Institutional Core Competency Plan

Henry Ford Macomb Hospitals
July 1, 2010

The Henry Ford Macomb Hospitals Institutional Core Competency Plan (ICCP) is a road map for continuous improvement in teaching and in evaluating competency-based medical education based on the seven core competencies defined by the American Osteopathic Association (AOA). Professional competence is the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values and reflection in daily practice for the benefit of the individual and community being served.

The AOA's postdoctoral institutional accreditation program, used as a guide to developing the Henry Ford Macomb Hospitals ICCP, includes the overt assessment and documentation of each intern's and resident's work toward mastery of the seven core competencies:

  1. Osteopathic Philosophy and Osteopathic Manipulative Medicine
  2. Medical Knowledge
  3. Patient Care
  4. Interpersonal and Communication Skills
  5. Professionalism
  6. Practice-Based Learning and Improvement
  7. Systems-Based Practice

Many assessment and documentation tools are in place at Henry Ford Macomb Hospitals. The Statewide Campus System of MSUCOM, the Michigan OPTI, also assists in the development and implementation of the assessment instruments. Residents also participate in the Henry Ford Health System (HFHS) Institutional Curriculum, Building Bridges: Linking Graduate Medical Education to Quality and Safety, Informed Consent, Disclosure of Errors and Delivering Bad News modules.

The designated ICCP institutional official for Henry Ford Macomb Hospitals is the Director of Medical Education (DME), Joseph T. Naughton, D.O. As DME, Dr. Naughton is charged by the AOA to draft the ICCP. The Medical Education Committee of Henry Ford Macomb Hospitals is charged to approve the ICCP and monitor the plan's implementation and performance. Specifically, the DME and the Directors of each Residency Program and the Program Faculty are responsible for implementation of the ICCP.

The AOA has provided a Core Competency Map (CCM), available on the DO-Online website, to assist each institution in choosing and developing the metrics to assess intern and resident achievement of any competency. The metrics must parallel the teaching process(es) used by the program. The Henry Ford Macomb Hospitals DME, with the concurrence of each Program Director, has selected at least one recommended methodology to achieve compliance with each core competency. Likewise, the DME has selected at least one recommended evaluation tool for that core competency.

Implementation of the core competencies

Osteopathic philosophy and Osteopathic Manipulative Medicine (OMM)

The Henry Ford Macomb Hospitals Medical Education Program utilizes bedside teaching, monthly didactic sessions in OMM, clinical skills labs, and online OMM modules developed by the Statewide Campus System (SCS).

The program evaluates competency using the SCS modules, which contain pre- and post-exams, clinical observation, monthly written evaluations of trainee performance after each rotation using the Evaluation of Clinical Performance form, Observed Structured Clinical Exams (OSCEs) and review of procedure and case logs. During the intern orientation, all interns and PGY1 are required to complete an OMM Module.

Medical knowledge

The Henry Ford Macomb Hospitals Medical Education Program utilizes multiple modalities to teach and evaluate competency in Medical Knowledge. Bedside instruction, daily lectures sponsored by the medical education department, clinical department morning reports, reading programs, journal and reading clubs, and SCS educational days for each clinical specialty are methods in place.

The program evaluates competency using the monthly Evaluation of Clinical Performance, in-service exams in specific specialties, chart stimulated oral recall, checklists, and encounter logs. The written Evaluation of Clinical Performance of each intern and resident completed by program faculty after each rotation measures the trainees' abilities in this competency by using a rating scale.

Patient care

The Henry Ford Macomb Hospitals Medical Education Program utilizes various methods to teach and evaluate competency in patient care. The required elements in this competency are the ability to gather accurate essential information from all sources including medical interviews, physical exams and medical records; the ability to provide accurate diagnoses, treatment plans and procedures appropriate to the patients' illnesses and the residents' specialties; the ability to provide health care services consistent with the osteopathic philosophy including disease prevention and health maintenance all based on current scientific evidence. These skills are taught at the bedside, through the HFHS Institutional Curriculum Informed Consent, Disclosure of Errors and Delivering Bad News modules and in the HFHS Fundamentals of Critical Care Surgery (FCCS) simulation course.

