RESIDENT PORTFOLIO

  • INTRODUCTION TO THE RESIDENT PORTFOLIO ACGME Description

    A learning portfolio can be a powerful tool for evaluating resident knowledge and the general competencies. Maintaining portfolios on your residents is an ACGME program requirement and will be an important part of meeting the general competencies.


    What is a Learning Portfolio?
    A learning portfolio is a collection of materials that represents the learner’s efforts, progress and achievements in multiple areas of the curriculum throughout their training. The purpose of a learning portfolio is to facilitate improvement in abilities and contribute to the life long learning process. A portfolio is a method to encourage residents to reflect on their experiences and learn from them. A portfolio is a place to store and keep work products of the residency and would include: (a) Collection of personal work, i.e. PowerPoint slides, handouts, exhibits, effort, progress, achievement; (b) Serves as an ongoing diary of their learning experiences. A portfolio will help mentors and coaches use the system to help residents gain insight into their education. By creating a portfolio the resident takes an active role in his/her achievements during training.


    A portfolio is a record of growth, achievement and professional attributes that illustrate progression toward competence over time and to self-directed, life long learning. During the four years of training the resident will construct a portfolio with evidence of growing competency as a radiologist. Upon graduation the portfolio should be given to the trainee and will give them documentation that will enhance their marketability and serve as proof to others as well as the trainee that they are a competent physician. A portfolio provides the opportunity for residents to learn and demonstrate skills needed to develop an approach to self-directed, lifelong learning because the resident is responsible for its creation.

    Key Elements of a Portfolio

    • Self assessment

    • Goal setting

    • Mentored observation/feedback

    • Works in progress

    • It should coincide with the resident’s training plan and objectives

    • Should be linked with which competencies a particular portion of the portfolio is meeting

    Why a Portfolio

    • The resident takes an active role in his/her achievements because the trainee selects the content of the portfolio. However, any documents that might be helpful at a later date can also be added.

    • A portfolio is a method to evaluate, acquire feedback, self reflection and achieve growth and development

    • A portfolio serves as a method of comparisons; such as comparing grades on in-training exams and mock boards during the residency training period to make sure the resident is attaining adequate progress in their training

    • A portfolio is a way to self-reflect on learning experiences during training.

    • A portfolio can be used for credentialing purposes post-residency training because it will contain much of the information necessary for credentialing completion.

    Benefits of Keeping a Portfolio
    • The resident is accountable for most of what is included in the portfolio and therefore, involved in their own assessment by having a portfolio
    • A portfolio contains samples of the resident’s work and what the outcomes are, i.e. publications, presentations, and other projects done during residency training and whether they were presented at a national, state, or local meeting or appeared in print in a refereed journal
    • The portfolio aids in the final evaluation because you have a report of everything the resident has accomplished during their residency training therefore making it simpler to put the final evaluation together
    • The portfolio is the property of the resident
      • The portfolio should be kept as a part of the residents file
      • Upon completion of residency training the resident will take the portfolio portion of their file with them. Before giving the portfolio to the resident make a copy for the resident’s permanent record. Much of the information in the portfolio is helpful when completing the PIF. The ACGME will most likely request a copy of the resident portfolio at the time of their site visit
    Pros of Keeping a Portfolio - Resident: Some of the pros of the resident keeping a portfolio are:
    • Aids the resident in documenting “self-directed” learning behaviors such as a compilation of what has been read, what conferences and journal clubs have been attended, etc.
    • It helps the resident create a habit of inquiry and practice of evidence based medicine
    • It aids the resident in keeping a list for examination preparation and credentialing. Enables the resident to check to see what has been covered and what may still need to be covered.
    • It gives the resident a chance to address individual deficiencies with the program director
    Pros of Keeping a Portfolio - Program Director: Some of the pros of a portfolio from the program director’s perspective are:
    • It is a real-time assessment of resident clinical activities
    • It serves as a vehicle of immediate feedback to the resident
    • It is an assessment of resident self-directed learning activities and their use of medical literature
    • It serves as a database of resident and program learning needs
    • It includes medical education research done by the resident and is on hand for PIF completion
    • It promotes faculty development
    • Portfolio entries can be linked to a competency (i.e. if a resident identifies a problem and works the problem toward a solution, this is an example of what can meet portfolio requirements for Practice Based Learning, or if a problem is identified at a resident meeting, bring a solution to the next meeting)
    The portfolio is a self reflection on how the resident achieves the objectives of the program and the program rotations. The resident requires the program director’s input on how to achieve
    their goals and this should be discussed during their semi-annual review with the program director. Definition of the competencies should be discussed as well as the goals the resident has set for themselves, along with expectations as to how to achieve these goals. If the goals are not achieved, new goals need to be set and re-evaluated.
  • RADIOLOGY RESIDENCY PORTFOLIO CONTENT DISCUSSION AND EXAMPLES Enter description here.
    Resident Evaluation - ACGME Requirements

