Physician - Fellow Boston Children's Hospital Boston Children's Hospital Division of Critical Care Medicine Brookline, Massachusetts, United States
Background: A cornerstone of working in an academic center is the opportunity to teach and guide residents. However, timely written resident feedback is challenging with a large volume of learners and irregular schedules, which disrupt faculty-resident continuity. In our ward rotation, these issues were compounded by our cumbersome evaluation process which used a common document to collect faculty comments which were then transferred by rotation directors into our New Innovations evaluation system (NI). In 2017-18, 0% of our residents received a written evaluation within 14 days of completing their inpatient rotation (19% returned <30 days, average return=36 days) and 50% never received an evaluation.
Objective: To improve completion rates of resident inpatient evaluations returned <30 days from 19% to 50% and the average return time from 36 to <30 days over 6 months. The balance measure was the administrative time needed to meet this aim.
Design/Methods: Intervention 1: Residents initiated “point-of-care” written feedback from attendings. Intervention 2: Faculty received personal NI accounts and were manually paired with their team residents. They received automatic reminders from NI with direct links to the residents’ evaluation forms. Forms, once completed on a computer or mobile device, were instantly released to the resident. Batched comments were sent to rotation directors for use in summative evaluations. Intervention 3: Admit and night team residents and attendings were paired. Intervention 4: QI project was approved by our Maintenance of Certification (MOC) governance committee to offer Part 4 credit to faculty who meet goals for timely evaluation completion.
Results: Intervention 1 was unsuccessful and led to lower rates of evaluation return. Interventions 2 and 3 combined were very effective (see Runchart). Faculty consistently returned at least 50% of assigned evaluations by 30 days post-rotation (67% returned <30 days, average return=18 days). The MOC incentive further sustained this improvement. Administrative time was 1 hour per week to complete the pairings and 5 hours every 6 months to assess MOC credit. Faculty found this new system easy to use and residents and program/rotation directors valued the robust feedback. Conclusion(s): Our new system enabled faculty to complete resident rotation evaluations on time with minimal administrative and physician burden, and incentivized faculty with MOC credit. This process can be used by programs across institutions, with thresholds modified to further improve evaluation metrics.
Authors/Institutions: Himali Bhatt, Boston Children's Hospital Division of Critical Care Medicine, Brookline, Massachusetts, United States; Wing Truong, Phoenix Children's Hospital, Phoenix, Arizona, United States; Niki Gionson, Phoenix Children's Hospital, Phoenix, Arizona, United States; Vasudha Bhavaraju, Phoenix Children's Hospital, Phoenix, Arizona, United States