The Development of Resident “Report Cards” in the Context of Managed Care Education

Abstract

This article describes the development of residents' report cards as one component of a curriculum on physician profiling for primary care residents. Thirty-two first-year residents matriculating into family practice, internal medicine, pediatrics, and obstetrics-gynecology residency programs in 1998 were profiled. The patient information in the report cards was limited to data on a panel of Medicaid patients initially seen in the resident ambulatory care clinics. All subsequent patient care for that population was also included. The method was multi-step and complex, involving hospital billing personnel and cooperation with a managed care partner. A three-session educational program was developed to introduce the concept of physician profiling. The first session consisted of a panel discussion on managed care. The second session was devoted to a discussion of hypothetical physician profiles with inappropriate length of stays, days/1,000, low numbers of office visits combined with high urgent-care use, and high outpatient services utilization. Small groups of residents participated in a problem-identification process as if they were members of a group practice. Residents identified problems in the reports and made suggestions for behavioral changes. A final session presented residents with their own personal report cards. Residents were surveyed both at the beginning of their first year and before and after the educational intervention on profiling. Resident attitudes, which were negative toward managed care at the outset, became generally more positive. Comparisons of pre-test and post-test means on the five-point Likert scale, using a paired-samples t-test, revealed significant changes in the residents' attitudes overall.

Developing and authenticating an electronic health record–based report card for assessing residents' clinical performance

“…With the shift to competency‐based medical education (CBME), many educators have emphasized the potential of EHR data to support the teaching and assessment of trainees 2–4 . In recent decades, several medical education scholars have innovated around the development and operationalization of resident report cards and dashboards 4–9 . In one attempt to create a resident report card based solely on EHR data, Farquhar and colleagues 5 identified two constraining factors: (1) gathering robust, secure data from multiple sources (e.g., Medicaid insurance data) and (2) tagging residents consistently and accurately to patient charts when they do not bill for medical services.…”

“…[2][3][4] In recent decades, several medical education scholars have innovated around the development and operationalization of resident report cards and dashboards. [4][5][6][7][8][9] In one attempt to create a resident report card based solely on EHR data, Farquhar and colleagues 5 identified two constraining factors: (1) gathering robust, secure data from multiple sources (e.g., Medicaid insurance data) and…”

“…In recent decades, several medical education scholars have innovated around the development and operationalization of resident report cards and dashboards 4–9 . In one attempt to create a resident report card based solely on EHR data, Farquhar and colleagues 5 identified two constraining factors: (1) gathering robust, secure data from multiple sources (e.g., Medicaid insurance data) and (2) tagging residents consistently and accurately to patient charts when they do not bill for medical services. This work evaluated residents' attitudes towards report cards and found 79%–90% agreed or strongly agreed that they: (1) understood report card data and (2) supported its use in health systems.…”