    Will the Resident Learning Portfolios contain documentation of the following items? [PR V.A.1.b).(6).(c). - (c).(vii)]

    • Case/procedure logs
    • Conferences, courses/meetings attended
    • Self-assessment modules completed
    • Compliance of nuclear medicine and breast imaging regulatory-based training requirements
    • Performance on yearly objective examinations
    • Reflective process evidenced by individual learning plans and self-assessment
    • Formal assessment of oral and written communicationCompliance with institutional and departmental policies
    • Status of medical licensure, if appropriate
    • Learning activity that involves deriving a solution to a system problem
    • Scholarly activity
    CONTENTS

    Portfolio Content


    The portfolio should be a part of the resident’s permanent file and should     include:
    Personal goals and statements about what has been learned and what is wished to learn during their training

     
    Self Reflection – reflect on learning experiences and what future goals for learning are
     
    Daily Learning Plan
    • Books read, i.e. chapter numbers, number of pages
    • Literature reviewed, i.e. journals, on-line articles
    • Media reviewed
    • Educational web-sites visited
    • Quality Improvement Plan and report of results
     
    Case Log Summary
    • Case Log information and case summaries should be included. This information is helpful when requesting privileges, especially in nuclear medicine where numbers of cases are necessary for a radiologist to be added to an institution’s NRC license.
     
    Conference Attendance
    • Noon Conference
    • Journal Clubs
    • Grand Rounds
    • Intra- and Inter-departmental conferences
     
    Work Products/Scholarly Activity
    • Research
    • Publications
    • Presentations
    • Slides/Handouts used when presenting at conferences, grand rounds, M&M conferences
    • Summary of research literature reviewed in preparation for articles to be submitted for publication or for a conference presentation.
     
    Teaching
    • Noon Conference Presentations
    • Quiz Conference Presentations
    • Medical Student teaching
     
    Meetings with Program Director
    • Should also have a record of meetings with program director or mentor including signed documentation of the meeting.
     
    Examinations
    • ACR In-Training Exam
    • Mock Boards
    • AOBR Boards
     
    Dictation Review, Feedback
     
    Critical Incidents
     
    Professional Meetings Attended
    • List of professional meetings attended and whether or not a presentation or poster was done
     
    Certificates, Records, Awards
     
    Personal Experiences
    • Duty Hours
    • Rotations
    • Conferences Given
    • Leave (vacation/sick)
     
    Copies of Evaluations and Ratings
    • 360 evaluations - nurses, technologists, patients, peers, self
      • Evaluations should be printed if they are done in an electronic format and placed in the resident’s permanent file. The reviewer wants to see them in print at the time of the site visit and they will be available in the portfolio for review.
    • Patient feedback
      • Letters of appreciation from patient or patient’s family or, on the down side, letters of non-appreciation
    • Monthly faculty evaluations
    • Summary evaluations
    • Final evaluations
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    EXAMPLE
    The following is an example of a portfolio table of contents. The portfolio is kept in a separate folder in the resident’s permanent file and divided into 15 sections.

