1. Vu Q. C. Nguyen, MD, MBA Carolinas Medical Center Carolinas Rehabilitation Charlotte, North Carolina ACGME Competency Measures

2. Perspective Large healthcare system 43 hospitals system 2 nd largest healthcare system in the nation Carolinas Medical Center is flagship Three education campuses Charlotte: 15 residencies and 11 fellowships Concord: 1 family medicine residency Greenville: 1 family medicine residency Large rehabilitation system Carolinas Rehabilitation (CR): Main, Mt Holly, NE, Pineville Levine Children’s Charleston, Greensboro, Greenville, Lancaster, Wilmington 1

3. Perspective Geography Facilities and physicians spread across 4 states Challenges communication and processes Diverse patient population The variable composition of patients across facilities drives the type of care being delivered –CR Main: neurotrauma rehabilitation –Pineville Rehab: general rehabilitation Unique medical staff culture Charlotte, Concord, and Greenville are more education oriented Faculty vs. practitioner Facility vs. clinics 2

4. System Strong centrally-oriented leadership Division of Medical Education drives processes Heavy reliance on electronics MedHub residency management system Cerner EMR for all inpatient and outpatient interfaces iPads and smartphones for clinical and communication Virtual care for ICU, primary care, referral, and on-call Video and audio conferencing for meetings and lectures 3

5. PM&R Competency Measures All measures are distributed in electronic and printed formats to faculty MedHub End of Rotation Evaluations ROCA 360 Globals Procedures Log Diagnoses Log PM&R-oriented Competencies 4

6. MedHub End of Rotation Eval measures the established ACGME competencies Patient Care –General skills, physiatric skills, clinical judgment, patient care Medical Knowledge –General knowledge, physiatric knowledge Practice Based Learning and Improvement Interpersonal and Communication Skills Professionalism –Professional attitudes, humanistic qualities Systems Based Practice 5

7. MedHub 6 Modified MedHub End of Rotation Evaluation Language and evaluation levels are more consistent with ACGME’s NAS

8. 360s, Diagnoses, Procedures, and ROCA 360 Globals Patients, therapists, nurses, assistants, colleagues Procedure Log ACGME ROCA Diagnoses Log All cases evaluated during the Consults Rotation are logged 7

9. PM&R-oriented Competencies 63 competencies based on 9 core subspecialties TBI, SCI, Stroke, Peds, Cancer, Ortho-Amp, EDx, MSK, Sports 7 competencies per core subspecialty The competencies are the most pertinent conditions in PM&R Creation of the Competencies Core faculty in each subspecialty were surveyed as to the 7 most appropriate conditions that they felt all physiatrists should be able to manage comfortably PD drafted all of the competencies and forwarded them to the subspecialized faculty to review and modify PD then revised the competencies based on the cumulative feedback from faculty Each batch of 7 competencies were debated and ratified at the monthly GME meetings 8

10. Stroke Competencies 1.PC Stroke: Hemiplegic Shoulder Pain 2.PC Stroke: Spasticity 3.PC Stroke: Post-stroke Depression 4.PC Stroke: Botulinum Toxin Injection 5.MK Stroke: Scales – NIHSS, MMSE, Modified Rankin, Barthel Index, FIM, GOS, and Aphasia Tree 6.MK Stroke: Primary and Secondary Stroke Prevention 7.SBP Stroke: Assess caregiver support and resources available 9

11. Stroke Competencies 10

12. Stroke Competencies Overview of expectations for the resident: Patient Care Competency – Stroke: Hemiplegic Shoulder Pain (HSP) Resident must demonstrate an understanding of the pathophysiology of HSP and differentiate the condition from other painful disorders of the shoulder; outline an appropriate management plan that includes prevention of the condition, identification of the condition, initiation of therapy and modalities including oral pharmacotherapeutics and shoulder injections. Appropriately utilize imaging and other diagnostic testing modalities. The resident must be able to educate the patient and/or family members in regards to the condition and its management. 11

13. Stroke Competencies Instruction for Faculty: The resident will hand you this form when they feel they have mastered any of the competency levels below. Please rate them according to the scale below by putting today’s date on the level that you feel they have achieved. Please recognize that a level 4 should only be given if you feel this resident is competent to manage this condition today, equivalent to that of a “graduate”. A level 5 is reserved for a resident who has shown competency level equivalent to that of an “expert”. 12

14. Stroke Competencies Competency Level 123 4 Target Graduation 5 Aspirational Definition of Each Level Recognizes that there are potential shoulder complications from hemiplegia and takes appropriate actions to prevent and monitor for emergence Identifies and manages co- morbidities and differentiates HSP from other painful shoulder conditions Understands functional impact and initiates appropriate levels of intervention for the management of HSP Develops a comprehensive treatment plan to address all aspects of HSP that includes prevention, therapy, medications, injections, and consultations Able to incorporate evidence based management into practice and discuss controversial or emergent management Faculty scoring date 13

15. Vu’s contact info: 704-615-5214 (cell) 704-355-9330 (office) Vu.nguyen@carolinashealthcare.org 14

16. Thank you 15