Abstract
BACKGROUND
Chart review represents a critical cornerstone for practice-based learning and improvement in our internal medicine residency program.
OBJECTIVE
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.
DESIGN
Retrospective longitudinal design with repeated measures.
PARTICIPANTS
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.
MEASUREMENT
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.
RESULTS
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.
CONCLUSIONS
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.
Similar content being viewed by others
References
Swing SR. The ACGME outcome project: Retrospective and prospective. Med Teach. 2007;29(7):648–54.
Duffy FD, Lynn LA, Didura H, et al. Self-assessment of practice performance: development of the ABIM Practice Improvement Module (PIM). J Contin Educ Health Prof. 2008;28(1):38–46, Winter.
Houston TK, Wall T, Allison JJ, et al. Implementing achievable benchmarks in preventive health: a controlled trial in residency education. Acad Med. 2006;81(7):608–16, Jul.
Foy R, Eccles MP, Jamtvedt G, Young J, Grimshaw JM, Baker R. What do we know about how to do audit and feedback? Pitfalls in applying evidence from a systematic review. BMC Health Serv Res. 2005;13;5:50, Jul.
Kogan JR, Reynolds EE, Shea JA. Effectiveness of report cards based on chart audits of residents’ adherence to practice guidelines on practice performance: a randomized controlled trial. Teach Learn Med. 2003;15(1):25–30, Winter.
Jamtvedt G, Young JM, Kristoffersen DT, O’Brien MA, Oxman AD. Does telling people what they have been doing change what they do? A systematic review of the effects of audit and feedback. Qual Saf Health Care. 2006;15(6):433–6, Dec.
Haan CK, Edwards FH, Poole B, Godley M, Genuardi FJ, Zenni EA. A model to begin to use clinical outcomes in medical education. Acad Med. 2008;83(6):574–80, Jun.
Lyman JA, Schorling J, Nadkarni M, May N, Scully K, Voss J. Development of a web-based resident profiling tool to support training in practice-based learning and improvement. J Gen Intern Med. 2008;23(4):485–8, Apr.
Keirns CC, Bosk CL. The unintended consequences of training residents in dysfunctional outpatient settings. Acad Med. 2008;83(5):498–502, May.
Mladenovic J, Shea JA, Duffy FD, Lynn LA, Holmboe ES, Lipner RS. Variation in internal medicine residency clinic practices: assessing practice environments and quality of care. J Gen Intern Med. 2008;23(7):914–20, Jul.
Stevens DP, Sixta CS, Wagner E, Bowen JL. The evidence is at hand for improving care in settings where residents train. J Gen Intern Med. 2008;23(7):1116–7, Jul.
Sisson SD, Boonyasai R, Baker-Genaw K, Silverstein J. Continuity clinic satisfaction and valuation in residency training. J Gen Intern Med. 2007;22(12):1704–10, Dec.
Cook DA, Beckman TJ, Thomas KG, Thompson WG. Adapting web-based instruction to residents’ knowledge improves learning efficiency: a randomized controlled trial. J Gen Intern Med. 2008;23(7):985–90, Jul.
Dearinger AT, Wilson JF, Griffith CH, Scutchfield FD. The effect of physician continuity on diabetic outcomes in a resident continuity clinic. J Gen Intern Med. 2008;23(7):937–41, Jul.
Warm EJ, Schauer DP, Diers T, et al. The ambulatory long-block: an accreditation council for graduate medical education (ACGME) educational innovations project (EIP). J Gen Intern Med. 2008;23(7):921–6, Jul.
Lynch DC, Swing SR, Horowitz SD, Holt K, Messer JV. Assessing practice-based learning and improvement. Teach Learn Med. 2004;16(1):85–92, Winter.
Morrison LJ, Headrick LA. Teaching residents about practice-based learning and improvement. Jt Comm J Qual Patient Saf. 2008;34(8):453–9, Aug.
Moskowitz EJ, Nash DB. Accreditation Council for Graduate Medical Education competencies: practice-based learning and systems-based practice. Am J Med Qual. 2007;22(5):351–82, Sep–Oct.
Oyler J, Vinci L, Arora V, Johnson J. Teaching internal medicine residents quality improvement techniques using the ABIM’s practice improvement modules. J Gen Intern Med. 2008;23(7):927–30, Jul.
Halverson LW, Sontheimer D, Duvall S. A residency clinic chronic condition management quality improvement project. Fam Med. 2007;39(2):103–11, Feb.
Thomas KG, Thomas MR, Stroebel RJ, et al. Use of a registry-generated audit, feedback, and patient reminder intervention in an internal medicine resident clinic- A randomized trial. J Gen Intern Med. 2007;22(12):1740–4, Dec.
Holmboe ES, Prince L, Green M. Teaching and improving quality of care in a primary care internal medicine residency clinic. Acad Med. 2005;80(6):571–7, Jun.
U.S. Preventative Services Task Force. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: recommendation statement. Ann Intern Med. 2004;140(7):554–6, Apr 6.
National Committee for Quality Assurance <http://www.ncqa.org>. Accessed 2008 February 26.
Mezirow J. Transformative dimensions of adult learning. San Francisco: Jossey-Bass; 1991.
Zeger SL, Liang KY, Albert PS. Models for longitudinal data: a generalized estimating equation approach. Biometrics. 1988;44(4):1049–60, Dec.
Statistical Analysis Software Package Version 9.1. Cary, NC: SAS Institute Inc.
Meyers FJ, Weinberger SE, Fitzgibbons JP, Glassroth J, Duffy FD, Clayton CP. Redesigning residency training in internal medicine: the consensus report of the Alliance for Academic Internal Medicine Education Redesign Task Force. Acad Med. 2007;82(12):1211–9, Dec.
Kern DE, Harris WL, Boekeloo BO, Barker LR, Hogeland P. Use of an outpatient medical record audit to achieve educational objectives: changes in residents’ performances over six years. J Gen Intern Med. 1990;5(3):218–24, May–Jun.
Holmboe ES, Bowen JL, Green M, et al. Reforming internal medicine residency training. A report from the Society of General Internal Medicine’s task force for residency reform. J Gen Intern Med. 2005;20(12):1165–72, Dec.
Willett LL, Palonen K, Allison JJ, et al. Differences in preventive health quality by residency year. Is seniority better. J Gen Intern Med. 2005;20(9):825–9, Sep.
Kiefe CI, Allison JJ, Williams OD, Person SD, Weaver MT, Weissman NW. Improving quality improvement using achievable benchmarks for physician feedback: a randomized controlled trial. JAMA. 2001;285(22):2871–9, Jun 13.
Duffy FD, Holmboe ES. Self-assessment in lifelong learning and improving performance in practice: physician know thyself. JAMA. 2006;296(9):1137–9, Sep 6.
Bowen JL, Salerno SM, Chamberlain JK, Eckstrom E, Chen HL, Brandenburg S. Changing habits of practice. Transforming internal medicine residency education in ambulatory settings. J Gen Intern Med. 2005;20(12):1181–7, Dec.
Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L. Accuracy of physician self-assessment compared with observed measures of competence: A systematic review. JAMA. 2006;296(9):1094–102.
Acknowledgement
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
None disclosed.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hildebrand, C., Trowbridge, E., Roach, M.A. et al. Resident Self-Assessment and Self-Reflection: University of Wisconsin-Madison’s Five-Year Study. J GEN INTERN MED 24, 361–365 (2009). https://doi.org/10.1007/s11606-009-0904-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-009-0904-1