consequence avoidance; little to no behavioral change occurs in response to feedback Advanced Uses the medical interview to establish rapport and focus on exchange relevant to a patient s or family s primary concerns; identifies social concerns but has difficulty managing them Begins to use past experiences to anticipate and read the emotional assessment and constructed goals and with consideration of nature of learning content and method Able to gain insight for opportunities from reflection on both individual patients and populations; grasps methodologies Understands others points of view and changes behavior to improve specific deficiencies that are noted by others methods that are known to be effective in the development of the relevant knowledge content, application of that knowledge, and development of skills Able to use both individual encounters and population data to drive using methodology; able to lead a team in Internal sources of feedback allow for insight into limitations and engagement in selfregulation; improves daily practice based on both external formative feedback and internal insights high efficiency and effectiveness, with open and flexible inclusion of the influences from outside sources continuous activities and appropriately uses quality methodologies; tries to use one s own successes to benefit others Professional maturity and deep commitment that lead to continuous reflection and internal feedback that lead to continuous Uses the interview to effectively establish rapport; able to mitigate social concerns in most situations Anticipates, reads, and reacts to emotions in real time with Uses communication to establish and maintain a therapeutic alliance; works to tailor communication to the individual Perceives, understands, uses, and manages emotions in a broad Connects with patients and families in an authentic manner that fosters a trusting and loyal relationship Intuitively perceives, understands, uses, and

4 emotions in verbal and nonverbal communication; unaware of one s own emotional and behavioral cues responses in herself and others; does not have the insight to moderate her behavior to effectively manage the emotions Professionalism Novice Advanced Duty and accountability Ethical Behavior Humanism, Integrity, Compassion Self-awareness of knowledge, skills and emotions Appears to be interested in learning pediatrics but not fully engaged and involved as a Repeated lapses in conduct wherein responsibility to patients, peers and/or the program are not met Sees the patients in a we versus they framework and is detached and not sensitive to the human needs of the patient The lack of insight into limitations results in the need for help going unrecognized, sometimes resulting in unintended consequences Appreciates the role in providing care and being a, at times has difficulty in seeing self as a, which may result in not taking appropriate responsibility Under conditions of stress or fatigue, there are documented lapses in conduct that lead others to remind, enforce, and resolve conflicts compassion for patients in selected situations but has a pattern of conduct that demonstrates a lack of sensitivity to many of the needs of others Concern that limitations may be seen as weaknesses that will negatively impact evaluations results in helpseeking behaviors typically only in response to external prompts appropriate and behavior in nearly all typical medical communication scenarios range of medical communication scenarios and learns from new or unexpected emotional experiences; perceived as a humanistic provider manages emotions to improve the health and wellbeing of others and to foster therapeutic relationships understanding and appreciation of the role and the gravity of being the doctor by becoming fully engaged in patient care activities; has a sense of duty In nearly all circumstances, conducts interactions with a mindset, sense of duty and accountability consistent understanding of patient and family expressed needs and a desire to meet those needs on a regular basis Recognizes limitations, but perception that autonomy is a key element of one s identity as a physician may interfere with internal drive to engage in appropriate helpseeking behavior Has internalized and accepts full responsibility of the role and develops fluency with patient care and relationships In-depth understanding of ism that allows him to help other team members and colleagues with issues of ism Is altruistic and goes beyond responding to expressed needs of patients and families Recognizes limitations and has matured to the stage where a personal value system of helpseeking for the sake of the patient supersedes any perceived value of physician autonomy Extends role beyond the care of patients and sees self as a who is contributing to something larger Others look to this person as a model of conduct Is a proactive advocate on behalf of individual patients, families and groups of children in need Beyond recognizing limitations, the personal drive to learn and improve, results in the habit of engaging in help-seeking behaviors

5 Trustworthiness Recognize uncertainty and ambiguity in medicine Systems-Based Practice Coordination of care Advocate for quality care Work in inter teams Has significant knowledge gaps or is unaware of knowledge gaps; demonstrates lapses in gathering or in follow-through Feels overwhelmed and inadequate when faced with uncertainty or ambiguity Novice Develops care plans independent of patient; no written plan provided; requests consultations with little or no communication; not involved in the transition of care; social concerns not addressed Attends to medical needs of individual patients Tends to dismiss input from other Has a solid foundation in skill but is not always aware of or seeks help when confronted with limitations; lapses in follow-up Recognizes uncertainty and feels tension/pressure from not knowing or knowing with limited control of outcomes Advanced Begins to involve the patient in plan of care; written care plan is occasionally made; variable communication with consultants; social concerns are considered recognition that an individual patient s issues are shared by other patients, that there are systems at play, and that there is a need for quality Beginning to have an understanding of the other Solid foundation in skill with realistic insight into limits with responsive help seeking; little prompting is required for followup Broad scope of skill and assumes full responsibility for all aspects of patient care, anticipating problems and demonstrating vigilance in all aspects of Anticipates that uncertainty at the time of diagnostic deliberation will be likely; uses such uncertainty as a motivation to seek or understanding of unknown As above, but any uncertainty brings about rigorous search for answers and conscientious review of to address change Anticipates and focuses on uncertainty, looking for resolution by seeking additional Seeks to understand patient goals for health and their capacity to achieve those goals, given the uncertain treatment options Recognizes the responsibility to assist families in navigation of the complex healthcare system and involves patient in plan of care; written care plan is frequently made available; discusses case with consultants and involved in transition of care; social concerns are usually addressed Acts within the defined medical role to address an issue or problem that is confronting a cohort of patients Aware of the unique contributions of Actively assists families in navigating the complex healthcare system; care plan is developed and decisions are made jointly with the patient; facilitates care through active communication with consultants and coordinates seamless transitions of care; focuses on familycentered, culturally effective care Actively participates in hospital-initiated quality and safety actions; demonstrates a desire to have an impact beyond the hospital walls In addition to the above features, individuals at this Identifies and acts to begin the process of projects both inside the hospital and within one s own practice community

6 s aside from other physicians s on the team and is open to their input; still acquiesces to physician authorities to resolve conflict and provide answers other health care s; seeks their input for appropriate issues; excellent team player stage understand the broader connectivity of the professions and their complementary nature; recognizes that quality patient care only occurs in the context of the inter team

CCC: Milestone Descriptions for 21 Sub-Competencies

CCC: Milestone Descriptions for 21 Sub-Competencies A. PATIENT CARE 1. Gather essential and accurate information about the patient Either gathers too little information or exhaustively gathers information