The patient care competency is evaluated by the faculty using the Evaluation of Clinical Performance form after each rotation, credentialing check lists, procedure and case logs and performance on yearly in-service exams. OSCEs with standardized patients and immediate debriefing of video by faculty is used to assess performance in the HFHS Institutional Curriculum. Performance in the FCCS course is measured by. . .

Interpersonal and communication skills

The Henry Ford Macomb Hospitals Medical Education Program requires residents to become proficient in interpersonal and communication skills to enable them to establish and maintain professional relationships with patients, families and members of the health care team. The resident must demonstrate effectiveness in developing appropriate doctor-patient relationships and must exhibit effective listening, written and oral communication skills in professional interactions with patients, families and health care professionals. These skills are taught by requiring residents to complete formal oral presentations to the medical staff, participate in the teaching of medical students, attend lectures on communication skills and participate in interactive feedback with program directors and faculty monitoring the resident's performance. These skills are also taught through the HFHS Institutional Curriculum Informed Consent, Disclosure of Errors and Delivering Bad News modules.

Residents are evaluated on this competency using the Evaluation of Clinical Performance form after each rotation, formal written evaluations after lecture presentations, and 360 degree evaluations by patients and health care staff. OSCEs with standardized patients and immediate debriefing of video by faculty is used to assess performance in the HFHS Institutional Curriculum.

Professionalism

The Henry Ford Macomb Hospitals Medical Education Program requires competence in the following elements related to professionalism: demonstration of respect for patients and their families; advocacy for the primacy of the patient's welfare and autonomy; demonstration of respect for all the members of the health care team; adherence to ethical principles in medical practice; sensitivity to a diverse patient population. The professionalism competency is taught using a lecture series given by the patient care advocate; a lecture series given by the palliative care team and by interactive feedback with program directors and faculty monitoring the resident's performance. These skills are also taught through the HFHS Institutional Curriculum Informed Consent, Disclosure of Errors and Delivering Bad News modules.

This competency is evaluated using the Evaluation of Clinical Performance form after each rotation and 360 degree evaluations of the residents by health care personnel, patients and their families. OSCEs with standardized patients and immediate debriefing of video by faculty is used to assess performance in the HFHS Institutional Curriculum.

Practice-based learning and improvement

The Henry Ford Macomb Hospitals Medical Education Program demands that residents demonstrate the ability to critically evaluate their methods of clinical practice, integrate evidence-based medicine into patient care, show an understanding of research methods and improve patient care practices. This competency is taught through an evidence-based medicine series, required journal clubs for all specialties with formal evaluations of performance, a mini lecture series on statistical concepts in medical literature, encouraging original research projects with poster displays and encouraging participation in the AOA Clinical Assessment Project. Interlibrary loan and networked access to electronic resources of the Henry Ford Health System's Sladen Library, including UpToDate, PubMed, Ovid Medline and ILLiad are available and librarians at two campus libraries provide on-site assistance to residents. These skills are also taught through the HFHS Institutional Curriculum Informed Consent, Disclosure of Errors and Delivering Bad News modules.

This competency is evaluated using the Evaluation of Clinical Performance form after each rotation, formal evaluations of performance in journal club presentations, review of research methods and statistical concepts used in original research and review of resident portfolios used to document exposure in all areas of this competency. OSCEs with standardized patients and immediate debriefing of video by faculty is used to assess performance in the HFHS Institutional Curriculum.

Systems-based practice

The Henry Ford Macomb Hospitals Medical Education Program requires that the residents demonstrate an understanding of health care delivery systems, provide effective and qualitative patient care within the system and practice cost-effective medicine. The resident must also demonstrate the ability to advocate on behalf of the patient so as to obtain care within the complexities of this system. This competency is taught through training in the outpatient settings in practice management, Statewide Campus System educational days and lectures on managed care. Residents are also required to participate in hospital committees and M&M conferences. These skills are also taught through the HFHS Institutional Curriculum Disclosure of Errors module.

