University of California San Francisco
UCSF School of Medicine UCSF Medical Center

GME Competencies & Assessment

GME Core Competencies, Assessment Methods, Educational Activities, Assessment Terminology, and Improvements listed below.

Competencies

  1. Patient Care - Gather data; order diagnostic tests; interpret data; make decisions; perform procedures; manage patient therapies; work with others to provide patient-focused care.
  2. Medical Knowledge - Fund of knowledge; active use of knowledge to solve medical problems.
  3. Practice-Based Learning & Improvement - Analyze practice performance and carry out needed improvements; locate and apply scientific evidence to the care of patients; critically appraise the scientific literature; use the computer to support learning and patient care; facilitate the learning of other health care professionals.
  4. Interpersonal & Communication Skills - Develop a therapeutic relationship with patients and their families; use verbal and non-verbal skills to communicate effectively with patients and their families; work effectively as a team member or leader.
  5. Professionalism - Demonstrate integrity and honesty; accept responsibility; act in the best interest of the patient; demonstrate sensitivity to patients' ethnicity, age, and disabilities.
  6. Systems-Based Practice - Demonstrate awareness of interdependencies in the health care system that affect quality of care; provide cost-effective care; advocate for quality patient care; work with hospital management and interdisciplinary teams to improve patient care.

Assessment Methods

  1. Clinical Performance Ratings - Monthly, rotation, semi-annual or annual ratings of resident performance
  2. Focused Observation and Evaluation - Supervisor/attending observation of individual resident-patient encounters, operations, specimen preparation, etc., and concurrent (same day) evaluation
  3. 360 Assessments - Evaluation by MDs (supervisors, residents, medical students) and non-MDs (nurses, technicians, social workers, PAs ) using the same or similar evaluation forms<
  4. Evaluation Committee - Evaluation of resident performance in a small group discussion format, e.g., Evaluation Committee
  5. Structured Case Discussions - An informal structured mini-oral exam consisting of a small set of pre-determined questions; the exam occurs during a resident's case presentation to his/her supervisor
  6. Stimulated Chart Recall - Uses a resident's patient records in an oral exam-like format to explore decisions made and patient management; is conducted "after the fact" using patient charts to stimulate memory of the case
  7. Standardized Patient - The resident provides care to an SP as if (s)he were a real patient and is evaluated concurrently by the SP or another trained observer; the SP is a well person or actual patient trained to present a case in a standardized way
  8. OSCE - A multi-station exam of simulated clinical tasks, which might include SPs, anatomical models, X-ray interpretation, lab test interpretation, etc.; a resident performs the tasks and is evaluated concurrently by a trained observer
  9. High Tech Simulators/Simulations - Residents' performance of procedures on a high-tech simulator (e.g., Harvey) is evaluated; this may involve built-in evaluation by the simulator or observation and concurrent evaluation.
  10. Anatomic or Animal Models - Residents' performance of procedures on non-computerized, 3-dimensional models that replicate the properties of human anatomical structures is observed and evaluated concurrently
  11. Role-play or Simulations - Residents are evaluated based on their performance on assigned responsibilities in a staged replica of a potentially real situation, e.g., mobilization of medical team in a multi-victim accident, confrontation of an "impaired" colleague, negotiation with administration regarding facilities and equipment upgrade
  12. Formal Oral Exam- "Mock" oral exam in which an examiner asks residents questions about what to do in a clinical scenario presented verbally or role played by the examiner
  13. In-training Exams - A multiple-choice exam developed by an external vendor
  14. In-house Written Exams - A multiple choice exam developed by residency program faculty
  15. Multimedia Exam - A computer based multiple choice or branching question exam in which authentic visual and auditory patient information is presented as question information
  16. Practice/Billing Audit - Educational equivalent of physician profiling; this data-based process benchmarks individual resident billing data against peers in the office, hospital, or managed care setting
  17. Review of Case or Procedure Log - Review of number of cases or procedures performed and comparison against minimum numbers required
  18. Review of Patient Chart/Record - Involves abstraction of information from patient records, such as tests ordered, and comparison of findings against accepted patient care standards
  19. Review of Patient Outcomes - Aggregation of outcomes of patients cared for by a resident and compared against a standard
  20. Review of Drug Prescribing - Systematic review of drug prescribing for selected conditions to determine adherence to protocol
  21. Resident Project Report (Portfolio) - Evaluation of resident work products, such as reports of research studies, practice improvement, or systems-based improvement
  22. Resident Experience Narrative (Portfolio) - Evaluation of performance based on residents' narratives of critical incidences or other experiences, usually accompanied by reflection on the event, e.g., what happened, why, what could have been done differently
  23. Other Portfolio - Evaluation of resident performance based on other work/performance products not included above, e.g., audiotapes, slide presentation

