The Mid-America PD group discussed and defined a number of methods to address the upcoming RRC requirements for documentation of competency in Pediatric Residency Programs. The group discussed several strategies for most requirements. In some cases, programs have already instituted these measures. Listed below is a compilation of proposed strategies for compliance with these requirements.

Patient Care
Residents must be evaluated performing histories and physical examinations through direct observation with different evaluators in different settings –

• Utilize documented observations in clinic, ward, ICU settings
• Use entire CEX in clinic rotations, mini-CEX in ward rotation; ABIM CEX; Peds CEX (Wright State)
• Utilize faculty preceptors in continuity clinic, chief residents in ward assessments

Supervising residents and faculty must document the resident's ability to make diagnostic and therapeutic decisions based on best evidence and to develop and carry out management plans. This may be accomplished through direct observation in the clinical setting, by chart reviews or chart stimulated recall, faculty review of completed case-based modules, an OSCE or some combination of these or other methods

• Add line in monthly evaluation form that documentis faculty direct observation of resident’s ability to make diagnostic and therapeutic decisions during specific rotations (eg., clinic months) or in all rotations
• Do chart stimulated recall (eg., 5 charts per rotation) in specific rotations and check off – done well/not done well

The program must document instruction in the performance of procedures including indications, contraindications and complications

• Utilize a workshop, such as Technical Skills Assessment course (OSU), successful participation in periodic Procedure Fair (Detroit Children’s), ED/Anesthesia procedure rotations, assignments to Procedure Simulation Center during selected rotations, and/or successful participation in Mock Codes

Faculty must document effective counseling of patients and families by residents based on direct observation and comment from patients and families

• Add line in monthly evaluation form that documents faculty direct observation of resident’s ability to effectively counsel patients and families
• Have families complete evaluation form that assesses resident’s ability to counsel

Faculty must document that residents possess the necessary knowledge, skills, and attitudes to provide longitudinal primary care to patients

• Add line in monthly evaluation form that documents faculty direct observation of resident’s ability to provide longitudinal primary care to patients

The program must document the resident's ability to use the information technology systems within the clinical setting and to apply the information to patient care

• Add line in monthly evaluation form that documents faculty observation of resident’s ability to utilize IT within clinical settings

Medical Knowledge
Faculty must document the resident's ability to access, appraise and apply knowledge. Faculty evaluations must address the ability of residents to apply best medical evidence to the care of patients. Evaluations must be based on direct observation and precepting in a clinical setting

• Add line in monthly evaluation form that documents faculty observation of resident’s ability to access, appraise and apply medical knowledge

The program must evaluate the competence of residents in performing an evidence-based exercise

• Require completion of EBM exercise in a specific rotation and include completed EBM in resident’s educational portfolio
• Require EBM work in Journal Club and include completed EBM in resident’s educational protfolio

Practice-based Learning and Improvement
Documented meetings between an individual resident and mentor or advisor for purposes of feedback and guidance must occur at least twice a year. Mentors must guide the residents in their ability to use self-assessment techniques and analysis of events that exemplify particularly positive or negative behaviors to identify personal and professional strengths and weaknesses. In response the residents must develop relevant learning plans that begin during and extend beyond residency

• Include semi-annual review forms that document mentor’s feedback and guidance to the resident in resident’s educational portfolio
• Include line in semi-annual form that states “What is next step resident needs to take to improve performance during residency and as a graduate of program?” and document answer from resident
• Document actions taken by resident in response to any performance concerns

Resident familiarity with general and rotation-specific learning goals and objectives and attendance at conferences must be documented

• Add line in resident evaluation of rotation that states “I have reviewed goals and objectives of the rotation”
• Keep record of resident attendance at conferences

The program must document that residents acquire the skills needed to analyze and improve the quality of clinical practice. This can be accomplished by participation in a quality improvement project or activity

• Assign and collect evidence of a Quality Improvement Project activity done during a specific rotation (eg., clinic month)

Evaluation of participation in education must be documented with evaluations of the resident's teaching abilities by faculty and/or learners

• Include line in monthly evaluation form that documents faculty direct observation of resident’s teaching ability
• Utilize a senior education month that includes resident efforts to teach medical students and interns, precept in clinic and complete an education project
  Interpersonal and Communication Skills

Written evaluations based on direct observation must document effective communication with patients/families, supervisors, fellow residents, allied health professionals, non-medical staff, and referring physicians

• Include line in monthly evaluation form that documents faculty direct observation of effective communication by resident

The program must document a process for evaluation of each resident's skill in written documentation and timely completion of medical records

• Include line in monthly evaluation form that documents faculty direct observation of effective written communication by resident
• Include a standardized evaluation of resident’s written communications during a rotation (or several rotations throughout training) in resident’s educational portfolio

Professionalism
Written evaluations of residents' professional and ethical behavior by patients/families and members of the health care team, based on direct observation, must document elements of this competency

• Utilize a 3600 evaluation completed by patients/families and members of health care team during a specific rotation (or several rotations done throughout training)
• Have faculty complete a mini-CEX regarding resident’s professional and ethical behavior during a specific rotation

Discussion of critical incidents (especially positive or negative behaviors) in the realm of professionalism must be part of the ongoing mentoring of every resident

• Utilize a form like the ABIM mini-CEX to be completed by faculty regarding critical incidents by residents and include in resident’s educational portfolio

Systems-based Practice
The program must document experiential learning for the element that addresses the system causes of health care errors. Examples include but are not limited to, a resident presentation at morbidity and mortality conference focusing on potential system errors, or resident participation in an institutional process that identifies a system- based cause of an adverse patient outcome

• Document resident attendance at Morbidity & Mortality conferences and/or conferences that address Medical Errors
• Have residents complete online modules that address JACHO requirements
• Document resident participation in Root Cause Analysis of a clinical or educational issue in program or institution

Evaluations by other health professionals must be obtained to assess residents' ability to function as part of an interdisciplinary team

• Utilize a 3600 evaluation completed by members of an interdisciplinary team during a specific rotation (or several rotations done throughout training)