Abstract
IntroductionProfessionalism is a vital component of quality patient care. While competency in professionalism is Accreditation Council for Graduate Medical Education (ACGME)-mandated, the methods used to evaluate professionalism are not standardized, calling into question the validity of reported measurements. We aimed to determine the type and frequency of methods used by United States (US) -based emergency medicine (EM) residencies to assess accountability (Acc) and professional values (PV), as well as how often graduating residents achieve competency in these areas.MethodsWe created a cross-sectional survey exploring assessment and perceived competency in Acc and PV, and then modified the survey for content and clarity through feedback from emergency physicians not involved in the study. The final survey was sent to the clinical competency committee (CCC) chair or program director (PD) of the 185 US-based ACGME-accredited EM residencies. We summarized results using descriptive statistics and Fisher’s exact testing.ResultsA total of 121 programs (65.4%) completed the survey. The most frequently used methods of assessment were faculty shift evaluation (89.7%), CCC opinion (86.8%), and faculty summative evaluation (76.4%). Overall, 37% and 42% of residency programs stated that nearly all (greater than 95%) of their graduating residents achieve mastery of Acc and PV non-technical skills, respectively. Only 11.2% of respondents felt their programs were very effective at determining mastery of non-technical skills.ConclusionEM residency programs relied heavily on faculty shift evaluations and summative opinions to determine resident competency in professionalism, with feedback from peers, administrators, and other staff less frequently incorporated. Few residency programs felt their current methods of evaluating professionalism were very effective.
Highlights
Professionalism is a vital component of quality patient care
37% and 42% of residency programs stated that most of their graduating residents achieve mastery of Acc and professional values (PV) non-technical skills, respectively
Few residency programs felt their current methods of evaluating professionalism were very effective. [West J Emerg Med. 2020;21(1):152-159.]
Summary
Professionalism is a vital component of quality patient care. While competency in professionalism is Accreditation Council for Graduate Medical Education (ACGME)-mandated, the methods used to evaluate professionalism are not standardized, calling into question the validity of reported measurements. Non-technical skills (NTS) such as communication, teamwork, leadership, and professionalism are vital to providing high-quality patient care.[1,2] NTS deficiencies have been associated with conflict, lawsuits, and loss of medical license, leading to a call for integration of formal NTS assessment into residency training.[3,4,5] In response, the Accreditation Council for Graduate Medical Education (ACGME) developed core competencies for residents to master during training, of which one-third are NTS including professionalism.[6] The ACGME further expanded the core competencies with the Accreditation System (NAS, or Milestone Project), in which each medical specialty created sub-competencies and milestones (levels within the subcompetencies that showed progressive skill development to guide assessment of trainees).[7,8] These NTS milestones were not meant to be assessment tools themselves; rather they were to “inform the use and development” of such tools.[7]. Finding standardized milestone-assessment tools that are emergency medicine (EM) specific and easy to use is difficult, causing residency programs to struggle to integrate competencies into their curricula.[7,13] Given this challenge, various CORD workgroups have proposed a number of ways that model behaviors of professionalism could be assessed, including incorporating non-EM tools; no standardized recommendation has been established.[12,14,15]
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