During the Residency Orientation, the Program Director will set out some of the department's general expectations as to resident responsibility and professional behavior.
Evaluations by Rotation
More specifically, the Goals and Objectives for each rotation over the course of the entire residency are provided in this book for reference. These Goals and Objectives are intended to help the resident understand their clinical and professional duties on each rotation and what knowledge and skills they should expect to be learning with each new experience over the course of the program. In addition, at the beginning of each rotation, the supervising attending should delineate any specific expectations they may have for that block.
While on service, the resident can expect both informal and formal feedback on their performance, based on the rotation's Goals and Objectives, from both their senior resident and the attending. At the end of each rotation, the supervising attending will fill out a formal evaluation through the department's New Innovations system, based on the preceding feedback sessions. These evaluations are available to the resident at any time via New Innovations and are discussed along with the resident's overall clinical and professional progress at their semi-annual meeting with the Program Director.
Feedback Fridays
It is the responsibility of the attending physician to give feedback to each resident that they work with. Faculty are advised to have an individualized, private feedback session at least once with each resident during a 2-week rotation. In order to ensure this occurs, the senior resident on the service and the attending should schedule a 30-minute block of time dedicated for this purpose at the beginning of the rotation. The default time is Friday at 2:30 – 3:00 PM. However, the day and time may be changed if another time is more suitable. After the time is set, the resident should send an outlook invite to the attending and the residents on the team.
NEX Exams
A resident's diagnostic and clinical achievement is evaluated via observed NEX exams. During a NEX exam, the resident interviews and examines a patient under the supervision of a faculty member and evaluated based on the ACGME core competencies. It is the resident's responsibility to ensure that NEX exams are performed by graduation. The NEX evaluations are reviewed with the resident during their meetings with the Program Director and are required for ABPN board certification.
Clinical Competency Committee and the 360-Degree Review
Twice a year, the Clinical Competency Committee meets to review the performance of each resident. The CCC is comprised of core faculty members and the Program Director. The Program Director is a non-voting member of the committee. It is the responsibility of the CCC to review the evaluations for each resident, and to determine whether a resident can be promoted to the next level of training. The CCC should provide actionable feedback so that the resident might continue to grow and improve. If a resident is not progressing as expected, the CCC should identify this as early as possible. In this case, the resident should be offered an individualized learning plan and remediation, hopefully to allow them to reach the expected level of performance.
The CCC reviews the data that is collected through the 360-Degree Review process. This data consists of faculty evaluations, interdisciplinary evaluations, medical student evaluations, peer evaluations, self-evaluation, and any unsolicited feedback to the program director from faculty and/or peers. Details of each type of formal evaluation are included below.
Faculty Evaluations
After each rotation, the attending physician is sent an evaluation form through New Innovations for each member of the team. The form allows for evaluation of the Neurology Milestones that have been put in place by the ABPN. The milestones are based upon the ACGME Competencies. The faculty member is also allowed to provide free text comments. Faculty Evaluations are reviewed by the Clinical Competency Committee every 6 months as part of the 360-degree review process.
Peer Evaluations
Peer Evaluations are anonymous. They are available through New Innovations. A resident can choose any of their peers to evaluate. Peer evaluations are conducted once a year, prior to the first semi-annual review. Peer evaluations are made available to the CCC and are reviewed at the CCC meeting. Peer evaluations should be honest appraisals of peer performance and should cover both strengths and weaknesses of the resident. The evaluator should comment on behaviors rather than personality traits. Specific examples of behaviors are advisable, as they can be used to identify targeted areas for improvement.
Self Evaluations
Once a year the resident should complete a Self-Evaluation. This evaluation offers the resident an opportunity for self-reflection, and it gives the CCC insight into the resident’s view of their own performance. The evaluation is based on the ACGME Competencies and is available through New Innovations.
Interdisciplinary Evaluations
Nursing, social work, physical therapists and occupational therapists that work on 8W can evaluate a resident. Evaluations are based on the ACGME Competencies. The CCC reviews these evaluations twice yearly as part of the 360-degree review of each resident.
Medical Student Evaluations
Medical Students can, but are not required to, evaluate any resident with whom they work. These evaluations are sent to the Residency Coordinator and are reviewed twice a year in the CCC Meeting as part of the 360-degree review.
After the CCC meets, the PD meets with each resident for the semi-annual review. During the review, the feedback from the CCC is provided to the resident. Also, study plan, fellowship plans, research plans and resident wellness are discussed. After the meeting, the PD completes the semi-annual evaluation in New Innovations. The Program also completes the ACGME Milestone Assessment Form.
Semi-Annual Program Director Meetings
All residents are reviewed semi-annually by the ACGME-required Clinical Competency Committee (CCC), which generates a summative review according to the ACGME Milestones. Each resident then has mandatory performance evaluation meetings with the Program Director that serve as both a review of the resident's progress and as a mentoring and career-planning session. Each meeting begins with the resident identifying what they feel are their own strengths and weaknesses, both in knowledge base and clinical practice. The Program Director then discusses these points with the resident, using collected 360 degree evaluations as examples of their assessment. Mismatches between a resident's self-assessment and their performance in their evaluations is an opportunity to build self-reflection skills and identify areas for improvement. The resident and program director collaboratively establish goals for the short and long-term, and concrete objectives to be met along the way to accomplishing them. Opportunities for focused mentorship (both to address relative weaknesses and for career planning) can be identified. The program director and the resident then agree on when their next meeting will be to assess the resident's progress, and the Program Director signs the evaluation and comments.
Remediation
Behavior that falls short of the program's goals for the resident is first addressed by the supervising resident or chief resident, then by the supervising attending on the rotation and finally by the Program Director. Feedback regarding professional behavior initially is given orally but is also integrated into the evaluation process. If the problem cannot be dealt with informally by the chiefs or supervising attending, the Program Director is made aware so they they may arrange a meeting with the resident. Together, the resident and PD assess the nature and severity of the situation and devise a remediation plan, at times in consultation with the GME office. Remediation plans are designed on a case-by-case basis to be formative rather than punitive whenever possible. The principles on which the plans are based are to facilitate self-assessment and reflection, to identify specific deficiencies, and to facilitate stepwise observation and remediation by chief residents, the resident's designated faculty mentor, and the Program Director and Chairman. Remediation strategies may include directed reading, increased faculty mentoring, proposed lifestyle changes, changes in the schedule to allow for respite in cases of possible burnout, buddy-call and pairing with a chief or senior resident, additional NEX exams, and repetition of rotations.
For housestaff facing mental health issue or crises, they will be referred to the Student Trainee Mental Health Office. Referrals for psychological or psychiatric services are kept strictly confidential, and the department can provide financial assistance for those services if necessary. The program may refer the resident to the institutional Ombudsman, if indicated, for further problem-solving on an institutional level. Rarely, the program will involve the GME Office for formal probation, and convene the Housestaff Affairs Committee if the resident's position is at risk of termination, as per Mount Sinai institutional policy.
Note: Our program deeply values each resident and attempts to remediate early to avoid any need for probation or further actions.