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Presenters: •Dr. Rae Wright, Family Medicine of
Southwest Washington•Dr. Zinna Johns, East Pierce Family
Medicine
Hosted by: Family Medicine Residency Network
Webinar: October 1, 2014
CCC: Lessons Learned
– Two Programs,
Two Case Examples
Structure
Program 1: Family Medicine of Southwest Washington
Developing the CCC Team Developing and Determining Evaluation
Tools Case: Resident Profile
Program 2: East Pierce Family Medicine CCC Background Case: Resident Profiles – CCC Discussion
and Response Outcome
Discussion
CCC and Case 1Family Medicine of Southwest Washington
Presented By: Dr. Rae Wright
Strategically Select CCC Members
Start with a champion
Respected and trusted by faculty and residents
Active in teaching and evaluating residents in a variety of settings
Interested in learning Milestones lingo
History of being collaborative in meetings, etc.
FMSW has 6 members, 5 full spectrum FM faculty and one BH faculty
Develop a Milestones Based Evaluation System
Collect aggregate date on Milestones over time
Tools should be easy to interpret
New Innovations has built-in tools Direct vs. indirect evaluations Shift cards Milestones reports
Gradually integrate new evaluations
Periodic Meetings for CCC
Discussion of residents of concern
Use Competencies and Milestones based language for discussion
FMSW Style CCC meets 1-2 times per month Must have at least 3 members present for interim
meeting. Usually 4-5. Pre-biannual meeting with other faculty including
advisors
Case 1: Concern
“Working to improve documentation – some uncertainty about what is needed.”
“Still struggling on nights to get work done by [themself], as well as learning about all the small extra tasks that are required, but once [resident] is shown will then consistently perform them. Visible improvement over the few days I was with [resident].”
“Needs some improvements in organizational skills to prioritize and perform duties as needed for care of patients.”
“Presentations are a work in progress. I encourage [resident] to avoid extraneous comments and questions during presentations. Presentations were initially difficulty to follow due to the lack of structure, but they improved in the week we had together.”
“Presentations not yet polished, can be scattered.”
“Does not consistently carry pager when on call.”
Discussion
Competencies/Milestones of Concern Patient Care
(PC-1) Professionalism (Prof-
1,2) Communication (C-
3,4)
Plan for Improvement Seek out feedback to
improve performance real time.
Carry pager as required.
Focus on task at hand before moving to next tasks.
Practice oral presentations as part of active precepting and with senior residents.
Semi-Annual Meetings
Preparation Use support staff to gather all data beforehand Pre-meet with advisors and other available faculty for
Resident Review
Meeting Consider splitting into 2 groups Use a time keeper
Case 1: Resident Profile
“Enthusiastic, energetic, and always eager to learn.”
“Actively seeks out feedback and takes suggestions well.”
After the CCC Semi-Annual Review
Milestones information completed in NI
Email sent to advisors with instructions and meeting time
Advisors review all information with advisees, including Milestones info on NI
Informal vs. formal feedback to CCC after advisors meet with advisees
What did we do with our resident?
Interim meetings with advisor
Active precepting in clinic
Fine tune presentations when in clinic
Shadow senior residents in the inpatient setting to see the other side
Resident received all feedback well and has made some progress
CCC and Case 2East Pierce Family Medicine
Presented By: Dr. Zinna Johns
CCC Background
3 CCC meetings per class broken up into specific teams: Pine, Oak, and Maple.
Thus a total of 9 CCC meetings biannually at EPFM.
Advisor(s) for each team must be at the CCC for their advisees. Other faculty members may attend if schedule allows.
Program Director, Program Coordinator and Behavioral Health Specialist present for all CCC meetings.
CCC EPFM Style
Case 2: Resident Profile: Above or Below the Bar?
SA is one of 6 residents in the 1st class of residents at EPFM
At time of CCC, is half way through her 2nd year of residency
In general, performance is “meets” or “exceeds expectations”
Had a reputation as a resident that “sets the bar”
Case 2: Resident Profile: Above or Below the Bar?
Spring 2014 CCC for R2s on average took about 35-42 minutes.
The outlier was the CCC evaluation for SA, which took 75 minutes.
Areas of concern were: SBP4, Prof1-4, and Com3.
Tools used for evaluation include: Faculty observation, 360 evaluations, ITEs, Rotation evaluations that were mapped to Milestones
Case 2: Resident Profile
Case 2: Concern
Through out residency, SA has had cyclical episodes of interactions that were concerning for lack professional conduct.
Behaviors such as explosive response to changes to a previously established policy; inappropriate selection of time and modality of giving negative feedback (to med students, peers, and faculty); repeated inflexibility with changes that are perceived as unfair
Resident is effectively isolating self from fellow residents because of lack of willingness to be a team player.
Case 2: Mock CCC Discussion
Case 2: Outcomes
Resident was given Milestones feedback, after completing self assessment with the Milestones packet.
On average scored 2.5. except for the areas of concern.
On self assessment, scored self at 3.5.
Areas of weakness were reviewed with resident.
Resident was informed that the behavior was problematic and needed to change.
Case 2: Outcomes
Reviewed the cyclic pattern with resident and outlined correlation with stressful schedules such as night float.
Resident was directed to Behavioral Health Specialist for tools and/or reading a book about professionalism and communication.
2 follow-up meetings have occurred since.
SA never met with BH (now 4-5 months later). Resident chose a book about spirituality at the workplace and felt overall improvement.
Planned pre-CCC meeting with SA to revisit areas of weakness, which persist with clarification that persistence these behaviors could lead to formal process.
Lessons Learned
CCC Meetings increase in value with higher number of faculty members.
The more faculty members, the longer the CCC meetings.
If there is a prolonged discussion on a specific Milestone for a certain resident, that person is possibly struggling in that area.
CCC’s task is simply to evaluate the data and assign the resident’s progress for the Milestones.
This must be separated from identification of whether a resident is in difficulty.
CCC is not intended for problem solving and the tendency to do so will limit efficiency.
Questions & Discussions
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