Significant event reporting in a postgraduate deanery

Abstract

Context and setting The University of WisconsinMadison's Internal Medicine Programme structures each resident's semi-annual review as a series of chapters authored jointly by the resident and the programme director. Residents self-assess their growth in the Accreditation Council for Graduate Medical Education (ACGME) competencies (professionalism, communication, medical knowledge, practice-based learning and improvement, systems-based practice, patient care), evaluate their career development and professional-personal life balance, reflect on their strengths and gaps, and identify goals, objectives, tasks and monitoring strategies for selfimprovement. Then, during a 1-hour conversation with a programme director, residents align their opinions of their performance with multi-source evaluations (patients, peers, faculty) and prioritise specific commitments to change. Why the idea was necessary The commitment to change (CTC) strategy has been linked to improved medical practices in continuing medical education. Doctors who attend training and commit to a behavioural change later demonstrate improvements in practice compared with those who do not commit to change. Adoption of the CTC strategy during graduate medical education might similarly reduce the gap between residents' performance on the competencies and the programme's standards for best practices. What was done We recently formalised our semiannual review process by asking residents to document three self-selected and two externally driven (i.e. patient outcome core measure and patient safety) commitments to change. Residents also categorised progress on each of their prior goals as completed, not completed or not addressed at the end of residency. We analysed the content of residents' commitments, the types of advice summarised in directors' follow-up letters, and progress toward completion of residents' commitments across 3 years of semi-annual reviews for our class of 27 residents who graduated in 2008. Evaluation of results and impact Career issues, followed by a desire to increase medical knowledge, dominated residents' commitments. Residents effectively identified their competency gaps, allowing programme directors to target the low-hanging fruit, the high yield, and important areas with advice on how to identify mentors, prioritise goals and break down objectives into actionable tasks. Conversations necessarily revolved around externally driven, programme-specific competencies, organisational requirements (American Board of Internal Medicine, ACGME, Joint Commission on the Accreditation of Healthcare Organizations), fellowship and job seeking, which all residents eventually met. However, directors also consistently pushed residents to clarify their commitments within the internally driven areas of personal-professional balance, professionalism, communication and patient care. Outcome analyses indicated that residents were more successful at meeting externally driven patient safety (72%) and core measure (57%) commitments than at meeting internally dri...