Vu Q. C. Nguyen, MD, MBACarolinas Medical Center

Carolinas RehabilitationCharlotte, North Carolina

ACGME Competency Measures

Perspective

• Large healthcare system• 43 hospitals system

• 2nd largest healthcare system in the nation

• Carolinas Medical Center is flagship

• Three education campuses• Charlotte: 15 residencies and 11 fellowships

• Concord: 1 family medicine residency

• Greenville: 1 family medicine residency

• Large rehabilitation system• Carolinas Rehabilitation (CR): Main, Mt Holly, NE, Pineville

• Levine Children’s

• Charleston, Greensboro, Greenville, Lancaster, Wilmington

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Perspective

• Geography • Facilities and physicians spread across 4 states

• Challenges communication and processes

• Diverse patient population• The variable composition of patients across facilities drives the

type of care being delivered

– CR Main: neurotrauma rehabilitation

– Pineville Rehab: general rehabilitation

• Unique medical staff culture• Charlotte, Concord, and Greenville are more education oriented

• Faculty vs. practitioner

• Facility vs. clinics

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System

• Strong centrally-oriented leadership• Division of Medical Education drives processes

• Heavy reliance on electronics• MedHub residency management system

• Cerner EMR for all inpatient and outpatient interfaces

• iPads and smartphones for clinical and communication

• Virtual care for ICU, primary care, referral, and on-call

• Video and audio conferencing for meetings and lectures

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PM&R Competency Measures

• All measures are distributed in electronic and printed formats to faculty• MedHub End of Rotation Evaluations

• ROCA

• 360 Globals

• Procedures Log

• Diagnoses Log

• PM&R-oriented Competencies

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MedHub

• End of Rotation Eval measures the established ACGME competencies• Patient Care

– General skills, physiatric skills, clinical judgment, patient care

• Medical Knowledge

– General knowledge, physiatric knowledge

• Practice Based Learning and Improvement

• Interpersonal and Communication Skills

• Professionalism

– Professional attitudes, humanistic qualities

• Systems Based Practice

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MedHub

Has Not

Achieved

Level 1 Level 1 Level 2 Level 3

Level 4

(Graduation Target)

Level 5

(Aspirational) N/A

Has not Achieved

Level 1

Not

Competent

Not

Competent

Progressing

Progressing

Progressing

Competent Graduation

Target

Competent Graduation

Target

Competent Graduation

Target

Competent

Aspirational

Insufficient Contact to

Judge

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• Modified MedHub End of Rotation Evaluation

• Language and evaluation levels are more consistent with ACGME’s NAS

360s, Diagnoses, Procedures, and ROCA

• 360 Globals• Patients, therapists, nurses, assistants, colleagues

• Procedure Log• ACGME

• ROCA

• Diagnoses Log• All cases evaluated during the Consults Rotation are logged

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PM&R-oriented Competencies

• 63 competencies based on 9 core subspecialties• TBI, SCI, Stroke, Peds, Cancer, Ortho-Amp, EDx, MSK, Sports

• 7 competencies per core subspecialty

• The competencies are the most pertinent conditions in PM&R

• Creation of the Competencies• Core faculty in each subspecialty were surveyed as to the 7 most

appropriate conditions that they felt all physiatrists should be able to manage comfortably

• PD drafted all of the competencies and forwarded them to the subspecialized faculty to review and modify

• PD then revised the competencies based on the cumulative feedback from faculty

• Each batch of 7 competencies were debated and ratified at the monthly GME meetings

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Stroke Competencies

1. PC Stroke: Hemiplegic Shoulder Pain2. PC Stroke: Spasticity3. PC Stroke: Post-stroke Depression4. PC Stroke: Botulinum Toxin Injection5. MK Stroke: Scales – NIHSS, MMSE, Modified Rankin,

Barthel Index, FIM, GOS, and Aphasia Tree6. MK Stroke: Primary and Secondary Stroke Prevention7. SBP Stroke: Assess caregiver support and resources

available

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Stroke Competencies

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15. Patient Care Competency – Stroke: Hemiplegic Shoulder Pain (HSP)

Resident must demonstrate an understanding of the pathophysiology of HSP and differentiate the condition from other painful disorders of the shoulder; outline an appropriate management plan that includes prevention of the condition, identification of the condition, initiation of therapy and modalities including oral pharmacotherapeutics and shoulder injections. Appropriately utilize imaging and other diagnostic testing modalities. The resident must be able to educate the patient and/or family members in regards to the condition and its management.

Instruction for Faculty: The resident will hand you this form when they feel they have mastered any of the competency levels below. Please rate them according to the scale below by putting today’s date on the level that you feel they have achieved. Please recognize that a level 4 should only be given if you feel this resident is competent to manage this condition today, equivalent to that of a “graduate”. A level 5 is reserved for a resident who has shown competency level equivalent to that of an “expert”.

Competency Level

1 2 3 4

Target Graduation

5

Aspirational

Definition of Each Level

Recognizes that there

are potential shoulder

complications from

hemiplegia and takes

appropriate actions to

prevent and monitor for emergence

Identifies and manages

co-morbidities

and differentiates

HSP from other painful

shoulder conditions

Understands functional impact and

initiates appropriate

levels of intervention

for the management

of HSP

Develops a comprehensive treatment plan to address all

aspects of HSP that includes prevention,

therapy, medications,

injections, and consultations

Able to incorporate

evidence based

management into practice and discuss

controversial or emergent management

Faculty scoring date

Stroke Competencies

Overview of expectations for the resident:

Patient Care Competency – Stroke: Hemiplegic Shoulder Pain (HSP)

Resident must demonstrate an understanding of the pathophysiology of HSP and differentiate the condition from other painful disorders of the shoulder; outline an appropriate management plan that includes prevention of the condition, identification of the condition, initiation of therapy and modalities including oral pharmacotherapeutics and shoulder injections. Appropriately utilize imaging and other diagnostic testing modalities. The resident must be able to educate the patient and/or family members in regards to the condition and its management.

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Stroke Competencies

Instruction for Faculty:

The resident will hand you this form when they feel they have mastered any of the competency levels below. Please rate them according to the scale below by putting today’s date on the level that you feel they have achieved. Please recognize that a level 4 should only be given if you feel this resident is competent to manage this condition today, equivalent to that of a “graduate”. A level 5 is reserved for a resident who has shown competency level equivalent to that of an “expert”.

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Stroke Competencies

Competency Level

1 2 3 4Target

Graduation

5Aspirational

Definition of Each Level

Recognizes that there are

potential shoulder

complications from

hemiplegia and takes

appropriate actions to

prevent and monitor for emergence

Identifies and manages co-morbidities

and differentiates

HSP from other painful

shoulder conditions

Understands functional

impact and initiates

appropriate levels of

intervention for the

management of HSP

Develops a comprehensive

treatment plan to address all

aspects of HSP that includes prevention,

therapy, medications,

injections, and consultations

Able to incorporate

evidence based management into practice and discuss

controversial or emergent

management

Faculty scoring date

         

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• Vu’s contact info:

• 704-615-5214 (cell)

• 704-355-9330 (office)

• Vu.nguyen@carolinashealthcare.org

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Thank you

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