authentic performance assessment allison d.spinelli,d.o. assistant professor of anesthesiology...
TRANSCRIPT
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Authentic Performance Assessment
Allison D.Spinelli,D.O.
Assistant Professor of Anesthesiology
Residency Program Director
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Authentic Performance Assessment
Background What is competency How to assess competency Examples of APA model Competency rating scale Pros/cons Looking ahead
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Background
Why change evaluation system Standardizes faculty approach to
evaluating residents Helps to define resident’s competency
level for a particular year/rotation Better defines competency
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What is Competency
‘Know it when I see it”
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How to Assess Competency
Authentic Performance Assessment Model
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Authentic Performance Assessment Model
Real-time assessment of resident performance during actual patient care
Clearly defines the skills/knowledge the resident must possess to be deemed competent at a task
Specific to resident year of training Specific to rotations
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Examples of APA Model
CAY 1 Mentorship period Occurs 2 weeks after start of 1st year Resident should be able to set-up
room,perform machine check,start iv,intubate uncomplicated airway
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Examples of APA Model
Four month APA for CAY1 resident All of previous skills/knowledge plus: Induction of GA
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Examples of APA Model
8 month APA for CAY1 resident All of previous skills/knowledge plus Maintenance of GA and intra-op
differential dx of vital sign abnormalities
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Examples of APA Model
12 month APA for CAY1 resident All of previous knowledge/skills as well
as emergence of patient from GA and post-op care
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Examples of APA Model CAY 2 resident on cardiac anesthesia
rotation Pre-op,line placements,induction,airway Manage prebypass period Manage postbypass period Manage transfer of care to CSICU Diagnose and treat postop
complications
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Examples of APA Model
CAY 3 residents on any rotation and for the most acute and complex patients
Pre-op assessment and anesthetic plan Line placement Induction and airway management Intra-op management of data Emergene and transfer of care Post-op complications
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Competency Rating Scale Rubric system Highly competent Competent Becoming competent Not competent Gauges the degree of resident’s ability
to perform independently vs. need for attending intervention
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Examples of Competency Rating Scale
Highly competent The resident is smooth and efficient The resident adapts
knowledge,judgement,and skill to start the case and induce anesthesia with no significant errors and most appropriately
The resident does not require attending intervention
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Examples of Competency Rating Scales
Competent The resident lacks smoothness and
efficiency but adapts knowledge,judgement,and skill to start the case and induce anesthesia with no significant errors and most appropriately
The resident does not require attending interevention
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Examples of Competency Rating Scales
Becoming competent The resident lacks smoothness and
efficiency and some knowledge,judgement or skill and exhibits some limits in adaptability.
The resident makes some signifiant errors but is able to start the case although not most appropriately
May require attending intervention
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Examples of Competency Rating Scales
Not competent The resident can only start the case and
induce anesthesia with extensive coaching.The resident requires attending intervention
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APA Model Logistics
Scheduled to occur at the 4,8,and 12 month intervals for the CAY1 and CAY3 residents
Scheduled to occur at the end of each subspecialty month for theCAY2 residents
Requires 3 different cases and faculty members
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APA Model
Goal is for all residents to be competent or above
Becoming competent can be acceptable at start of new rotation but need to see improvement otherwise,remediate
Not competent=remediation/probation/ Daily evaluations til competent or no
credit
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APA Model Pros Helps to simply define competency Residents know what is expected of them
and what goals are Helps faculty gauge competence in a
uniform way Easy form to fill out Helps faculty give timely and constructive
feedback Works well with one-to-one system
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APA Model Cons Can be difficult to match patient /case
complexity to resident year Faculty/resident cooperation to assure
timeliness of assessments Residents free to pick and choose
attendings who evaluate them Residents(and faculty)wait until they have
a perfect case to assess Creates paperwork
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Future of APA Model
Randomize assessments Assessment teams Expand concept to use for resident
evaluation of faculty teaching