Pediatric Continuity Clinic Self-Assessment: A Framework for Competency-Based Self-Assessment
|1695||August 24, 2009||1|
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.
Residents who have used the CCSA report that the rating framework "makes sense" and is very simple to use. 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.
Stuart E, Jones L. Pediatric Continuity Clinic Self-Assessment: A Framework for Competency-Based Self-Assessment. MedEdPORTAL Publications; 2009. Available from: https://www.mededportal.org/publication/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 (MeSH)
Interpersonal & Communication Skills
Knowledge for Practice
Practice-based Learning & Improvement
- Clinical Skills/Doctoring
Professional School Post-Graduate Training
Authors & Co-Authors
Elizabeth Stuart, MD
Stanford University School of Medicine
Laurie Jones, MD, FAAP
St. Josephs Hospital and Medical Center
Effectiveness and Significance
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.
Special Implementation Guidelines or Requirements
The cases are designed to raise questions -- beyond the brief ideas presented in each scenario. For example, a discussion of Case 1 - The parents of a two-month-old do not want to immunize their child - might expand to address the following:
Patient Care/Medical Knowledge:
- Disease epidemiology
- Herd immunity
- Vaccine benefits, side effects, adverse reactions
- Resources for families and physicians (e.g., CDC Parents Guide to Childhood Immunizations; AAP template for documenting refusal to vaccinate)
- Active listening
- Models for shared decision-making and cross-cultural communication, including negotiation
- School vaccination requirements, policies
- Awareness of and reflection on one's own biases, perspectives, reactions to vaccine refusal
Potential uses: The CCSA can be used in its original format or adapted for a variety of uses and settings:
As an individual self-assessment:
- To identify individual learning needs and goals for self-directed learning -- either informally or as part of an individualized learning plan
- To monitor progress over time
At a program level, as a foundation for curriculum planning and evaluation:
- To assess trends and patterns in residents' learning needs As a framework for developing training materials, (e.g., each case serving as the basis for an educational module)
- To evaluate the impact of an educational intervention (for example, by comparing pre- and post-intervention ratings)
To maximize the educational benefit of the CCSA, self-assessment and reflection are best conducted with guidance from or discussion with a faculty mentor. The mentor can ask prompting questions to help the resident explicitly identify the full range of learning issues embedded in each case. It may be helpful to challenge the resident to defend his or her self-ratings ("Tell me why you gave yourself a 4"), or to point out inconsistencies between the resident's self-ratings and others' perceptions of his or her abilities. 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.
This information is made available under the Creative Commons license.
Publications, Presentations, and/or Citations for this Publication
- 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