The Medical Microbiology Milestone Project

Transcription

1 The Medical Microbiology Milestone Project A Joint Initiative of The Accreditation Council for Graduate Medical Education and The American Board of Pathology July 2015

2 The Medical Microbiology Milestone Project The Milestones are designed only for use in evaluation of fellows in the context of their participation in ACGMEaccredited residency or fellowship programs. The Milestones provide a framework for the assessment of the development of the fellow in key dimensions of the elements of physician competency in a specialty or subspecialty. They neither represent the entirety of the dimensions of the six domains of physician competency, nor are they designed to be relevant in any other context. i

3 Medical Microbiology Milestones Chair: Gary W. Procop, MD Working Group Karen Carroll, MD Paul Edelstein, MD Laura Edgar, EdD, CAE Sandy Richter, MD Advisory Group C. Bruce Alexander, MD Julia C. Iezzoni, MD Rebecca Johnson, MD Wesley Y. Naritoku, MD, PhD ii

4 Milestone Reporting This document presents Milestones designed for programs to use in semi-annual review of fellow performance and reporting to the ACGME. Milestones are knowledge, skills, attitudes, and other attributes for each of the ACGME competencies organized in a developmental framework from less to more advanced. They are descriptors and targets for fellow performance as a fellow moves from entry into fellowship through graduation. In the initial years of implementation, the Review Committee will examine Milestone performance data for each program s fellows as one element in the Next Accreditation System (NAS) to determine whether fellows overall are progressing. For each period, review and reporting will involve selecting milestone levels that best describe each fellow s current performance and attributes. Milestones are arranged into numbered levels. Tracking from Level 1 to Level 5 is synonymous with moving from novice to expert in the subspecialty. These levels do not correspond with post-graduate year of education. Selection of a level implies that the fellow substantially demonstrates the milestones in that level, as well as those in lower levels (see the diagram on page v). Level 1: The fellow demonstrates milestones expected of an incoming fellow. Level 2: The fellow is advancing and demonstrates additional milestones, but is not yet performing at a mid-fellowship level. Level 3: The fellow continues to advance and demonstrate additional milestones, consistently including the majority of milestones targeted for fellowship. Level 4: The fellow has advanced so that he or she now substantially demonstrates the milestones targeted for fellowship. This level is designed as the graduation target. Level 5: The fellow has advanced beyond performance targets set for fellowship and is demonstrating aspirational goals which might describe the performance of someone who has been in practice for several years. It is expected that only a few exceptional fellows will reach this level. iii

5 Additional Notes Level 4 is designed as the graduation target and does not represent a graduation requirement. Making decisions about readiness for graduation is the purview of the fellowship program director. Study of Milestone performance data will be required before the ACGME and its partners will be able to determine whether milestones in the first four levels appropriately represent the developmental framework, and whether Milestone data are of sufficient quality to be used for high-stakes decisions. Examples are provided with some milestones. Please note that the examples are not the required element or outcome; they are provided as a way to share the intent of the element. Some milestone descriptions include statements about performing independently. These activities must occur in conformity to the ACGME supervision guidelines, as well as to institutional and program policies. For example, a fellow who performs a procedure independently must, at a minimum, be supervised through oversight. Answers to Frequently Asked Questions about Milestones are available on the Milestones web page: iv

6 The diagram below presents an example set of milestones for one sub-competency in the same format as the ACGME Report Worksheet. For each reporting period, a fellow s performance on the milestones for each sub-competency will be indicated by selecting the level of milestones that best describes that fellow s performance in relation to those milestones. Selecting a response box in the middle of a level implies that milestones in that level and in lower levels have been substantially demonstrated. Selecting a response box on the line in between levels indicates that milestones in lower levels have been substantially demonstrated as well as some milestones in the higher level(s). v

7 PC1 Consultation Understands the role of the medical microbiologist as a consultant to all health care providers Effectively teaches consultation skills to rotating residents and supervises resident consultations Observes and assists in the consultation Performs clinically useful consultations in a timely manner with faculty member guidance (e.g., guiding appropriate test ordering, optimal specimen collection, results interpretation) Independently performs clinically useful consultations in a timely manner (e.g., guiding appropriate test ordering, optimal specimen collection, results interpretation) Effectively communicates consultative action plans and recommendations to other health care providers Proficient in medical microbiology consultations, including those involving complex clinical scenarios Suggested Evaluation Methods: Direct Observation, Portfolio, 360 Evaluations, EMR Review grant third parties the right to use the Medical Microbiology Milestones on a non-exclusive basis for educational purposes. 1

