Resident & Fellow Evaluation

Table of Contents

Table of Contents

• Definitions
• Milestones
• Entrustable Professional Activities (EPAs)
• Feedback
• Individualized Learning Plans (ILP)
• Assessment and Evaluation Samples
• Templates
• Resources

Definitions

Feedback is ongoing information provided regarding aspects of one’s performance, knowledge, or understanding. The faculty empower residents to provide much of that feedback themselves in a spirit of continuous learning and self-reflection. Feedback from faculty members in the context of routine clinical care should be frequent, and need not always be formally documented [CPR. V.A.1.]

Formative and summative evaluation have distinct definitions.

Formative evaluation is monitoring resident learning and providing ongoing feedback that can be used by residents to improve their learning in the context of the provision of patient care or other educational opportunities. More specifically, formative evaluations help:

• residents identify their strengths and weaknesses and target areas that need work

• program directors and faculty members recognize where residents are struggling and address problems immediately

Summative evaluation is evaluating a resident’s learning by comparing the residents against the goals and objectives of the rotation and program, respectively. Summative evaluation is utilized to make decisions about promotion to the next level of training, or program completion.

End-of-rotation and end-of-year evaluations have both summative and formative components. Information from a summative evaluation can be used formatively when residents or faculty members use it to guide their efforts and activities in subsequent rotations and to successfully complete the residency program.

Feedback, formative evaluation, and summative evaluation compare intentions with accomplishments, enabling the transformation of a neophyte physician to one with growing expertise.

Entrustable Professional Activities (EPAs)

• Nuts and Bolts of EPAs. Olle ten Cate. JGME (2013)
• Five Stage Approach for Developing Specialty-specific EPAs. Kwan et al. BMC Medcial Education (2016).

EPA Worksheets:

• DeMystifying “Entrustable Professional Activities (EPAs)” Worksheet – Residencies
• DeMystifying “Entrustable Professional Activities (EPAs)” Worksheet – Fellowships

Feedback

• Feedback, Evaluation, and Program Improvement Inventories (UW GME)
• “Prepare to ADAPT” Feedback Framework for learners and coaches (UW GME)
• Oral questioning method: SNAPPS
• What’s In Your Influence Toolkit & Influencing Your Subordinates: Giving Great Feedback (Christina Fong 4/26/2018 PDDS)
• Do’s, don’ts, and don’t knows of feedback. (Lefroy et al. Perspect Med Educ, 2015)
• Do’s, don’ts, and don’t knows of direct observation. (Kogan et al. Perspect Med Educ, 2017)
• How to give difficult feedback (Eileen Klein, UW CLIME, Podcast)
• Feedback Presentation + Group Discussion & Exercises (Monica Van de Ridder, 10/10/17 PDDS)

Individualized Learning Plan (ILP)

An individualized learning plan (ILP) is documented personal roadmap for learning developed by a resident with the help of a program director, mentor, faculty member, or facilitator. It is a tool designed to help create self-directed learning skills for residents, which also support lifelong learning.

ILP is not set in stone. Generally speaking, ILP consists of long-term and short-term goals, specific objectives, career choice, self-identified strengths and weaknesses, development of strategies to achieve the goal and objectives, assessment of progress on goal and objectives, feedback from faculty/mentor/advisor, and a new goal. [Note that the terms “goal” and “objective” are sometimes used interchangeably while other times they are not. In this document, the term “goal” is defined as a broad, intangible, and an abstract description of a destination (where residents want to go) while objective explains specifically how residents get there.]

Research often finds that generating specific, measurable, and achievable objectives is a challenge for residents. Many residents call for training about developing objectives. Remember that if a resident has objectives that can be hard to achieve, a mentor/faculty should raise concern, let the resident think about it, and guide the resident toward developing specific and reasonable objectives. A mentor/faculty’s role is not to tell them to change ILP, but guide them to revise it.

• Individualized learning plans: Basics and beyond
• I-SMART strategies for goal generation and plan development 
• Is residents’ progress on individualized learning plans related to the type of learning goal set?
• Are residents ready for self-directed learning? A pilot program of individualized learning plans in continuity clinic

ACGME Common Program Requirements
The program director or their designee, with input from the Clinical Competency Committee, must (1) assist residents in developing individualized learning plans to capitalize on their strengths and identify areas for growth [CPR V.A. 1.d).(2)]; and develop plans for residents failing to progress, following institutional policies and procedures [CPR V.A.1.d).(3)].

Assessment and Evaluation Samples and Tools

Review the following tools and samples, which are provided to illustrate how some GME programs have approached assessment and evaluation. The assessment samples are categorized as formative, occurring during the learning process, or summative, at the end of training.

Formative Assessment

• Direct Observation
  • Tools
    • Direct Observation of Clinical Care (DOCC) app by ACGME
  •  Samples
    • MINI-CEX: ABIM
    • Field Notes: Family Medicine
    • Field Notes: Family Medicine-Alberta
    • Procedural Competency – Radiology
    • Case Presentation – Urology
    • Technical Skills Evaluation – Otolaryngology
• End-of-Rotation Samples
  • HMC Rotation
  • VA MICU Rotation
  • PM&R HMC Clinic Rotation
  • PM&R Intern ID Rotation
  • Radiology – Global
  • Urology UWMC
  • End-of-Shift Assessment – EM
• 360 Degree (Multi-Source Assessment)
  • Tools
    • Teamwork Effectiveness Assessment Module (TEAM) by ACGME
  •  Samples
    • 360o Assessment Tool OVERVIEW with mapping
    • 360o Nursing Assessment of Trainee – Pediatrics
    • 360o Patient Evaluation of Trainee – AIDET
    • 360o Professional Staff Assessment of Trainee – Urology
    • 360o Resident Peer Assessment – Internal Medicine
    • 360o Resident SELF Assessment – Urology
• Semi-Annual Samples
  • Internal Medicine
  • General Surgery
  • Urology
  • Fellowship – Generic

Templates

• Resident/Fellow Final Evaluation Template (PDF)
• Resident/Fellow Final Evaluation Template (Word)
• Individualized Learning Plan Template (Word)

Resources

• UW GME Resident/Fellow Evaluation Guidelines
• UW CLIME
• Faculty Development
• JGME
• Academic Medicine
• JAMA

Full access available to journals through the UW Library