Yale University School of Medicine
The instrument is implemented at Yale University as an evaluation of residents’ performance throughout the course of a four week rotation on the Acute Care for the Elderly unit. The instrument is used twice during the rotation. At the beginning of the rotation, it gives the residents an opportunity to preview the various domains on which they are going to be evaluated. This helps them reflect on their current geriatric skills and setting learning goals for the rotation. At the end of the rotation, it is used by the geriatric faculty in conjunction with input from the interdisciplinary team to provide feedback, making it a powerful evaluation tool. To determine the data points that the faculty consider in placing the resident along the series of milestones in each competency, we included a checklist of potential observations, including several Cex’s. The completed evaluations are available online for review by both the residents and the residency program director.
On completion, the learner will be able to:
- Develop a competency-based resident evaluation instrument for a geriatrics rotation
- Determine the feasibility of implementation this type of evaluation
- Determine the utility of the instrument in guiding learning and facilitating formative feedback
Internal medicine residency programs must teach and evaluate geriatric medicine skills, given the significant proportion of older adults cared for by internists. The general evaluation form for our Acute Care for the Elderly unit proved inadequate, both because it failed to capture specific geriatrics skills and the numerical rating scale had poor construct alignment. In keeping with competency-based medical education, we developed an instrument that consists of a series of developmental milestones in four geriatrics competencies. Each milestone is represented with a detailed iconic narrative description of resident performance. The terminal milestone reflects our expectations for a graduating resident. The competencies, which reflect the learning objectives of the rotation, include:
1) Perform geriatric assessment, including assessment of function, mobility, cognition, fall risk, nutrition, and polypharmacy,
2) Negotiate and implement goals of care with older adults and their families,
3) Work effectively with interdisciplinary teams, including physician assistants, therapists, pharmacists, and nurses and
4) Safely oversee transitions of care for hospital to non-hospital settings.
Faculty supervisors are instructed to synthesize all their evaluation observations over the course of the month in determining the residents’ progression along the series of developmental milestones. They also write specific examples of performance to “justify” their rating.