8 PC2 Testing (Methodology/Performance/Interpretation and Reporting) and Microorganism Identification Methodology Understands basic test methodology Understands the basic test platforms Understands more complex test platforms and methodology Understands the integration of different test methodology and platforms (e.g., testing algorithms) Develops a novel test, methodology, or diagnostic algorithm Performance Observes and assists in the performance of commonly used microbiology tests Becomes familiar with fundamental test performance characteristics (e.g., sensitivity, specificity, and positive and negative predictive values [PPV and NPV]) for tests used in medical microbiology, and understands how these affect the establishment of a definitive diagnosis Performs commonly used microbiology tests Observes and assists in the performance of less commonly used (i.e., esoteric) microbiology tests Independently performs all microbiology tests Understands the utility and methods of currently outsourced commercial and public health microbiology tests Selects the optimal test methodology for a particular disease Effectively teaches the features of microbiology testing, including the utility, strengths, and limitations of the various methods of testing Independently chooses the optimal test based on an analysis of test characteristics and patient population variables for any clinical scenario grant third parties the right to use the Medical Microbiology Milestones on a non-exclusive basis for educational purposes. 2

9 Interpretation and Reporting Understands the basic indications for microbiology tests and the importance of accurately reporting laboratory tests Observes and assists in the interpretation and reporting of common microbiology tests Understands the strengths and limitations of clinical microbiology tests Interprets and reports common microbiology tests Observes and assists in the interpretation and reporting of less common microbiology tests Understands criteria for the creation of critical action values, and is familiar with the laboratory s critical action values Calculates test performance characteristics (e.g., sensitivity, specificity, positive and negative predictive values, ROC curve, and post-test probability) Independently interprets and reports all microbiology tests Understands the role of the laboratory in public health reporting Assembles aggregate data to produce meaningful reports (e.g., antimicrobial susceptibility data to produce an antibiogram; blood culture contamination rate) Proficient in the interpretation and reporting of microbiology tests Teaches the strengths and limitations of microbiology tests and how to calculate test performance characteristics Understands the influence of population variables on test performance (e.g., the effect of prevalence on positive predictive value) Synthesizes aggregate data to identify trends or aberrant patterns important for infection prevention, laboratory error detection, recognition of novel pathogens, or new resistance patterns Interprets and reports microbiology tests even in complex clinical scenarios Designs metrics to improve the quality of laboratory services Suggested Evaluation Methods: Direct Observation, 360 Evaluation, Quality Assessment Results, Identification of Unknowns grant third parties the right to use the Medical Microbiology Milestones on a non-exclusive basis for educational purposes. 3

10 MK1 Fundamental and Diagnostic Knowledge Methodology Observes and assists in the identification of microorganisms of all groups (e.g., bacteria, fungi, parasites, and viruses) that are commonly encountered in the clinical microbiology laboratory Identifies microorganisms of all groups that are commonly encountered in the clinical microbiology laboratory Observes and assists in the identification of microorganisms of all groups that are less commonly encountered (i.e., rare) in the clinical microbiology laboratory Identifies microorganisms of all groups that are encountered in the clinical microbiology laboratory, both the commonly and the rarely encountered Knows the mechanisms of action and standard antimicrobial drugs used for patient care Effectively teaches the features of microorganism identification for all groups of organisms Achieves clinical competence in the identification of all commonly encountered organisms in the clinical microbiology laboratory Proficient in microorganism identification Demonstrates the ability to consistently use the literature or other means to investigate difficult to identify or novel pathogens Suggested Evaluation Methods: Direct Observation, 360 Evaluation, Quality Assessment Results, Identification of Unknowns grant third parties the right to use the Medical Microbiology Milestones on a non-exclusive basis for educational purposes. 4

11 MK2 Test Development and Validation/ Verification Is familiar with the multiple learning sources to acquire knowledge Performs literature reviews to inform patient care Evaluates and assesses research and scholarly articles from the literature Understands the need for knowledge of pathogenesis, diagnostic techniques, and prognostic factors in disease processes commonly diagnosed by microbiologic methods Uses multiple learning sources to acquire knowledge (e.g., textbooks, clinical conferences, journals) Demonstrates the application of basic textbook-level knowledge as it applies to clinical problems in medical microbiology and infectious diseases Teaches the fundamentals of microbiology to pathology residents and peers Applies medical knowledge to prepare a differential diagnosis Participates in the broader contribution to the medical knowledge of others in medical microbiology and infectious diseases (e.g., presentations at a national meeting, journal article submission) Participates in interdepartmental conferences Possesses an expert level of knowledge in all areas of microbiology as defined by the Program Requirements for Graduate Medical Education in Medical Microbiology and the program goals and objectives Demonstrates commitment to life-long learning (e.g., participates in Maintenance of Certification, maintains licensure and hospital privileges) Contributes significantly to the medical knowledge of others in medical microbiology and infectious diseases Possesses and maintains a mastery of knowledge in the subspecialty of medical microbiology Suggested Evaluation Methods: Direct Observation, Journal Club, Examination, Evaluation of Teaching Efforts grant third parties the right to use the Medical Microbiology Milestones on a non-exclusive basis for educational purposes. 5

