Presenting Author:

Dorothy Dschida, M.D.

Principal Investigator:

Dorothy Dschida, M.D.

Department:

Family and Community Medicine

Keywords:

graded supervision, milestone assessment, inpatient medicine, resident training, simulation

Location:

Third Floor, Feinberg Pavilion, Northwestern Memorial Hospital

E5 - Education

First Night On Call: Using simulation to assess inpatient skills

According to the ACGME Program Requirements for Graduate Medical Education in Family Medicine, effective July 2014, each program must determine the appropriately graded level of supervision. Furthermore, the program must document that residents’ skills are progressing from “care that is dependent on supervision by faculty toward unsupervised, independent care at the time of graduation,” and that residents can appropriately supervise their junior team members (ACGME 2014). Traditionally, these assessments have been made through observation of patient care while on service. However, this approach may miss the opportunity to observe the interaction between resident and patient, as well as supervision of co-resident that may occur in the attending’s absence. As a supplement to observation of patient care on service, implementing a structured simulation activity allows faculty to directly observe resident assessment and management of 3 urgent inpatient clinical scenarios. Faculty members then provide structured assessment of appropriate patient care and timely notification of supervising attending. In addition, the seniors are specifically evaluated on their ability to instruct and evaluate the junior residents. Faculty can map resident performance to core Family Medicine Milestones and track progress for promotion and graduation. Over the last several years, our team has used this First Night On Call session to identify several learners that required additional clinical experience to help them to achieve milestone levels appropriate for promotion to indirect supervision. Currently data analysis is underway to evaluate the effect of the session on resident confidence in managing urgent and emergent clinical situations. As this project moves forward, we will be tracking a resident’s progression in milestone level and confidence across years of residency training.