Educational Activities

  1. Clinical Teaching - teaching that occurs in the clinic, EDs, ORs, laboratories, or other medical settings and addresses issues related to residents; current patient cases or clinical responsibilities.
  2. Clinical Experiences - direct, hands-on clinical or patient care activities. This may include surgery, patient exams, the reading of radiographs and preparation of pathology assays.
  3. Performance Feedback - information provided to a resident that describes what (s)he has done well or poorly and provides specific guidance as to how performance might be improved.
  4. Departmental Conferences, Lectures or Discussions - formal, classroom instruction on a specific topic or method, led by one or more faculty, residents, or staff, etc.
  5. Institutional Conferences, Lectures, or Discussions - formal educational event involving institution-sponsored grand rounds, lectures, discussions, or workshops for residents and/or faculty from multiple specialties; may be part of an institutional core curriculum (i.e. a set or course of learning activities arranged to impart knowledge and skills in fundamental domains, for example, communication skills, legal issues, ethics).
  6. Individual or Group Projects - multi-step, multi-component tasks performed as vehicles for learning and applying knowledge and skills. Projects should result in a product. Examples are literature reviews, research, clinical quality improvement projects, and community health advocacy work.
  7. Computer Modules - computer-based instructional units that present medical knowledge or clinical tasks, etc, that residents work through independently. These modules are developed either by the institution/program or purchased from commercial vendors.
  8. Standardized Patients - professional actors or real patients trained to present realistically and reliably a medical condition and/or specific patient behaviors; the standardized patient provides instruction to the resident or feedback about his/her performance.
  9. High-Tech Simulators/Simulations - 3-dimensional, high tech, computerized devices that represent human anatomy and physiological responses (simulators) are used by residents to learn procedures and operations. Or realistic patient care scenarios are generated using high tech/virtual reality devices (simulations). Residents engage in the scenario as in real life to learn or apply clinical or teamwork skills.
  10. Anatomic or Animal Models - non-computerized, 3-dimensional devices that replicate the properties of human anatomical structures are used by residents to learn procedures.
  11. Role Play or Simulations - staged replicas of potentially real situations are engaged in by residents to learn, practice or rehearse skills needed in those situations. This method is often used in difficult or high-risk situations, e.g. mobilization of a medical team in a multi-victim accident or confrontation of an "impaired" colleague.
  12. Games - informal activities with goals, rules, rewards and penalties for various courses of action. Games may be computerized, played individually or in groups, facilitated or self-paced.
  13. Role Modeling - portrayal of desired professional behaviors, communication skills, or clinical skills, etc. by attending/supervising physician with the expectation that residents will learn these behaviors and skills by observing the role models.

Assessment Terminology

  1. Criteria - specific behaviors, actions, outcomes, or product characteristics that are indicative of how well clinical work or learning tasks have been performed and are used as standards for evaluating performance. Points on a rating scale, such as "satisfactory"or "unsatisfactory" are not criteria.
  2. Evaluator training- occurs (minimally) if evaluators review and discuss the criteria and (more robustly) if they practice using the criteria and resolve differences in evaluations of the same sample performance.
  3. Objective standards - pre-determined scores, ratings, or patterns of ratings and comments that trigger specific educational decisions such as a requirement for remediation or denial of promotion to the next level of training.