12 MK3 Test Development, and Validation/ Verification Understands the necessity of test validation/verification Understands the essentials of test development and test validation/verification Actively participates in test development, and/or test validation/verification Able to independently verify/validate a new test or appropriately modifies an existing test Develops a new test Suggested Evaluation Methods: Direct Observation, Journal Club, Examination grant third parties the right to use the Medical Microbiology Milestones on a non-exclusive basis for educational purposes. 6

13 SBP1 Regulatory Understands that laboratories are regulated by state, federal, and professional organizations Participates as a team member for the inspection of a laboratory or equivalent (e.g., tracers, self-inspection) Understands the use of proficiency testing Understands the basics of quality assurance Demonstrates compliance with national regulations for patient privacy and confidentiality (e.g., HIPAA, state laws, institutional policies) With substantial guidance, implements state, federal, and professional organizations standards or elements of checklists in the laboratory Reviews proficiency testing results Suggests corrective action based on proficiency testing results With minimal guidance, implements state, federal, and professional organizations standards or elements of checklists in the laboratory Understands the concept of root-cause analysis and the need for corrective action for unacceptable proficiency testing results Determines corrective action based on proficiency testing results Is able to perform a rootcause analysis and produce a corrective action for unacceptable proficiency testing results Leads a mock inspection of a laboratory Performs continuous surveillance to detect suboptimal practices, improve quality, and prevent errors Suggested Evaluation Methods: Direct Observation, Attendance at Administrative Conferences, Attendance at Institutional Inspection grant third parties the right to use the Medical Microbiology Milestones on a non-exclusive basis for educational purposes. 7

14 SBP2 Health Care Teams Understands the importance of the role of the microbiologist in the health care team With substantial guidance, plays a role in the health care team (e.g., case presentation, consultation, test selection With minimal guidance, plays a role in the health care team (e.g., case presentation, consultation, test selection Independently plays a role in the health care team (e.g., case presentation, consultation, test selection Effectively plays a lead role in the health care team (e.g., case presentation, consultation, test selection guidance) guidance) guidance) guidance) Understands the structure and organization of the medical record, and how it is used Is aware of the committees and multidisciplinary patient care conferences in which the microbiologist contributes (e.g., hospital infection prevention committee) Summarizes pertinent clinical aspects of a patient s infectious disease from review of the medical record, and with guidance, determines the meaning of diagnostic tests and therapies for the patient s illness Attends multidisciplinary patient care conferences and hospital infection prevention conferences Using the medical record, independently summarizes a case history and explains the clinical rationales for diagnostic tests and therapies as they pertain to infectious diseases Understands the basics of diagnostic imaging as it pertains to infectious diseases Represents the laboratory at multidisciplinary patient care and infection prevention conferences, particularly explaining the role of the microbiologist in the care of the patient Independently presents a patient s clinical history and relevant diagnostic and therapeutic events in a clinical case conference Participates in antimicrobial stewardship activities Leads a multidisciplinary patient care conference Routinely uses the medical record to inform microbiologic diagnostic testing and interpretation Suggested Evaluation Methods: Direct Observation, Attendance and Participation in Multidisciplinary Conferences, 360 Evaluation, Portfolio grant third parties the right to use the Medical Microbiology Milestones on a non-exclusive basis for educational purposes. 8

15 SBP3 Laboratory Management: Resource Utilization (Personnel and Finance) Aware of the roles of a microbiologist in managing personnel; able to interpret an organizational chart Knows the personnel and lines of reporting in the laboratory Participates in employee interviews/performance evaluation (real or simulated experiences) Manages personnel effectively Recognizes different budget types (e.g., capital vs. operating budget) Describes the elements of a budget (e.g., personnel, capital equipment) Describes the process of personnel management and employment laws (e.g., interview questions, Family and Medical Leave Act, termination policies) Understands the basics of pathology practice finance (e.g., Part A and Part B, Centers for Medicare & Medicaid Services [CMS]) Participates in budget activities and proposes changes to improve the operating margin Works with administrative staff to ensure the laboratory is adequately staffed with competent personnel Develops a budget and implements policies to consistently meet budget targets without compromising patient care Suggested Evaluation Methods: Direct Observation, Portfolio, Attendance a Laboratory Operational/Business meetings grant third parties the right to use the Medical Microbiology Milestones on a non-exclusive basis for educational purposes. 9

16 PBLI1 Evidence-based Utilization Understands the importance of evidencebased utilization of laboratory tests and results With substantial guidance, critically reviews the literature addressing evidence-based utilization of laboratory tests and results With minimal guidance, critically reviews the literature addressing evidence-based utilization of laboratory tests and results Independently performs a critical review of the literature addressing evidence-based utilization of laboratory tests and results, and designs utilization guidelines Designs and implements institutional utilization guidelines for laboratory tests and results Suggested Evaluation Methods: Direct Observation, Journal Club, Portfolio, Attendance at Test Utilization Committee Meetings grant third parties the right to use the Medical Microbiology Milestones on a non-exclusive basis for educational purposes. 10

