Learning tool for tomorrow’s competent physicians: The eFolio

DEFINTION OF PORTFOLIO N. 1. A flat, portable case (as a briefcase, a large heavy envelope, or loose-leaf binder) for carrying papers or drawings. N. 1. A flat, portable case (as a briefcase, a large heavy envelope, or loose-leaf binder) for carrying papers or drawings. 2. The office and functions of a minister of state or member of a cabinet. 2. The office and functions of a minister of state or member of a cabinet. 3. The securities held by an investor or the commercial paper held by a bank or other financial house 3. The securities held by an investor or the commercial paper held by a bank or other financial house Webster’s Third International Dictionary

Definition of e-folio Educational tools for documenting learner achievement of competence and fostering reflection on practice with the intent of improvement. –Longitudinal record of professional growth –Documents learning –Self-assessments –Assessment by others

State of e-folios Many different eFolios under development Many different eFolios under development UME Collaborative UME Collaborative ACGME Portfolio Project ACGME Portfolio Project We are poised to create a fragmented collection of tools that are not portable and cannot communicate. We are poised to create a fragmented collection of tools that are not portable and cannot communicate.

Interest in a National eFolio Framework Colloquium (AAMC, NBME) May 2007 Colloquium (AAMC, NBME) May 2007 Invitational Conference (AAMC, ACGME, FSMB, NBME) October 2007 Invitational Conference (AAMC, ACGME, FSMB, NBME) October 2007 Aim – focus attention nationally on development of transportable, inter- operable efolios that meet the needs of the individual physician and local programs Aim – focus attention nationally on development of transportable, inter- operable efolios that meet the needs of the individual physician and local programs

Potential purposes of efolio Designation of learning objectives and expectations Designation of learning objectives and expectations Documentation of learning experience (case and procedure logs) Documentation of learning experience (case and procedure logs) Performance measures and processes of care Performance measures and processes of care Patient outcomes Patient outcomes Self-assessment (e.g. knowledge, skills, behaviors) Self-assessment (e.g. knowledge, skills, behaviors) Reflection and self-appraisal Reflection and self-appraisal Mentoring Mentoring External assessment of competencies External assessment of competencies Evaluation of programs Evaluation of programs Targeting of CME/CPD and maintaining CME/CPD logs Targeting of CME/CPD and maintaining CME/CPD logs Transparency for consumer choice Transparency for consumer choice

Proposed design principles For physicians and their needs, regardless of national origin, site of training, experience, status of licensure and certification For physicians and their needs, regardless of national origin, site of training, experience, status of licensure and certification Non-punitive system for private learning, self-assessment and self-improvement Non-punitive system for private learning, self-assessment and self-improvement State-of-the-art security and confidentiality State-of-the-art security and confidentiality

Proposed design principles Individual physician controls access to data and can authorize transmission of select data to demonstrate proficiency or satisfy external mandates Individual physician controls access to data and can authorize transmission of select data to demonstrate proficiency or satisfy external mandates Inter-operability across settings and transportability across the continuum of education and practice Inter-operability across settings and transportability across the continuum of education and practice

Service and Functions

Private learning environment for the physician in practice Self-assessment Self-assessment Self-appraisal and reflection Self-appraisal and reflection ?Mentoring ?Mentoring Planning for self-improvement Planning for self-improvement Finding and tracking CME Finding and tracking CME ?Expunge data when no longer contributory ?Expunge data when no longer contributory

Documenting proficiency to public Basic credentials (CV) for different purposes Basic credentials (CV) for different purposes External validation of data reported from private learning environment External validation of data reported from private learning environment Maintenance of certification Maintenance of certification Record of CME Record of CME Licensure application Licensure application Clinical privileges Clinical privileges Facility accreditation Facility accreditation

Challenges and Issues Balancing learning and evaluative uses Balancing learning and evaluative uses Two structural layers – private and public Two structural layers – private and public Protecting the private layers Protecting the private layers Connecting efolios across the continuum Connecting efolios across the continuum Managing efolio content at transitions along the education – practice continuum Managing efolio content at transitions along the education – practice continuum Financial responsibility for the system Financial responsibility for the system

Challenges and Issues Infrastructure to prepare both teachers and learners to use the efolio Infrastructure to prepare both teachers and learners to use the efolio Infrastructure to assist practicing physicians to use the efolio Infrastructure to assist practicing physicians to use the efolio IMGs IMGs Strategies and tools to stimulate skills of self-assessment Strategies and tools to stimulate skills of self-assessment

The Hope for E-folios Connect medical education competencies across the curriculum Connect medical education competencies across the curriculum Function as epr- electronic physician record for the individual Function as epr- electronic physician record for the individual Facilitate reflective practice (competency of practice-based learning and improvement) Facilitate reflective practice (competency of practice-based learning and improvement) Manage longitudinal data about individual physician’s patient outcomes Manage longitudinal data about individual physician’s patient outcomes