Competency Evaluation Forms Karen M. Weidenheim, M.D. Neuropathology

The Problem What do the competencies mean for a small subspecialty program? How should the re-defined competency criteria be measured? How can the required assessments be performed efficiently? How can the assessment process be made useful to both trainee and Program Director?

#1: Patient Care in Neuropathology. Fellows must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. In the context of neuropathology, this means recognizing one’s personal responsibility to provide clear, accurate, and timely consultations in the context of a medical team. Extent to which Resident communicates effectively and demonstrates caring and respectful behavior when interacting with patients, next of kin, technicians, secretaries, funeral home personnel and others. Observe the right of privacy about personal health information in public places (elevator, hall, cafeteria) Observes discretion during surgical procedures Provides lay language answers to questions from technicians, secretaries, funeral home personnel Provide lay language answers to questions from families in a caring and respectful manner Extent to which Resident gathers essential and accurate information about their patients Pertinent clinical history, imaging data and laboratory results are available at sign-out

#1: Patient Care in Neuropathology. Fellows must... Recognize one’s personal responsibility to provide clear, accurate, and timely consultations in the context of a medical team (continued) Extent to which Resident makes an informed diagnosis incorporating patient information, pathological/clinical judgment and up-to-date scientific evidence. Able to formulate a Neuropathology diagnosis in the context of prognostic and therapeutic implications for the patient, the clinical history and implications for family Extent to which Resident performs dissection and sectioning skills necessary for diagnostic services Able to remove brain and spinal cords at autopsy Able to accurately describe and section gross neurosurgical specimens Able to accurately describe microscopic features Able to evaluate special stains and their controls

#1: Patient Care in Neuropathology. Fellows must... Recognize their personal responsibility to provide clear, accurate, and timely consultations in the context of a medical team (continued) Extent to which Resident makes informed selections of diagnostic tests, is able to counsel clinician on selection of additional testing, and can take responsibility for the cost and ethical implications of the tests recommended/ordered Able to order appropriate work-up of case so as to arrive at correct final diagnosis Able to recognize cases that require additional testing of tissue or body to counsel clinician on additional testing Extent to which Resident uses information technology to support patient care decisions, especially searching the current literature and Web for help in difficult diagnostic situation. Effectively searches literature for information pertinent to a given entity Effectively searches Web for information pertinent to a given case

Competency #2. Medical Knowledge in Neuropathology. Resident must demonstrate knowledge about established and evolving biomedical, clinical and cognate (epidemiological and social- behavioral) sciences and the application of this knowledge to patient care in neuropathology. Extent to which Resident knows and applies the basic and clinically relevant sciences that are appropriate to the practice of Neuropathology Demonstrates knowledge of basic pathological processes appropriate for level of training Demonstrates organized approach to a case in context of own knowledge base Formulates appropriate differential diagnosis Demonstrates knowledge of neuropathology facts appropriate for level of training (See attached test)

#3. Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practice. Residents are required to keep a log of cases in which they found it necessary to look up a technical or professional issue, including case number, date, issue identified, by what means the problem was solved (look up a specific article, call the manufacturer of a reagent, ask a technician or colleague for assistance). Case logged checked and found to be acceptable/unacceptable by_____________.

#4: Interpersonal and communication skills in neuropathology. Neuropathology fellows must be able to demonstrate excellent interpersonal and communication skills that result in effective information exchange and teaming with patients, patients’ families, colleagues, technicians, secretaries, other residents, and students. Able to explain diagnosis and implications for therapy –Observe interactions with Neurosurgeons and Neurologists –Performance in clinical conferences Able to explain how to perform a diagnostic test (e.g., muscle and nerve biopsies, brain biopsy, brain autopsy) –Observe interactions with Neurosurgeons and their residents –Observe interactions with general pathology residents Able to write diagnoses and reports in standard English Able to work with technicians to solve problems –Observe interactions with technical staff –Inquire about quality of interactions Pathologist Assistants Dieners Technicians