    Portfolio Contents

     
    Personal Goals
     
    Self Reflection and assessment, yearly
     
    Daily Learning Plan (Books read, Literature reviewed, Media reviewed, Education web-sites)
     
    Case Log Summary
     
    Conference Attendance (Noon Conference and participation, Journal Clubs)
     
    Work Products/Scholarly Activity – Quality Improvement Project ; (Research, Publications, Presentations, Slides/Handouts)
     
    Teaching (Noon conference, Quiz conference, Medical student teaching)
     
    Meetings with Program Director
     
    Exams: In-Training/Mock Boards
     
    Dictation Review, Feedback
     
    Critical Incidents
     
    Professional Meetings Attended
     
    Certificates, Records
     
    Personal Experiences (Leave (vacation/sick), Duty Hours, Rotations, Conferences Given)
     
    Evaluations (Monthly/semi-annual, 360, Summary)
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  • OSUMC DIAGNOSTIC RADIOLOGY BIANNUAL RESIDENT PORTFOLIO – SELF EVALUATION AND REFLECTION REVIEW Enter description here.
  • ONLINE myPORTFOLIO PROVIDED BY RSNA Organized online organizational tool for required portfolio items.
    User Guides for:

    Residents

    Administrator



Committee Yearly Assignments

Hospital Committee Assignments
BIOETHICS
Lora Cotton, DO
Quarterly, 1st Mon, Noon, ABR
Katherine Rankin
Becca Dennis

INFECTION PREVENTION (CONTROL)
Laurie Duckett, DO
Odd Months, 2nd Wed, 6:30AM, ABR
Kyle Summers
Corey Matthews

MEDICAL RECORDS CMMTTEE
Kathy Cook, DO
Quarterly, Last Tues, Noon, AUD
Justin Becker
Brian Do

OSTEOPATHIC PHIL/UTIL
Mark Thai, DO
Quarterly, 4th Tues, 7:30AM MSCR
Brandon Mason
Nick Strle

P & T
Mousumi, DO
Monthly, 3rd Thur, 7AM, ABR
Cameron Smith

TRANSFUSION REVIEW CMMTTEE
Melvin VanBoven, DO
Odd Months, Last Thurs, 7:00AM, QCR
Jeff Lee
Adam Foster

UTILIZATION REVIEW COMMITTEE
Terence Grewe, DO
Monthly, 3rd Tues, 12:30pm ABR
Anna Morgan
Leo Bautista
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Resident Quality Initiative Project

QI Project

Resident Quality Initiative


Purpose


The purpose of the Performance Improvement Program is to develop, implement, and maintain an effective, ongoing, hospital-wide, data-driven quality assessment and performance improvement (QAPI) program. The program involves all hospital departments and services (including those services furnished under contract or arrangement) and focuses on indicators related to improved health outcomes and reduction of medical errors. The QAPI program is a continuous effort of sustaining improvements throughout the organization.


Accountability

All individuals in the organization are responsible for quality of care, services, patient safety, operations, and safety of the environment; this includes, but not limited to, the governing body, all physicians, residents, hospital leadership, hospital employees and volunteers, as well as those individuals contracted to provide services. The hospital Chief Executive Officer, leadership from the Medical Staff, the Nurse Executive, and the person assigned overall responsibility for quality management ensures the hospital Quality Assessment and Performance Improvement (QAPI) efforts and training programs address the identified priorities in the hospital.

Importantly, the program leadership promotes incorporation of the quality curriculum across all aspects of the residency. Resident QI education is incorporated into practice management, grand rounds, morbidity and mortality conferences, and other institutional activities. All core faculties are involved in mentoring residents on QI projects.


Structure

The curriculum is built on three principles. First, we have created a foundation of institutional support, taking advantage of the fact that QI is an integral part of this health system. The residency can draw on institutional expertise in QI project management and research from hospital staff whose principal assignments are Joint Commission readiness, performance improvement, auditing of Centers for Medicare and Medicaid Services quality measures, and outcomes tracking. Leadership provides ready access to data and analyst expertise because we select projects that support the institution’s core strategic aims within the hospital.

