Resident Self-Assessment and Self-Reflection: University of Wisconsin-Madison’s Five-Year Study
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Chart review represents a critical cornerstone for practice-based learning and improvement in our internal medicine residency program.
To document residents’ performance monitoring and improvement skills in their continuity clinics, their satisfaction with practice-based learning and improvement, and their ability to self-reflect on their performance.
Retrospective longitudinal design with repeated measures.
Eighty Internal Medicine residents abstracted data for 3 consecutive years from the medical records of their 4,390 patients in the University of Wisconsin-Madison (UW) Hospital and Clinics and William S. Middleton Veterans Administration (VA) outpatient clinics.
Logistic modeling was used to determine the effect of postgraduate year, resident sex, graduation cohort, and clinic setting on residents’ “compliance rate” on 17 nationally recognized health screening and chronic disease management parameters from 2003 to 2007.
Residents’ adherence to national preventive and chronic disease standards increased significantly from intern to subsequent years for administering immunizations, screening for diabetes, cholesterol, cancer, and behavioral risks, and for management of diabetes. Of the residents, 92% found the chart review exercise beneficial, with 63% reporting gains in understanding about their medical practices, 26% reflecting on specific gaps in their practices, and 8% taking critical action to improve their patient outcomes.
This paper provides support for the feasibility and practicality of this limited-cost method of chart review. It also directs our residency program’s attention in the continuity clinic to a key area important to internal medicine training programs by highlighting the potential benefit of enhancing residents’ self-reflection skills.
KEY WORDSpractice-based learning and improvement graduate medical education chart review ambulatory care settings
Completion of this paper was made possible by a grant from the Medical Education and Research Committee (MERC) of the University of Wisconsin-Madison School of Medicine and Public Health as well as by the support of the Education Innovation Project of the Residency Review Committee for Internal Medicine, of which we are a participating residency. This research was also supported by the University of Wisconsin Institute for Clinical and Translational Research, funded through an NIH Clinical and Translational Science Award (CTSA), grant no. 1 UL1 RR025011. Earlier results of this paper were presented at the Association of Program Directors in Internal Medicine meeting (2004). We wish to acknowledge the programmatic efforts of Suzy Griffiths, Toni Prisk, Vonnie Schoenleber, Jessalyn Richter, and Erik Stava at various stages in the process of this work.
Conflict of Interest
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