#4: Interpersonal and communication skills in neuropathology. Neuropathology fellows must be able to demonstrate excellent interpersonal and communication skills that result in effective information exchange and teaming with patients, patients’ families, colleagues, technicians, secretaries, other residents, and students. Is able to present clinical findings in patient-related conferences –Direct observation with documentation by checklist Is able to present clinical and research data at professional meetings –Observation –Documentation in conference proceedings Is able to publish clinical or research papers in peer-reviewed journals –Documentation in literature –Curriculum vitae –Resident’s portfolio

#5: Professionalism in neuropathology. Fellows must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diverse populations. It is recognized that neuropathologists interact only occasionally with patients and their families. More frequent interactions include those with colleagues in pathology, colleagues in neurology and neurosurgery, laboratory technicians, secretaries, other residents and students. Respect for others Honesty and integrity Tolerance, sensitivity to differences Altruism Dutifulness 360 o Evaluation –Peers –Subordinates

#5: Professionalism in neuropathology. Fellows must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diverse populations. It is recognized that neuropathologists interact only occasionally with patients and their families. More frequent interactions include those with colleagues in pathology, colleagues in neurology and neurosurgery, laboratory technicians, secretaries, other residents and students. Able to admit and correct mistakes Successfully represents field of (Neuro)pathology –Other Pathologists –Neurology and Neurosurgery –Other physicians Professional development Society at large –Professional and personal actions are those of a good citizen

#6: Systems-based practice in Neuropathology. Fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care. In neuropathology, the fellow must be able to provide effective guidance to the clinicians directly responsible for making treatment decisions and calling on system resources. The fellow must be aware of the consequences to the patient of the diagnosis and play an active role in assuring that the appropriate care is provided. The fellow must be able to interact successfully with technicians, clerical personnel and other paraprofessional members of the laboratory and health care team to obtain the best possible outcome for the patient. Extent to which Resident understands how their diagnostic opinion and other professional practices affect other health care professions, the organization and the larger society. Demonstrates awareness of clinical deadlines faced by clinical services that rely on their diagnostic services Demonstrates awareness of cost of tests

#6: Systems-based practice in Neuropathology. Fellows must demonstrate... responsiveness to the larger context and system of health care. In neuropathology, the fellow must be able to provide effective guidance to the clinicians directly responsible for making treatment decisions and calling on system resources... be aware of the consequences to the patient of the diagnosis and play an active role in assuring that the appropriate care is provided... interact successfully with technicians, clerical personnel and other paraprofessional members of the laboratory and health care team to obtain the best possible outcome for the patient. Able to allocate pathology resources in a way that does not compromise quality of care Willing to advocate for quality patient care –Day to day observation –OSCE

#6: Systems-based practice in Neuropathology. Fellows must demonstrate... responsiveness to the larger context and system of health care. In Neuropathology, the fellow must be able to provide effective guidance to the clinicians directly responsible for making treatment decisions and calling on system resources... be aware of the consequences to the patient of the diagnosis and play an active role in assuring that the appropriate care is provided... interact successfully with technicians, clerical personnel and other paraprofessional members of the laboratory and health care team to obtain the best possible outcome for the patient. Understands importance of using only CLIA-approved laboratories for diagnostic testing Able to refer specimens to appropriately certified reference laboratories for specialized testing Able to work with health care managers and providers to assess, coordinate and improve health care in the context of the clinical laboratory i.e. understands principles of Quality Assurance in Anatomic Pathology Understands how to prepare a laboratory for inspection by the CAP, JCAHO, or similar agency

Summary Helpful to resident –Specific subjects to study –Specific experiences to look for –Specific behaviors that are expected of a physician –Motivation to document their successes in a portfolio/curriculum vitae Helpful to Program Director –Monitor of resident progress –Specific areas of the program that need strengthening –Motivation to develop focused, more efficient evaluation methods –Identification of areas of the program that may be irrelevant