1. Lessons Learned - Portfolios Teresa Kulie, MD University of Wisconsin- Madison Department of Family Medicine STFM, April 2006

2. Objectives Describe the format of a competency-based reflection portfolio exhibit Create one competency-based portfolio exhibit Outline steps to ensure successful implementation of competency-based reflection portfolios at your home institution

3. Outline for today... Create Motivation! How do I do it? Do it! Take home lessons...

4. Outline for today... Create Motivation! (R1 Orientation) How do I do it? Do it! Take home lessons...

5. hmmmm…. How do you know your personal doctor is competent? If you were to describe a “competent” physician, what qualities would you list?

6. The Competent Physician: Smart Listens to me Good with hands Respects me Knows how to work the system Explains things to me Keeps up with changes

7. Generate the Competencies Group their ideas into 6 lists (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!

8. Probing Questions “You just moved to town, how did you pick your doctor? Is he/she competent?” “There are patients out there who consider YOU their new doctor. How do they know that you are competent?” “Do you think we have a good system to prove to the public that you’re competent?”

9. Probing Questions “Does your program director know everything you do?” “If not, how can he/she document that you’re competent? “Who does know everything you do?” Generate idea that residents know best… if only there was a way to capture this….

10. The solution! There is a way to capture these experiences… –A PORTFOLIO!!!!

11. Outline for today... Create Motivation! How do I do it? (Fall Portfolio Half-Day, Spring Portfolio Half-Day) Do it! Take home lessons...

12. UW Portfolios* - 2 parts: Required CV, In-training exam scores, Evaluations, Presentations, Publications, etc. Exhibits 6 Exhibits due each year (one per competency) Each exhibit has two parts –Documentation –Reflection *Material adapted from Maine Medical Center – Cynthia Cartwright, Alain Montegut

13. UW Portfolios* - 2 parts: Required CV, In-training exam scores, Evaluations, Presentations, Publications, etc. Exhibits 6 Exhibits due each year (one per competency) Each exhibit has two parts –Documentation –Reflection *Material adapted from Maine Medical Center – Cynthia Cartwright, Alain Montegut

14. Exhibit Details Residents think of an experience that will document that they’re competent Documentation should provide a link to reality Reflection is the most important part - they process the experience and goal-set

15. How do I Reflect*? What? So What? Now What? (*Very hard for residents! Must teach this!)

16. Sample Portfolio Create your own… or gather examples from current residents Make sample available while they’re working Sample exhibit for each competency

17. Patient Care Exhibit Documentation = letter from wife of patient thanking me for attending her husband’s funeral Reflection = –What? - describe his case –So what? - first time a patient in my care died, felt guilty/failure –Now what? - read “Final Gifts” to improve comfort with end-of-life care

18. Med. Knowledge Exhibit Documentation=In-Training Exam Scores Reflection = –What? -Explain which section of the exam I’m focusing on (Peds, OB) –So What? -Not accustomed to scoring poorly, worried about doing well –Now What? -Read Family Practice Obstetrics book, talk to Peds rotation coordinator

19. ICS Exhibit Documentation = Evaluation from Attending highlighting communication between OB faculty and med student Reflection = –What? Described situation –So What? My communication diffused situation, without me there… likely a mess! –Now What? Work on being sure communication is clear before acting

20. SBP Exhibit Documentation = email to Social Worker asking for help with a teen mom Reflection = –What? Describe the case –So What? Frustrated with teen mom, lack of support –Now What? Teach a session about contraception at local high school for Community Medicine project

21. PBLI Exhibit Documentation = my presentation handout (Antidepressants during Pregnancy) with audience evaluation Reflection = –What? - describe presentation –So What? - remark on a constructive comment about how to improve talk –Now What? - implement suggested improvement

22. Professionalism Exhibit Documentation = Letter nominating me for “Model of Mission” award in hospital Reflection = –What? Describe “Model of Mission” award –So What? Felt good to be recognized by peers –Now What? Plan on being more aware of the impact of my presence on co-workers

23. Exhibit Details Same Documentation used twice? –OK, as long as the reflection is different Is a “not-so-good encounter” usable? Discoverability HIPPA

24. Outline for today... Create Motivation! How do I do it? Do it! Take home lessons...

25. Your Turn…. Think of an experience that could show you’re competent…. With which competency domain will it fit? (You could ask your neighbor for help…) What? So What? Now What?

26. Willing to Share???

27. Outline for today... Create Motivation! How do I do it? Do it! Take home lessons...

28. Helpful Hints Do something to generate Buy-in Provide “protected time” Create your own sample portfolio

29. Helpful Hints Clear expectations (# exhibits, when due) Frequent reminders (email) Create/Know your allies (R2s, R3s, chiefs?)

30. Helpful Hints Teach residents how to reflect Grandfather your plan in Create a respectful setting to share ideas

31. Objectives Describe the format of a competency-based reflection portfolio exhibit Create one competency-based portfolio exhibit Outline steps to ensure successful implementation of competency-based reflection portfolios at your home institution

32. Discussion? Questions? (Residents -Why we do what we do)

33. Before you go…. Fill out ACGME Survey??? Would you like to join our Portfolio Listserv? Sign-up! teresa.kulie@fammed.wisc.edu