1. Six Core Competencies Redefined for Faculty Development STFM Annual Spring Conference
April 26, 2010
Janice Litza, MD
Director of Faculty Development
Aurora HealthCare

2. Objectives
Understand how to integrate spectrum of faculty responsibilities into modified six core competencies.
Compare and contrast six ACGME competencies for residents and faculty.
Discuss application of faculty competencies to faculty development.

3. Session Activities Review the overall development and process
Highlight Common Program Requirements relevant to faculty
Review ACGME Six Competencies
Discussion of spectrum of faculty responsibilities
Review Modified Six Competencies for faculty
Discuss how these are and might be used and are currently used to meet individual, program and institutional goals

4. Litza’s Process I like the 6 competencies
Response to RRC citation for lack of faculty development
Applying them to ourselves leads to greatest understanding and application
Role model/expectations similar
Can include organizational and academic expectations
A Foundation…

5. Goals of The Outcome Project
Patient Care
Interpersonal & Communication Skills
Professional- ism
Practice-based Learning & Improvement
Systems-based Practice
Medical Knowledge
Developing competence as a physician
Developing competence as a physician
Derstine, 2006

6. ACGME Common Program Requirements Highlighted Areas for Faculty
July 1, 2007

7. IIA Program Personnel and Resources-Program Director
Faculty evaluated and approved for continued participation (II4d)
Faculty receive and review policies and procedures for program (II4j1)

8. IIB Program Personnel and Resources-Faculty
Documented qualifications to instruct and supervise residents
Devote time to the educational program to fulfill supervisory and teaching responsibilities
Demonstrate strong interest in the education of residents
Administer and maintain an educational environment to teaching residents in each of the competency areas

9. IIB Program Personnel and Resources-Faculty
Current certification in specialty
Current medical licensure and medical staff appointment
Establish and maintain an environment of inquiry and scholarship with active research component
Regularly participate in organized clinical discussions, rounds, journal clubs, conferences
Some should demonstrate scholarship through publications, presentations, funding, national committee/organization participation

10. IV Educational Program A. The Curriculum
Faculty receive and review overall educational goals for the program
Competency-based goals and objectives distributed for review to faculty

11. V Evaluation A. Resident Evaluation B. Faculty Evaluation
Evaluate resident performance in timely manner and document
B. Faculty Evaluation
At least annually, program must evaluate faculty performance as it relates to the educational program
Include review of clinical teaching abilities, commitment to educational program, clinical knowledge, professionalism, and scholarly activities
Must include annual written confidential evaluations by the residents

12. V Evaluation C. Program Evaluation and Improvement
Program must monitor and track faculty development
Faculty must have opportunity to evaluate the program confidentially and in writing at least annually
Written plan of action for deficiencies which should be reviewed and approved by the teaching faculty and documented in meeting minutes.

13. VI Resident Duty Hours in the Learning and Working Environment
Supervision of residents-qualified faculty provide appropriate supervision in patient care activities
Fatigue-Faculty must be educated to recognize the signs of fatigue and sleep deprivation

14. The Core Resident Competencies
ACGME Introduction to Competency-Based Residency Education

15. Medical Knowledge
Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.

16. Medical Knowledge Residents are expected to:
Demonstrate an investigatory and analytic thinking approach to clinical situations
Know and apply the basic and clinically supportive sciences which are appropriate to their discipline

17. Patient Care
Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

18. Patient Care Residents are expected to:
communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families
gather essential and accurate information about their patients
make informed decisions about diagnostic and therapeutic interventions based on patient information, preferences, up-to-date scientific evidence, and clinical judgment
develop and carry out patient management plans
counsel and educate patients and their families
use information technology to support patient care decisions and patient education
perform competently all medical and invasive procedures considered essential for the area of practice
provide health care services aimed at preventing health problems or maintaining health
work with health care professionals, including those from other disciplines, to provide patient-focused care

19. Practice Based Learning and Improvement
Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.

20. Practice Based Learning and Improvement
Residents are expected to:
Analyze practice experience and perform practice-based improvement activities using a systematic methodology
Obtain and use information about their own population of patients and the larger population from which their patients are drawn
Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems
Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness
Use information technology to manage information, access on-line medical information; and support their own education
Facilitate the learning of students and other health care professionals

21. Systems Based Practice
Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

22. Systems Based Practice
Residents are expected to:
Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources
Practice cost effective health care and resource allocation that do not compromise quality of care
Advocate for quality patient care and assist patients in dealing with system complexities
Partner with health care managers and health care providers to assess, coordinate

23. Professionalism
Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

24. Professionalism Residents are expected to:
Demonstrate respect, compassion and integrity
Demonstrate a commitment to ethical principles
Demonstrate sensitivity and responsiveness to patients’ culture, age, gender and disabilities

25. Interpersonal and Communication Skills
Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients families, and professional associates.