A second principle is to build a QI knowledge base within the residency. All our physicians share an interest in improving patient care, so we encourage core faculty to turn their good ideas as well as their pet peeves about practice flow and environment into opportunities for study and improvement.
We teach root cause analysis, but we emphasize small scale cycles of plan-do-study-act (PDSA) as the best way to test and refine ideas. Rather than viewing success as a publishable paper, we measure the resident’s ability to lead small changes and then scale up to improve the care system for patients.

The third principle is to use project-based learning to empower residents to pursue their passions. We aim for every resident to “catch the bug” for QI, so individual residents select and lead a project that resonates with their own career interests.

At the end of their project, residents are encouraged to present, publish, and use QI work to pursue fellowships. New interns see senior residents making a contribution to their future careers, which fuels enthusiasm for developing their own QI project.



Workability for the Residency

A vibrant QI curriculum cannot be sustained unless it is workable within the time and budget constraints of the residency. We have identified strategies for success as well as cures for some common pitfalls.

Find Shining Eyes
For residency QI projects to succeed, the resident must put in long hours of unsupervised and often uncelebrated work. Consequently, we carefully listen to residents during the project selection process to find a project for which they feel great passion. We watch for what conductor Benjamin Zander has called “shining eyes”.

A Brick, a Wall, or a Cathedral?
Once they get excited about a problem, residents tend to envision drastic overhauls of complex processes. We encourage them to bite off a manageable piece of a project (add a brick) without losing their passion for the big-picture process (building the cathedral).

Sample the Soup
Busy residents tend to want to implement elaborate new processes (e.g., a pathway for depressed clinic patients) and then come back a year later to measure outcomes. Often, the new process has one or two flaws which, unaddressed, can foil an entire year’s work but can be easily identified and fixed by taking a sample of the first 10 patients going through the process. A cook does not have to eat the whole pot of soup; just a taste will reveal the need for more salt.

Solve a Real Problem
Occasionally, residents or faculty mentors will happen upon what sounds like a great QI project, but residents must confirm that their idea addresses a true practice gap and that potential interventions are based on a root cause analysis as well as available evidence.

Create an Explicit Schedule with Clear Roles and Responsibilities
Residents have some help with scheduling major meetings but are expected to create a timeline and meet deadlines. Specific responsibilities, which are delineated in support materials, help the residents as well as their mentors stay on task.


The Process

Residents are introduced to QI principles early in their first year, and these concepts are reinforced and expanded through readings and conferences. Mentors, with the assistance of the Quality Department, will help provide the Residents with readings that support the initiative that they choose or are provided to them. These readings should be based on current guidelines/CMS measures/Value Based Purchasing indicators.

Each Chief Resident is responsible for managing their Quality Initiative. They will be responsible for working with the Quality Department in developing a method to track their initiative and a means by which they can improve their designated Quality Initiative.

The Quality Department with provide the tracking method to the Chief Resident monthly, and the Chief Resident will be responsible for succinctly presenting this at the Chief’s Council Meeting monthly. This will be a forum for Residents to provide suggestions, or develop a collaborative plan to accomplish the goals set forth by the Resident. The Chief’s will be responsible to submit their progress to the Chief Quality Officer.

The Chief’s Council will determine who will be Chief Quality Officer. The Chief Quality Officer will be responsible to present their findings to monthly Quality Meeting. The Chief Quality Officer will also be asked to present findings at Grand Rounds at the end of the academic year.

We are encouraging the Chief’s to share this information with their respective Residencies, and work together as a group to fulfill their goals.

Based on the complexity, different timelines will be created for completion of their project.

Most important, residents learn while engaging in meaningful work by completing their own QI project.


Conclusion

Quality Improvement is on-going. As we work towards our goals, the projects chosen will be re-evaluated for continued successes. As we meet our goals, new projects will be formulated to continue promoting positive patient outcomes and reducing medical errors.

A strongly grounded QI curriculum can add value to both the institution and residency while remaining fluid and fun. We consider the curriculum development process our own QI project as we continually re-evaluate and redesign our program based on feedback.

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Miscellaneous items