1. I am a GREAT mentor….right? Teresa Kulie, MD University of Wisconsin, Madison Program Teresa.Kulie@fammed.wisc.edu May 3, 2008

2. Background By now, in 2008: –ACGME Competency Domains are the norm –Residents are progressing toward Competency Who helps residents interpret their evaluations and progress toward competency?

3. Background Department of Family Medicine, Madison, Wisconsin 14-14-14 (plus 2 each year in Rural track - Baraboo) Hospitals: UW, St Mary’s Clinics: Wingra, Northeast, Verona, Belleville (4-4-4-2 each year)

4. Background Need to decentralize some aspects of evaluation Each clinic takes ownership of “their” residents –Detailed Formal Evaluation –Assigns a faculty mentor (“advisor”) who meets regularly with resident to review progress.

5. Background Concerns: –Are the mentors comfortable with ACGME competencies? –Do we have adequate evaluation information to assess resident progress? –Do mentors know how to set meaningful goals? –Are the mentors themselves competent? (and what does a competent mentor look like?)

6. Background Faculty ½ Day –Mandatory for faculty who serve as mentors –Offered two times for sessions –Lesson Plan – white page in your packet

7. Today’s Objectives At the end of this session, you will be able to: –Teach faculty members about the ACGME competencies (and how they apply to their mentees) –Interpret evaluations of resident performance, and thus support resident goal-setting –Use a competency-based tool to evaluate faculty mentor performance

8. Agenda ACGME Competencies Interpreting Evaluation Goal Setting Evaluate yourself as a mentor

9. Agenda ACGME Competencies Interpreting Evaluation Goal Setting Evaluate yourself as a mentor

10. hmmmm…. How do you know your resident mentee is competent? What could you see your resident mentee doing that would convince you he/she was competent?

11. The Competent Resident: Smart Listens to patients Good with hands Respects patients Knows how to work the system Explains things to pts Keeps up with changes

12. Generate the Competencies Create their list of the 6 Competencies You may need a cheat sheet as you do this Once you think they’ve populated the groups… –“Name” the 6 groups –Congratulate them for deriving the Competencies!

13. Can you name all six*? Patient Care Medical Knowledge Practice-Based Learning and Improvement Interpersonal and Communication Skills Professionalism Systems-Based Practice *DO: Osteopathic Manipulation/Philosophy

14. Osteopathic Manipulation & Philosophy Residents are expected to demonstrate and apply knowledge of accepted standards in Osteopathic Manipulative Treatment (OMT) appropriate to their specialty. The educational goal is to train a skilled and competent osteopathic practitioner who remains dedicated to life -long learning and to practice habits in osteopathic philosophy and manipulative medicine.

15. Agenda ACGME Competencies Interpreting Evaluation Goal Setting Evaluate yourself as a mentor

16. Interpreting Evaluation Now that they have reviewed the Competencies, it is time for them to apply them to their resident mentees Pink Evaluation Summary –Bob –Laura

17. Interpreting Evaluations So, for your session, you will want to prepare: –One packet using your usual evaluation forms but with unhelpful feedback –One packet using your usual evaluation forms with helpful feedback (listing specific behaviors and examples) –Try to stack the deck !!

18. Agenda ACGME Competencies Interpreting Evaluation Goal Setting Evaluate yourself as a mentor

19. Goal Setting Now that they understand first hand the value of good feedback, they need to help the resident set some goals for improvement.

20. Who needs learning goals? The learner with remediation needs which have been identified The resident who is doing well Both!

21. Identify the problem Be as specific as you can Provide clear examples of resident behaviors Consider co-morbidities? (mental health, substance, etc) * If no problem identified, consider asking resident what area he/she identifies for improvement

22. Engage the resident Parallel to Motivational Interviewing? After all, we are aiming for a behavior change…. right?

23. Motivational Interviewing (TIBS) ASK about behavior –Ask initial questions about behavior –Determine stage of readiness to change

24. Stages of readiness to change Precontemplation (not considering) Contemplation (ambivalent) Determination/Preparation (committed to change) Action (changing) Maintenance (change is learned, could relapse) Relapse Termination (change is firmly entrenched) From Prochaska and DiClemente

25. Motivational Interviewing (TIBS) ASSESS Commitment/Barriers to change –Determine self-efficacy –Examine pros/cons of behavior –Identify relevant life goals (helping/hindering?) –Explore for more commitment Discrepancy between current behavior and goals –Reassess stage of readiness to change

26. Motivational Interviewing (TIBS) ASSIST –Reinforce commitment to change –Help develop/revise a plan –Follow up

27. Measurable outcomes “Resident needs to read more.” “I should get better at billing.”

28. Measurable outcomes “Read more” –When? (After clinic, before bed) –What? (Review articles, case-based) –Where? (Home, clinic, in-patient, call room) –How measure? “I will read one review article from the AFP at home before bed each Sunday night.”

29. Measurable outcomes “Bill better” –When? (at end of clinic, with each visit) –Ideas about how (staff each bill?) –Resources needed (find yellow card) “First, I will find my billing card. Then, I will include billing during staffing with at least one encounter per half day. I will decide what I think first, then ask staffer.”

30. Measurable Outcomes – try… “become more efficient in clinic” “streamline dictations” “communicate with patients at their level, less medical jargon” Another common resident problem?

31. Agenda ACGME Competencies Interpreting Evaluation Goal Setting Evaluate yourself as a mentor

32. Are you a competent mentor? We had no specific expectations for being a mentor We had no evaluation of mentors (other than the pooled entire faculty evaluation) Decide on competent behaviors – make this the “3”, then fill in behaviors above/below

33. Are you a competent mentor? Timeliness Usefulness of Feedback Career Direction Respectfulness Prepared/Follow-through Would you add other competencies?

34. Today’s Objectives At the end of this session, you will be able to: –Teach faculty members about the ACGME competencies (and how they apply to their mentees) –Interpret evaluations of resident performance, and thus support resident goal-setting –Use a competency-based tool to evaluate faculty mentor performance

35. Questions? Comments? Thank you! All materials have been uploaded to FMDRL.