26. Interpersonal and Communication Skills
Residents are expected to:
create and sustain a therapeutic and ethically sound relationship with patients
use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills
work effectively with others as a member or leader of a health care team or other professional group

27. Faculty Responsibilities
Discussion
This was a reflective and brainstorm opportunity to list the spectrum of faculty responsibilities and then apply the list to the competencies to see if everything is addressed. Discussion included-teaching students and residents, leadership and management within program and organization, mentoring/advising, clinical practice, productivity requirements, presentation skills, curriculum building, evaluations and feedback, balance, just to name a few.

28. Categories for Faculty
1990, Bland
Education
Administration
Research
Written Communication
Professional Academic Skills
2007 Academic Competencies (FFI)
Leadership
Administration
Teaching
Curriculum development
Research
Medical informatics
Care management
Multiculturalism
Other ways in which faculty have been organized into general groups. Good and the ACGME competencies can encompass these categories and more in my experience.

29. An Example of a Faculty Version
These competencies and the expectations within them can be modified to serve individual programs’ priorities, but would need to maintain the common program requirements. Consider adding RPS Criteria for Excellence and organizational priorities. I use these for more programs than FM, therefore less specific. I reserve specifics for outcomes measures by program and our organizations priorities are imbedded within the competencies.

30. Medical Knowledge
Faculty are expected to demonstrate knowledge of established and evolving biomedical, clinical and social sciences and apply knowledge to patient care and education of others.
Underlined areas highlight the addition and/or deviation from the resident competencies. Some were chosen as a way to even out the spectrum of responsibilities across the competencies.

31. Medical Knowledge Faculty are expected to:
1. Maintain current clinical skills and knowledge through CME and resources in literature and technology. (IIB)
2. Be an effective teacher through small group and large lecture/workshop learning and through innovation.(IIB)
3. Understand and apply adult learning principles through teaching of residents and students.(IIB)
4. Educate patients, their families and the community on current medical issues.
Expectations are very similar in some cases and very different in others. This reflects the expectation that faculty have already achieved basic competence from residency training and need to now master those skills and focus on the teaching, leading, evaluation aspects of medical knowledge and patient care. The ( ) indicate which of the ACGME Common Program Requirements are related and, in some cases, exact wording.

32. Patient Care
Faculty will model patient care that is compassionate, appropriate and effective for the promotion of health, prevention of illness, treatment of disease and at the end of life.
Faculty will supervise and provide effective feedback and guidance to residents, specific to expectation for quality in patient care.

33. Patient Care
1. Demonstrate comprehensive data gathering, decision-making and documentation with a focus on patient centered care. *
2. Seek and respond to patient feedback of physician performance and demonstrate willingness to learn from errors. (V)
3. Achieve clinical productivity goals according to department standards and expectations. (V)
4. Provide direct role modeling of compassionate care to residents and students. (VI)
5. Appropriately supervise residents in direct patient care activities and provide specific, focused and timely feedback to residents. (IIB, V, VI)
The asterisk (*) indicates the same expectations as the residents.

34. Practice Based Learning and Improvement
Faculty are expected to be able to use scientific evidence and methods to investigate, evaluate and improve patient care practices for their own and resident practices.

35. Practice Based Learning and Improvement
1. Maintain an environment of inquiry and scholarship through regular participation in scholarly activity, clinical discussions, rounds, journal club and conferences. (IIB)
2. Actively participate in QA/QI processes to perform practice-based improvement using systematic methodology. *
3. Complete annual individual learning plan for improvement using evaluations and self-assessment.
4. Assist residents with their individual development through advising, mentoring and goal setting. * (V)
5. Use information technology to manage information, access online medical information and support own education. *

36. Systems Based Practice
Faculty are expected to demonstrate an understanding of the contexts and system in which healthcare is provided within a residency program and the ability to apply the knowledge to improve and optimize healthcare and residency education.
This is where I chose to highlight the residency program as a “system” as well as the healthcare/academic organization.

37. Systems Based Practice
Faculty are expected to:
1. Maintain active licensure and certifications, clinical privileges, and professional memberships. (IIB)
2. Regularly participate in scholarly activity of various forms for advancement of clinical knowledge in the field of medicine and/or education of residents. (IIB)
3. Be actively involved in processes that evaluate and implement optimal clinical systems, care management, safety and/or cost effective patient care.
4. Be an integral part of residency program improvement through participation in program evaluations, curriculum development, and recruitment using the ACGME competencies. (IIB, IV)
5. Participate in interdisciplinary teaching opportunities across specialties and organizations.

