1. Communicating Milestones Evaluation Data and Comments from the CCC to Residents Using an Innovative “Grade Card”
Steven McDonald, MD – Program Director
Nicole McGuire, MS – Education Coordinator
Union Hospital Family Medicine Residency - Terre Haute, IN

2. Activity Disclaimer The material presented here is being made available by the American Academy of Family Physicians for educational purposes only. This material is not intended to represent the only, nor necessarily best, methods or procedures appropriate for the medical situations discussed. Rather, it is intended to present an approach, view, statement, or opinion of the faculty, which may be helpful to others who face similar situations. The AAFP disclaims any and all liability for injury or other damages resulting to any individual using this material and for all claims that might arise out of the use of the techniques demonstrated therein by such individuals, whether these claims shall be asserted by a physician or any other person. Every effort has been made to ensure the accuracy of the data presented here. Physicians may care to check specific details such as drug doses and contraindications, etc., in standard sources prior to clinical application. This material might contain recommendations/guidelines developed by other organizations. Please note that although these guidelines might be included, this does not necessarily imply the endorsement by the AAFP. Faculty Disclosure It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of interest (COI), and if identified, conflicts are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity. All faculty in a position to control content for this session have indicated they have no relevant financial relationships to disclose.

3. Objectives
Give an example of how Union Hospital FMR conducts thorough and efficient Milestones evaluations during CCC sessions
Describe an innovative grading process using the Milestones evaluations
Describe a method for adapting our CCC procedures and Milestones grading process for use in your residency

4. Background
Starting in July 2014, Family Medicine Residency programs were required to start reporting on resident educational progress using the Family Medicine ACGME Milestones.
As programs are creating Clinical Competency Committees (CCC’s) and testing out the Milestones, many are struggling to find a process that leads to thorough, yet efficient, evaluations for residents.
The 1st CCC/Milestones meeting was held October 2013
We entered our first Milestones evaluation data into WebAds in December 2014.

5. Union Hospital Family Medicine Residency
7-7-7 program
345 Bed Community Hospital
Single Residency
Open ICU
6 core faculty
NICU, Inpatient Pediatrics, OB

6. Union Hospital Family Medicine Residency
Established in 1976
Graduated 176 residents
> 20,000 patients annually
> 2,500 well child visits yearly
150 monthly deliveries

7. CCC Sessions Each session 3 ½ hours PGY1 – December and May
PGY2 – September and April
PGY3 – October and May

8. CCC Meeting Agenda First 30 minutes – Presentation of Objective Data
Discuss each resident ; assigned CCC members present the following information for consideration:
Duty hour logging
Didactic attendance
Medical record suspensions (if applicable)
Evaluations from community preceptors
Staff 360
Scholarly activity
Study plans
ITE scores
Individualized education plans (IEPs) / remediation plans
Community medicine assignment completion
Patient encounter logging
Logging of procedures
Timeliness of charting/administrative responsibilities
Disciplinary action or issues
OSCE performance
Video precepting feedback forms

9. CCC Meeting Agenda (cont.)
Remaining 3 hours – Milestones
Milestones in a PowerPoint presentation on the projector
Faculty comments are recorded - CRITICAL
For each Milestone, level of achievement is recorded

10. CCC Meeting Agenda (cont.)
Remaining 3 hours – Milestones
Example: Begin with PC-1 and assign a level for each resident before moving on to PC-2
Timers are helpful to keep committee members on task
Only move to next Milestone when a consensus is reached on the level assignment for each resident

11. After the CCC Meeting
Education Coordinator enters the Milestones data into a template for each resident
Data are entered into the grade card for each resident

12. After the CCC Meeting (cont.)
The Education Coordinator shares a copy of the Milestones Evaluation and Grade Card
Faculty review and sign (turnaround time - 1 week)
Education Coordinator schedules evaluation meetings with faculty advisor

13. Scheduling the Evaluation Meeting
Evaluation meetings are held between the resident and academic advisor
The Education Coordinator may also be present
Evaluation meetings typically last 30 minutes

14. Evaluation Meeting Agenda
First 5 minutes: Education Coordinator and faculty advisor provide the resident with an overview of the Milestones, explanation of grade point average and expectations for current level of training

15. Evaluation Meeting Agenda (cont.)
Next 15 minutes: Faculty advisor reviews each page of the Milestones evaluation with the resident, highlighting CCC comments, and providing examples and meaningful feedback for both high and low scores

16. Evaluation Meeting Agenda (cont.)
Next 5 minutes: Faculty advisor asks resident if they have any questions or need further explanation of any covered information. Advisor and resident engage in open discussion of the evaluation

17. Evaluation Meeting Agenda (cont.)
Last 5 minutes: Faculty uses an advisement tool as a guide to cover relevant topics with the resident (i.e., discuss goals , elective rotation selection, recognition of fatigue)
Resident receives a copy of the Milestones evaluation and Grade Card
Resident signs a copy that is placed in the resident file

18. PGY1 – 90 Evaluation Contains a Grade Point Average (GPA)
Shows a median GPA for the class
Provides an at-a-glance look at residence performance in each of the core competencies
Highlights areas needing improvement

19. PGY1 – 6 mo Evaluation

20. PGY1 – 11 mo Evaluation

21. PGY2 – 3 mo Evaluation

22. Grade Card Demonstration Handout Grade Card Instructions
CD with customizable Grade Card program

23. Discussion Since implementing our “Grade Card”…
Obstacles
Successes
Lessons Learned
Feedback from audience?

24. One last thing…
Please complete the online evaluation.

25. Questions? Steven McDonald, MD – Program Director samcdonald@uhhg.org
Nicole McGuire, MS – Education Coordinator