This competency is evaluated using the Evaluation of Clinical Performance form after each rotation and review of resident portfolios used to document exposure in all areas of this competency. OSCEs with standardized patients and immediate debriefing of video by faculty is used to assess performance in the HFHS Institutional Curriculum.

Overall assessment

All interns and residents are assessed by at least two evaluation tools for each core competency to qualify for program completion status. The CCM notes that "variability can be expected with Medical Knowledge and Osteopathic Philosophy and Osteopathic Manipulative Medicine that are unique to specialty training requirements as noted in the AOA basic standards. The remaining five core competencies are common to all medical specialties and trainees are assessed and evaluated in the same manner."

*Henry Ford Macomb Hospitals Medical Education Program
Core Competency Evaluation Measures Using AOA-Suggested Methodologies
360 Degree Evaluation Checklist OSCE Monthly Service Evaluation Procedure Case Logs Portfolios Written Exam Chart Stim Oral Recall Exam
OP-OMM x x x x
Medical Knowledge x x x x x
Patient Care x x x x
Interpersonal/
Comm Skills
x x x
Professionalism x x x
Practice based Learning & Improvement x x x
Systems based Practice x x x

Trainee remediation policy

At Henry Ford Macomb Hospitals, any trainee not meeting an acceptable level of achievement in any of the core competencies, based on evaluations, will be required to complete an academic remediation plan. The plan will be developed in conjunction with the Program Director and DME to address the trainee's competency deficit(s). The plan will be a confidential part of the trainee's education record and, if successfully completed, may be removed from the file. The written plan will define specific competency areas for improvement and evaluation timelines. It must be signed by the Program Director, DME, and trainee, and will be monitored by the DME.

The AOA requires that each institution develop a Continuous Quality Improvement Process cycle. Each year the ICCP is reexamined and enhanced to include refined metrics for evaluating each core competency. The ICCP and annual reports are to be made available to AOA evaluators when on-site accreditation reviews are conducted. The DME and Residency Program Directors held accountable for the integration of the plan into their programs.

Annual reports

The DME annually reviews and updates the Henry Ford Macomb Hospitals Medical education Program ICCP and provides a written progress report each July. The medical education administrative staff assists in collating, reviewing and preparing information for the annual report and ICCP updates. The DME and the medical education department administrative staff monitor monthly written evaluations, monthly evaluations of faculty by trainees, and other instruments used to measure the progress of each trainee. Within each residency, the Program Director monitors written monthly evaluations of each trainee, faculty evaluations within the department, in-service examinations and day-to-day progress of each trainee. Program Directors present periodic reports to the DME and the Medical Education Committee.

The Henry Ford Macomb Hospitals ICCP annual report includes, at a minimum, the following:

  • For each trainee, a statement whether the trainee has developed skills to appropriately and competently care for patients in a variety of clinical settings.
  • For each trainee, a statement whether the trainee has developed academic skills appropriate for the level of training in preparation to pass Board certification examinations.
  • For each trainee, a statement on each trainee's progress in each core competency as reported on their respective annual report (Program Director's Annual Evaluation Report).
  • For each trainee who is completing his/her respective program, a summary report with an attestation that a minimal level of performance has been achieved in all competencies (e.g., Program Completion Summary-Final Resident Assessment, as required by the specialty college).
  • Evaluation of the effectiveness of methods chosen to achieve compliance.

The updated ICCP and annual report are presented to the Medical Education Committee for review and approval. The DME sends a copy of the approved Henry Ford Macomb Hospitals ICCP annual report to the Graduate Medical Education Committee of the Statewide Campus System of MSUCOM, the Michigan OPTI.

Presented to and approved by the HFMH Medical Education Committees on August 18 and 26, 2009. A new Henry Ford Macomb Hospitals Medical Education Committee will be formed upon AOA final approval to consolidate these separate programs.