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Patient Care

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:

• communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families
• gather essential and accurate information about their patients
• make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment
• develop and carry out patient management plans
• counsel and educate patients and their families
• use information technology to support patient care decisions and patient education
• perform competently all medical and invasive procedures considered essential for the area of practice
• provide health care services aimed at preventing health problems or maintaining health work with health care professionals, including those from other disciplines, to provide patient-focused care

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Medical Knowledge

• This includes knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.
• Investigatory and analytic thinking approach to clinical situations
• Knowledge and application of the basic and clinically supportive sciences which are appropriate to their discipline

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Practice-based Learning & Improvement

• Investigate and evaluate patient care practices; appraise and assimilate scientific evidence; and improve patient care practices. This includes:
• analyze practice experience and perform practice-based improvement activities using a systematic methodology.
• locate, appraise, and assimilate evidence from scientific studies related to patients’ health problems.
• obtain and use information about the practitioner's own population of patients and the larger population from which their patients are drawn.
• apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness.
• use information technology to manage information and access on-line medical information.
• facilitate the learning of students and other health care professionals.

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Interpersonal and Communication Skills

Competent interpersonal and communication skills result in effective information exchange and teaming with patients, their patients families, and professional associates. To this effect, practitioners should:

• create and sustain a therapeutic and ethically sound relationships with patients.
• use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills.
• work effectively with others as a member or leader of a health care team or other professional group.

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Professionalism

• A commitment to carrying out professional responsibilities.
  • Respect compassion and integrity
  • Responsiveness to the needs of patients and society that supercedes self-interest
  • Accountability to patients society, and the profession
  • Commitment to excellence and on-going professional development.
• Sensitivity to a diverse patient population; sensitivity and responsiveness to patients' culture, age, gender, and disabilities.
• A commitment to ethical principles pertaining to providing or withholding clinical care, confidentiality of patient information, informed consent, and business practices.

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Systems-Based Practice

Practitioners need an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. To this end, the practitioner should:

• understand how their patient care and other professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice
• know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources
• practice cost-effective health care and resource allocation that does not compromise quality of care
• advocate for quality patient care and assist patients in dealing with system complexities
• know how to partner with health care managers and health care providers to assess, coordinate, and improve health care and know how these activities can affect system performance.

 

There are pressures to increase documentation of resident competencies in medicine. In order to accomplish this, we are developing tools to assess, document, and demonstrate competencies in training physicians.

Description of Competencies (summary)

Managing the Competencies in Ophthalmology

Teaching and Assessing Surgical Competence: Applications for Ophthalmic Residents and Practicing Ophthalmologists Teaching and Improving Cataract Surgery “Step by Step” (pdf document)(AAO Course 580, October 2005) presented by Thomas A. Oetting, MS, MD, Hilary A. Beaver, MD, A. Tim Johnson, MD, PhD, Andrew G. Lee, MD, University of Iowa and Bonnie An Henderson, MD, Harvard University.

1. What every eye doctor needs to know about ACGME General Competencies
2. ACGME Competencies: Translating a national mandate into local compliance
3. Task Force on Meeting the New Competencies
4. A new perspective on resident and education: The Flexner revolution continues
5. Implementation Matrix
6. The International Council of Ophthalmology (ICO) Curriculum for Resident & Specialist Training
7. The Learning Process
8. Teaching in the Clinic
9. Resident Portfolio: Why, What, How & When?
10. The integral role of feedback: The feedback sandwich (Food for Thought)
11. On Call Assessment Tool (OCAT)
12. Journal Club Tool
13. How to achieve faculty "buy in" of the ACGME competencies
14. What have I learned about the competencies (so far)?
15. Williams’ Ten Rules in performance assessment
16. The adult learning process
17. UIHC GME update on the ACGME General Competencies
18. Teaching & Assessing professionalism
19. "It Takes a Village: Moving Towards Systems-Based Practice." Teaching & Assessing Systems-Based Learning Competencies (PowerPoint show version)
20. Teaching & Assessing Ophthalmic Laser Competency (PowerPoint show version)
21. "All I Really Need to Know About the Competencies I Learned from my Kindergartner" (PowerPoint show version)
22. "Crouching Tiger Hidden Dragon": Managing the ACGME Competency Mandates (PowerPoint show version)

Mirror Site

Brief summaries of some available tools with the current status of validity, reliability, and feasibility data from the current literature. Several of these tools can be accessed on the ACGME site.

1. Journal club tool can be accessed at the following address: http://www.acgme.org/outcome/implement/rsvpTemplate.asp?rsvpID=28
2. The OCEX can be accessed at the following address: http://www.acgme.org/outcome/implement/rsvpTemplate.asp?rsvpID=31
3. The phone tool can be accessed at the following address: http://www.acgme.org/outcome/implement/rsvpTemplate.asp?rsvpID=27
4. Cataract Formative Feedback Form
5. ESSAT tool (bibliography)
6. Sample criterion referenced (rather than norm referenced) structured scoring rubric for a global evaluation

• Ophthalmic Clinical Exam (OCEX) (pdf)
• On Call Tool (OCAT) (pdf)
• Ophthalmic Knowledge and Assessment Program (OKAP) test and Oral Examination (pdf)
• Journal Club Tool (pdf)
• Global Evaluation Tool (pdf)
• Lee AG, Greenlee E, Oetting TA, Beaver HA, Johnson AT, Boldt HC, Abramoff M, Olson R, Carter K. The Iowa Ophthalmology Wet Laboratory Curriculum for Teaching and Assessing Cataract Surgical Competency. Ophthalmology. 2007 Jul;114(7):21-6. Epub 2007 May 1. PMID: 17475332.

Read more about the Competencies in Ophthalmology at "Academic Ophthalmology"

Bibliography of Task Force Publications [pdf document or PubMed search]

The ACGME website lists the Iowa ophthalmology wet laboratory (OWL) curriculum for residents as a "Good Practice"

Additional Links

Announcing: The Journal of Academic Ophthalmology, a peer-reviewed journal that serves as a national and international forum for the publication and scholarly exchange of ideas and information of interest to academic ophthalmology including medical education, resident and fellow training, research in health education, policy, and regulation.

You may view and ask the task force questions relating to the efforts in developing the competencies in ophthalmology via SDN. You will have to register with SDN to ask questions.

E-Mail Dr. Andrew G. Lee