38. Professionalism
Faculty are expected to demonstrate behaviors that reflect a commitment to continuous professional development, ethical practice, an understanding and sensitivity to diversity and a responsible attitude toward their patients, profession and society.

39. Professionalism Faculty are expected to:
1. Adhere to scientific/academic integrity through patient care practices, research and scholarly activity. (IIB)
2. Demonstrate professional behavior through leadership, business practices and role modeling to residents and students.
3. Actively monitor resident wellness including attention to fatigue and effects of sleep deprivation. (VI)
4. Demonstrate professional balance in personal wellness and work/life roles.
5. Demonstrate integrity and commitment to excellence through ongoing professional development. (V)
What might be measurable across faculty/programs?
Scholarly work-individual programs can determine expectations.
Leadership positions held.
Participate/complete annual training on sleep and fatigue.
Balance-reflective activity for discussion and monitoring
Professional Development credits or CME-how much clinically based versus educational versus leadership. Opportunity to do some specific goal setting as well.

40. Interpersonal and Communication Skills
Faculty are expected to demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families, members of healthcare teams, residents, students and colleagues.

41. Interpersonal and Communication Skills
Faculty are expected to:
1. Provide therapeutic and ethically sound professional relationships with patients, their families and colleagues.
2. Use effective listening, nonverbal, explanatory, questioning and writing skills to communicate in all settings, including respectful, honest and compassionate feedback.
3. Demonstrate leadership through active involvement within residency program, healthcare organization and educational system.
4. Give quality presentations through effective use of group based learning, PowerPoint, multimedia and interactive techniques.
5. Model and maintain comprehensive, timely and legible medical records; respond promptly to messages, pages and other forms of communication
Unfortunately, #5 was detailed because this has been a recurring issue among faculty and therefore a newly learned bad habit by residents. This was opportunity to be less vague and more specific on expectations on behaviors.

42. Uses of Faculty Core Competencies
The original attempt at this was longer and I’ve worked to reduce and refine it so it becomes a more easily reviewed document. Faculty, department chair, DIOs were involved in the initial feedback and development. Once the structure was established, the opportunity to create evaluation tools, needs assessment and curricula was a little smoother and the 6 competency language is consistent throughout.

43. University of Chicago (NorthShore) FMRP David Holub-PD
2006 RRC Citation response
Used to create new
Faculty Development Curriculum
Evaluation tool for faculty-self, resident
Professional Development with residents covering same/similar competencies
RRC Visit 2007
Positive comments on process, tools and no further citations
Suggested as possible Innovative Practice worth sharing
Original program when I was PD. No longer used since affiliated with UC since UC has more structured faculty evaluation and promotion process. We had created faculty outcomes chart, needs assessment, curriculum, and faculty evaluations by staff and residents using the competencies.

44. Northwestern McGaw FMRP Deborah Edberg-PD
New program with residents starting July 2010
Used same competencies for
New Faculty Development Curriculum
Evaluation tool-needs, learning plans, goal setting
RRC 2009-Reviewer commented positively on the comprehensiveness of FD process
Provided quick structure and increased comfort for new faculty of this new program.

45. Aurora St. Luke’s FMRP Jake Bidwell-PD
Director of Faculty Development across multiple specialties
Competencies challenged, but consistently applicable across specialties
Organization Peer Review Uses Competencies
Accepted by GMEC and Aurora Leadership
Used to create
Overall curriculum and individual program curricula
Needs assessment
Evaluation tools
Professional Development series with residents
Used more broadly at Aurora. Structured curriculum for overall faculty development and by program, not just family medicine. The competencies presented here have been used by multiple other programs and are written in such a way that they are applicable due to fact the Common Program Requirements are for every specialty. Plans to develop a Promotions Committee using the competencies. Family Medicine RRC (RC-FM) reviewer in 2009 had positive comments about process and curriculum derived using competencies.

46. The Curriculum A competency for all things
Ongoing learning and improvement
Identifies all FD opportunities
Role model with residents
Ability to capture all we do
Measurable outcomes for comparison, goal setting, compensation, skill building
Structure from ACGME Competencies used to create curriculum and using the 6 competencies as a filter, I found I could identify many activities that occurred could be highlighted as FD. Example-required completion of risk management on line module for malpractice reasons. This organizationally required activity was listed in a curriculum chart under Professionalism. This provided a more comprehensive way to highlight what we do regularly and then structure specific activities to cover the gaps.

47. Thank You! Janice Litza, MD Janice.litza@aurora.org
Director of Faculty Development for Aurora University of Wisconsin Medical Group