A. Evaluation of fellows

Faculty members provide feedback to fellows during the course of all rotations. This is done constructively, privately, and with the intent of complimenting the fellow at the level of his performance and demonstrating methods of improving achievement and procedures.

We have developed appropriate forms to provide an in depth assessment of the fellow’s performance with respect to the Core Competencies. The fellows are evaluated by the faculty following each rotation on the consultative service and each quarter at the completion of an ambulatory clinic block. Evaluations are compiled and reviewed with the program director twice a year and at least once a year a written record of the evaluation is prepared by the program director. Semi-annually the program director meets with the individual fellows to review these evaluations and provide them with a written composite. The program director is available for further discussion of the evaluations if needed.

Counseling and Remediation: In the unlikely event that a trainee requires remediation in one or more areas that impact on clinical competence, the program director will appoint an ad hoc committee of faculty to develop a plan of remediation, implement the plan and evaluate the trainee’s response. If a faculty member receives poor evaluations as an attending physician, those evaluations and plans for improving performance will be discussed in a meeting with the program director.

In addition to fellow evaluations by faculty, on 1-2 occasions per year the program conducts 360 degree evaluations which includes input from peers, patients, nursing staff, allied health professionals and administrative personnel. These evaluations are compiled by the program director and incorporated into the semi-annual evaluations.

B. Evaluation of faculty

For all evaluations, standard forms have been developed in parallel to those noted above with which fellows can provide a thorough evaluation of a faculty member’s performance. The fellows anonymously evaluate the faculty after each rotation on the consultative service and each quarter at the completion of an ambulatory clinic block. Evaluations are compiled and reviewed by the program director twice per year then those comments are given to the division chief for final review. The faculty evaluations are utilized by the division chief for faculty performance review which is done at least annually. In the event that a problem area of performance is identified, the program director and division chief will establish a plan for remedy and monitoring improvement.

C. Evaluation of rotations

For all rotations, standard forms have been developed to afford both fellows and faculty members the opportunity to evaluate the efficacy of the rotations. This includes both clinic rotations as well as time spent on the consultative service. Moreover, at each semi-annual evaluation, fellows are surveyed for any problems that might pertain to these duties.

D. Evaluation of program

At each semi-annual evaluation, fellows discuss the program in general with the program director. In addition, the Program Effectiveness Committee meets at least annually. Prior to that meeting, fellows convene a session at which time any issues are compiled and then presented to the PEC group. In that manner, a degree of anonymity is maintained. From that point, all matters are addressed by the PD and Division Chief. Any changes/alterations in the curriculum or program are then discussed with the fellows as a group.

1. Patient Care: This isevaluated by numbers of individual evaluations by attending physicians, clinic Directors, Program Director and Division Head, other faculty peers and nursing staff. The multiple Mini-CEX evaluations are extremely important for evaluation of this competency.

2. Medical Knowledge: Each trainee will complete the Endocrine Self-Assessment Program near the end of the first year of training and at the end of the training program. This is a computer (CD-ROM)-based exercise consisting of 150 questions distributed throughout all areas of Endocrinology and Metabolism. A standing committee of the Endocrine Society in collaboration with UpToDate prepares it. After questions are answered, for quantitative evaluation, the trainee can turn the page, learn the correct answer, and read a discussion of the subject area in general, and with specific reference to why the answer is correct and why the other possible answers are incorrect. During this discussion, hot links to specific pages in the UpToDate database are provided. All material is contained in this CD-ROM. Thus this exercise is an important quantitative evaluation tool for Medical Knowledge as well as an excellent self-learning exercise. The Endocrine Self-Assessment Program is updated annually. Medical knowledge is also assessed by attending physicians for consult rounds, Clinic Directors, by attending physicians during presentations at Endocrine Clinical rounds, and the Program Director. All of these evaluations are maintained in file.

3. Practice-Based Learning and Improvement: This competency is continuously evaluated by attending physicians, clinic directors and faculty during interactions in all teaching venues. Through the Fellows’ Conference, trainees prepare and deliver at least 12 clinical presentations based on their current patients with literature analysis and medical decision-making. Faculty evaluates these presentations, and the evaluations are provided to the Program Director. Also, records of these presentations including PowerPoint files for each one are maintained by the trainee and provided to the Program Director in their Portfolio.

4. Interpersonal and Communication Skills: These competencies are continuously evaluated by attending physicians on the inpatient service, attendings and continuity clinic directors, peers, nurses, the Program Director and the Division Head, during the activities listed in Chart 2, and employing the forms and interactions described above under Evaluations. All evaluations are maintained in file.

5. Professionalism: Similar to Interpersonal and Communication skills, this competency is evaluated as described in Chart 2. Direct observation and multiple evaluations, including at least 6 CEX exercises per year are employed.

6. Systems-Based Practice: Teaching and Evaluation of this competency occurs in many venues as outlined in Charts 1 and 2. Since almost all types of medical care systems are encountered in the various clinical activities during this training program, trainees have an excellent opportunity to understand and participate in modern health care systems. Our trainees are also required to complete the program of the Tufts Healthcare Institute.

MONITORING FOR STRESS AND FATIGUE. The program director is responsible for monitoring resident stress, including mental or emotional conditions inhibiting performance or learning, and drug- or alcohol-related dysfunction. Both the program director and faculty should be sensitive to the need for timely provision of confidential counseling and psychological support services to residents. Situations that demand excessive service or that consistently produce undesirable stress on residents must be evaluated and modified. The CD series “Learning to Enhance Stress and Fatigue (LIFE)” from Duke University is viewed by the faculty and residents each year. These talks emphasize that:

a. Long duty hours can cause emotional problems in the workplace.

b. Personal problems, e.g. marital problems and stresses in the family may cause serious emotional problems for physicians.

c. Female physicians face unique stressors.Female physicians often must balance domestic responsibilities and the need to care for children with their professional obligations. Female physicians sometimes encounter sexual harassment from patients or colleagues.

d. Attention to physician well-being promotes patient safety and reduces work-related errors.

e. The Program Director should strive to guide and support residents in career development and in balancing their personal and professional lives.