17 PBLI2 Process Improvement and Patient Safety Demonstrates awareness of common sources of error in laboratory processes and transitions in care Consistently demonstrates work habits that minimize error; consistently and promptly communicates discrepancies to clinicians Contributes to practice change based on an identified error or systematic problem (e.g., post-analytic, pre-analytic, laboratory, or interpretative) Participates in and completes or makes sufficient progress in the completion of a laboratory quality improvement project Routinely uses identified errors and discrepancies to improve practice and laboratory processes Direct Observation, Portfolio, 360 Evaluation grant third parties the right to use the Medical Microbiology Milestones on a non-exclusive basis for educational purposes. 11

18 PROF1 Receiving and Providing Feedback Receives feedback Modifies practice in response constructively to feedback Consistently receives feedback and modifies practice Accurately assesses strengths and areas needing improvement Modifies and maintains changes in practice based on feedback Provides constructive feedback Encourages and actively seeks and provides feedback to continually improve performance Direct Observation, 360 Evaluation, Portfolio grant third parties the right to use the Medical Microbiology Milestones on a non-exclusive basis for educational purposes. 12

19 PROF2 Accountability, Honesty, and Integrity Completes assigned tasks Anticipates team needs and on time proactively assists as needed Is honest and understands the concepts of ethical behavior; seeks counsel when ethical questions arise Reliably completes assigned tasks in a timely manner; assists team members when requested; respects assigned schedules Acknowledges personal limitations, near misses, and errors, and puts the needs of patients first; engages in ethical behavior Identifies personal limitations and takes responsibility for errors Anticipates team needs and takes a leadership role to independently implement solutions Institutes corrective measures for errors Is viewed by members of the health care team as accepting of personal responsibility, and as always putting the needs of the patient above his/her own interests Exemplifies effective management of multiple competing tasks, with reliable follow-up; is a source of support/guidance to other members of health care team Direct Observation, Portfolio, 360 Evaluation grant third parties the right to use the Medical Microbiology Milestones on a non-exclusive basis for educational purposes. 13

20 PROF3 Cultural Competency Respects diversity and autonomy; recognizes vulnerable populations Embraces diversity and respects vulnerable populations; is aware of potential for bias or cultural differences that affect care and the workplace Understands and complies with institutional policies affecting cultural competency Demonstrates an ability to interact effectively with people of different cultures and socioeconomic backgrounds; recognizes cultural differences that may affect care and the workplace; identifies and avoids biases Exemplifies cultural competency as defined in Level 3; recognizes cultural differences; identifies and avoids biases that may affect care and the workplace Models cultural competency, recognizing cultural differences that may affect care and the workplace; works with peers to avoid biases Serves on institutional diversity committees Suggested Evaluation Methods: Direct Observation, 360 Evaluation grant third parties the right to use the Medical Microbiology Milestones on a non-exclusive basis for educational purposes. 14

21 ICS1 Communication with Health Care Providers, Families, and Patients (as applicable) Understands the importance of timely and effective communication with health care providers, families, and patients (as applicable) With substantial guidance, provides timely and effective communication with health care providers, families, and patients (as applicable) With minimal guidance, provides timely and effective communication with health care providers, families, and patients (as applicable) Effectively communicates complex, difficult, or challenging information (e.g., errors, complications, adverse events, and bad news) Serves as a role model for effective and professional communication to health care providers, families, and patients (as applicable) Understands that the laboratory report is a form of communication that must be clear and understandable Effectively utilizes the electronic health record With substantial guidance, produces a clear and understandable laboratory report With minimal guidance, produces a clear and understandable laboratory report Understands the necessity of and regulations pertaining to a review of patient reports in the health record Independently and consistently produces a clear and understandable laboratory report Demonstrates proficiency in reviewing all test reports on an annual basis Develops a system within the laboratory to consistently review test reports for accuracy Suggested Evaluation Methods: Direct Observation, Portfolio grant third parties the right to use the Medical Microbiology Milestones on a non-exclusive basis for educational purposes. 15

22 ICS2 Personnel Management and Conflict Resolution Understands the importance of conflict and complaint resolution With substantial guidance, manages conflicts and complaints With minimal guidance, manages conflicts and complaints Independently manages conflicts and complaints Anticipates, mitigates, and manages potential conflicts and complaints Suggested Evaluation Methods: Direct Observation, 360 Evaluation, Portfolio grant third parties the right to use the Medical Microbiology Milestones on a non-exclusive basis for educational purposes. 16