Mapping of the Milestones for Meaningful Evaluations. Renuka Verma, MD The Children s Hospital at Monmouth Medical Center, Long Branch NJ 07740

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Sherman McDaniel
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1 Mapping of the Milestones for Meaningful Evaluations Renuka Verma, MD The Children s Hospital at Monmouth Medical Center, Long Branch NJ 07740

Presenters Janice Lichtenberger, MD Associate Pediatric Program Director The Children s Hospital at Monmouth Medical Center, Long Brach, NJ Angela L.

2 Presenters Janice Lichtenberger, MD Associate Pediatric Program Director The Children s Hospital at Monmouth Medical Center, Long Brach, NJ Angela L. Myers MD, MPH Assistant Professor of Pediatrics/Division of Infectious Diseases Pediatric Infectious Diseases Fellowship Program Director Children's Mercy Hospitals & Clinics University of Missouri Kansas City School of Medicine Chad Brands, MD Residency Program Director/Director of Medical Education All Children s Hospital Johns Hopkins Medicine, St. Petersburg, FL

3 Disclosure None

4 Background APPD LEAD Evaluation Tool Faculty participation Resident participation Workshop

5 Patient Care Gather essential and accurate information about the patient Too little information, Too Much Information Synthesizes Positive /negative pertinent findings, broad diagnostic categories Filters, prioritize and synthesize diagnostic considerations, with real-time development of a diff dx Well-developed illness scripts, precise diagnoses reached with ease with most pediatric problems Essential, accurate information gathered in efficient manner, leads to robust illness script Organize and prioritize responsibilities to provide patient care that is safe, effective, and efficient Struggles to organize patient care responsibilities between individual patients Vs multiple patients Organizes care of a few patients efficiently; occasional prioritization, interruption leads to decreases in efficiency Organizes care of many patients efficiently; Routine prioritization, Anticipates future needs; Ability to effectively prioritize, interruptions Organizes a large volume of patients with marked efficiency. Proactive prioritization, interruptions in task lead to brief breaks Role model efficiency. Proactive prioritization, safe and effective multitasking in essentially all situations. Perform complete and accurate physical examinations (PE) Performs and elicits most PE maneuvers incorrectly. Does not fine-tune the head-totoe PE approach based on complaint/patient's age Performs basic PE maneuvers correctly but does not regularly elicit, recognize, abnormal findings. Sometimes uses a developmentally appropriate approach. Performs basic PE correctly, recognizes and interprets abnormal findings. Consistently uses a developmentally appropriate approach, elicits a myriad of positive &negative findings for diff dx Performs, and interprets most PE maneuvers accurately with patient s cooperation, anticipates and look for specific positive or negative findings of only the most relevant diagnoses Performs, elicits, recognizes, and interprets the key specific PE findings correctly most of the time, that will discriminate between competing similar diagnoses Develop and carry out management plans out plans based on directives.unable to adjust plans for individual patient differences /preferences. Communication is unidirectional. out plans based on theoretical knowledge and/or directives. Adapt plans to the individual patient. Management plans based on the framework of one s own assumptions and values. out plans for common problems based on both theoretical knowledge /experience. Focuses on key information, but limited by time and convenience. Follows directives and utilizes bidirectional communication. out plans based on experience. Focuses on key information. Incorporates patients assumptions and values through bidirectional communication with little personal biases. Develops and carries out plans based on experience. Rapidly focuses on key information. Focuses on the patient/family values in a bidirectional conversation, with personal insight. MEDICAL KNOWLEDGE Demonstrate sufficient knowledge of the basic and clinically supportive sciences appropriate to pediatrics Does not know or remember the basic content knowledge of common pediatric problems. Understands the basic content knowledge of pediatrics, but is still learning to apply it to clinical situations. 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, generates a meaningful differential diagnosis Able to evaluate knowledge appropriately in clinical encounter to develop meaningful management plans. Learns from experience; analyzes, evaluates, and creates, adapts, or extrapolates information appropriately to new clinical situations and encounters.

6 Background APPD LEAD Evaluation Tool Faculty participation Resident participation Workshop

7 Workshop

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

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