Pediatric Continuity Clinic Self-Assessment: A Framework for Competency-Based Self-Assessment
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Background: Self-assessment and self-directed learning are essential components of Practice-Based Learning and Improvement (PBLI). To demonstrate competency in PBLI, residents must be able to:
- Identify strengths, deficiencies, and limits in knowledge and expertise
- Set learning and improvement goals.
In addition, residents are required to maintain Individualized Learning Plans (ILPs) to demonstrate competency in PBLI. Residents often have difficulty identifying specific learning needs and goals. The Continuity Clinic Self-assessment (CCSA) was originally developed as a resource for helping residents build ILPs. Description: The CCSA asks residents to rate their confidence and perceived need for guidance in managing 40 clinical scenarios. The cases were selected based on national curriculum guidelines for pediatric continuity clinic and local educational needs. The cases are framed as one-sentence descriptions of common problems encountered in pediatric primary care. The instrument lends itself particularly well to guided reflection with a faculty mentor and tracking progress over time. The case scenarios can be changed easily to fit the needs of an individual program or discipline. The CCSA can be employed as a needs-assessment tool for curriculum planning, as a springboard for case-based teaching, or to evaluate the impact of training.
The CCSA framework has been used most extensively by the pediatric residency program at the University of Tennessee College of Medicine -- Chattanooga Unit, in both continuity clinic and the newborn nursery. In continuity clinic, residents complete the CCSA at the beginning of the academic year. Faculty and residents review the completed form at the mid-point of the year to discuss progress over time. The cases are changed annually based on a formal survey of residents' interests, annual In-Training Exam results, and topics listed in the formal continuity clinic curriculum. In the nursery, the CCSA model has served as the foundation for a complete case-based rotation curriculum (to be submitted as a separate resource). Each of 34 self-assessment cases forms the basis of an electronic learning module, which includes a series of questions to guide learning and recommended readings relevant to each case. The nursery self-assessment has been added to the newborn nursery website at Stanford, where it is used for informal teaching and self-directed learning. We have not formally evaluated the effectiveness of the self-assessment framework. Informally, residents and faculty report that the rating scale is practical and easy to use. The anchors "make sense" on an intuitive level - by mirroring trainees' developmental progress through residency. From one program director's perspective, the rating scale's focus on confidence and the scenarios' emphasis on counseling and systems-based practice provide a unique opportunity for competency-based teaching and learning in continuity clinic. As with most self-assessment exercises, some residents will be prone to over-rating and others will underestimate their abilities. Residents completing the self-assessment at multiple points in time (e.g., at the beginning and end of an academic year) may end up lowering their ratings over time. Faculty preceptors should be prepared to discuss and provide feedback on these aspects of residents' self-ratings.
Stuart E, Jones L. Pediatric continuity clinic self-assessment: a framework for competency-based self-assessment. MedEdPORTAL Publications. 2009;5:1695. http://dx.doi.org/10.15766/mep_2374-8265.1695
Using the Continuity Clinic Self-assessment will enable residents to be able to:
- Reflect on their readiness for independent management of problems encountered in pediatric primary care
- Identify learning needs and goals for self-directed learning
- Monitor their own professional development and progress over time
- Continuity Clinic, Educational Measurement
Prior Scholarly Dissemination
This information is made available under the Creative Commons license.
- Sectish T, Stuart E, informal presentation: Continuity Clinic Special Interest Group meeting - Pediatric Academic Societies Annual Meeting, San Francisco, CA May 2006.
- Jones LJ, Newborn Nursery Competency-Based Self-Assessment and Module, poster presentation: University of Arizona Scholarly Teaching Symposium, "Newborn Nursery Compentency-Based Self-Assessment and Modules" February 2008.
- ACGME, Program Requirements for Graduate Medical Education in Pediatrics: http://www.acgme.org
- Stuart E, Sectish TC, Huffman LC, Are Residents Ready for Self-Directed Learning?: Description and evaluation of a pilot program using Individualized Learning Plans in Continuity Clinic, Ambulatory Pediatrics, 5(5): 298--301, September 2005. http://dx.doi.org/10.1367/A04-091R.1
- Academic Pediatric Association, Educational Guidelines for Pediatrics Residency: http://www.ambpeds.org
Authors & Co-Authors
Elizabeth Stuart, MD
Stanford University School of Medicine
Laurie Jones, MD, FAAP
St. Josephs Hospital and Medical Center