Improvements

  1. Learning Objectives - statements that describe the specific knowledge, skills, and attitudes residents are expected to obtain as a result of participating in educational activities.
  2. Faculty Development - formal educational activities in the form of workshops, discussions, or lectures which have as their goal improving faculty knowledge about the General Competencies and their ability to teach and assess the competencies.
  3. Clinical Experiences - direct, hands-on clinical or patient care activities. This may include surgery, patient exams, the reading of radiographs and preparation of pathology assays.
  4. Clinical Teaching - teaching that occurs in the clinic, EDs, ORs, laboratories, or other medical settings and addresses issues related to residents' current patient cases or clinical responsibilities.
  5. Performance Feedback - information provided (orally or in writing) to a resident that informs him or her of what (s)he has done well or poorly and provides specific guidance as to how performance might be improved.
  6. Departmental Conferences, Lectures or Discussions - formal, classroom instruction on a specific topic or method, led by one or more faculty, residents, or staff, etc.
  7. Institutional Conferences, Lectures, or Discussions - formal educational event involving institution-sponsored grand rounds, lectures, discussions, or workshops for residents and/or faculty from multiple specialties; may be part of an institutional core curriculum (i.e. a set or course of learning activities arranged to impart knowledge and skills in fundamental domains, for example, communication skills, legal issues, ethics).
  8. Required Reading - Required Reading
  9. Individual or Group Projects - multi-step, multi-component tasks performed as vehicles for learning and applying knowledge and skills. Projects should result in a product. Examples are literature reviews, research, clinical quality improvement projects, and community health advocacy work.
  10. Computer Modules - computer-based instructional units that present medical knowledge or clinical tasks, etc, that residents work through independently. These modules are developed either by the institution/program or purchased from commercial vendors.
  11. Standardized Patients - professional actors or real patients trained to present realistically and reliably a medical condition and /or specific patient behaviors; the standardized patient provides instruction to the resident or assesses performance and provides feedback.
  12. High-Tech Simulators/Simulations - 3-dimensional, high tech, computerized devices that represent human anatomy and physiological responses (simulators) are used by residents to learn procedures and operations. Or realistic patient care scenarios are generated using high tech/virtual reality devices (simulations). Residents engage in the scenario as in real life to learn or apply clinical or teamwork skills.
  13. Anatomic or Animal Models - non-computerized, 3-dimensional devices that replicate the properties of human anatomical structures are used by residents to learn procedures.
  14. Role-Play or Simulations - staged replicas of potentially real situations are engaged in by residents to learn, practice or rehearse skills needed in those situations. This method is often used in difficult or high-risk situations, e.g. mobilization of a medical team in a multi-victim accident or confrontation of an impaired colleague.
  15. Games - informal activities with goals, rules, rewards and penalties for various courses of action. Games may be computerized, played individually or in groups, facilitated or self-paced.
  16. Clinical Performance Ratings - new or revised monthly, rotation, semi-annual or annual ratings of resident performance.
  17. Focused Observation & Evaluation - formal, concurrent (same day) written evaluation following supervisors / attending observation of individual resident-patient encounters, operations, specimen preparation, etc.; might involve videotaping and formal, current, written assessment of the videotaped performance.
  18. 360 Assessment - evaluation by MDs (supervisors, residents, medical students) and non-MDs (nurses, technicians, social workers, PAs) using the same or similar evaluation forms.
  19. Formal Oral Exam- oral exam in which an examiner asks residents questions about what to do in a clinical scenario presented verbally or role played by the examiner.
  20. Portfolio Assessment - evaluations of resident learning or performance based on resident work products, such as reports of research studies, improvement projects, presentation slides or on residents' narratives of critical incidences or other experiences