The Development and Use of the Resident Growth Chart/er

• In Event: Teaching Professional Practice: A Cross-Program Examination of Innovation

Abstract

INTERACTIVE VIDEO DEMONSTRATION: Growth Chart/ers

In this two-part paper presentation, two groups of authors will demonstrate the use of the growth chart/er tools by showing clips of residents in practice and engaging the audience in conversation about how the resident would be rated using the competency tools. The purpose of this portion of the symposium is to introduce the growth charters to the audience to reveal notable features, including holistic and narrative nature of descriptions and designs that enable the tracking of growth over time. The presenters will also discuss questions for future work.

The Development and Use of the Resident Growth Chart/er

As part of its Next Accreditation System (2013), the accrediting agency for graduate medical education (ACGME) mandates 1) the use of multiple and varied forms of resident evaluation (e.g., competency-based evaluations from rotation supervisors, procedure logs), and 2) the twice yearly convening of a Clinical Competency Committee (CCC) tasked to digest and translate/transform these varied inputs to marks on the ACGME’s Milestone evaluation document. Although the ACGME’s Milestone document is a valuable reference, its checklist-like design, granularity, and bulk render it cumbersome and difficult to internalize, especially for non-experts.

Our Resident Growth Chart/er incorporates the ACGME’s “Core Competencies” and “Milestones” and simplifies or elaborates them as narrative descriptions. The RGC orders these descriptor blocks in progression from what is expected of an intern to what is needed to practice independently and beyond. The RGC accommodates relevant elements of the ACGME’s Clinical Learning Environment guidelines, as well as the American Board of Internal Medicine’s set of desired characteristics and required competencies.

The RGC divides resident performance into nine competency categories: Patient Care, Information Integration, Interpersonal Skills, Ownership, Integrity and Self-improvement, Citizenship, Teaching, Quality Improvement and Research, and Patient Safety. The descriptor blocks, within each competency category illustrate collections/patterns of behaviors, skills, attitudes and habits expected of residents as they progress in their training, and the growth curve shows when each descriptor is expected to be met. The descriptor blocks manifest increasing levels of independence, increasing sophistication and agility in assessment and decision making, in querying, extracting and applying information from the medical literature, a maturing in communication with and sense of duty to patients and families, a deepening commitment to self-improvement, to teaching others, and an increasing facility in working with and managing students, peers, ancillary care providers and supervising and consulting physicians.

Author

• Jonathan Zimmerman, Oakwood Hospital - Dearborn