PEM Competencies for PEM faculty

Dear PEM colleagues. As you have heard me mention, the ACGME has adopted a new set of "milestones" on which PEM fellows must be evaluated. These contain very specific language regarding physician attitudes, practices and behaviors. Appropriate use of these new milestones requires us all as faculty to become familiar with their use. As a faculty development exercise, I would like each of us to place ourselves on the milestones. Please read the responses carefully, think about your current practice and score yourself accordingly. Replies will be confidential but aggregated - I am very curios to see what we come up with!! Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.

Gather essential and accurate information about the patient

1. Information gathering not based on chief complaint, often gathering too little or too much information; cannot organize or filter information effectively

2. Relies primarily on analytic reasoning to gather information; starting to adapt information gathering to prior experiences and produce a broad differential

3. Gathers information while it is being filtered, prioritized, and synthesized into specific diagnostic considerations based on pattern recognition

4. Gathers essential and accurate information to reach precise diagnoses using well-developed pattern recognition but still uses analytic reasoning to gather information when faced with complex/uncommon problems

5. Uses advanced pattern recognition to gather essential and accurate information in a targeted manner; able to discriminate among diagnoses with subtle distinguishing features

Organize and prioritize responsibilities to provide patient care that is safe, effective, and efficient

1. Begins to organize and prioritize patient care responsibilities; focuses care on individual patients rather than multiple patients

2. Organizes and prioritizes the simultaneous care of a few patients efficiently but has decreased efficiency with additional patients

3. Organizes and prioritizes the simultaneous care of many patients with efficiency; has difficulty prioritizing only when patient volume is high

4. Organizes and prioritizes care of a large volume of patients with marked efficiency

5. Serves as a role model of efficiency; prioritizes patient care to maximize safe and effective multitasking of responsibilities in almost all situations

Provide transfer of care that ensures seamless transitions

1. Demonstrates frequent errors and variability in the transfer of information

2. Uses a standard template but may have errors of omission

3. Adapts a standard template with minimal errors of omission and communicates potential issues to the receiver of the information

4. Adapting a standard template, almost always effectively and accurately communicates information even in complex situations, and ensures open communication

5. Adapting a standard template, always effectively and accurately communicates information regardless of complexity and demonstrates professional responsibility to patients, families and other healthcare team members

Make informed diagnostic and therapeutic decisions that result in optimal clinical judgment

1. Does not develop an organized assessment of the diagnosis or a management plan

2. Recognizes potential diagnoses but has difficulty developing a unifying diagnosis and management plan

3. Develops a well-synthesized, focused differential diagnosis and management plan

4. Develops a unifying diagnosis, focused therapies, an effective and efficient diagnostic work-up and management plan tailored to the individual patient

Emergency stabilization: Prioritizes critical initial stabilization action and mobilizes hospital support services in the resuscitation of a critically ill or injured patient and reassesses after stabilizing intervention

1. Recognizes abnormal vital signs

2. Recognizes when a patient is unstable and requires immediate resuscitation; discerns relevant data to formulate a diagnostic impression and plan

3. Manages and prioritizes critical patients; prioritizes critical initial stabilization actions; reassesses after implementing a stabilizing intervention

4. Recognizes in a timely fashion when further clinical intervention is futile; integrates hospital support services into management strategies for problematic stabilization situations

5. Develops policies and protocols for the management and/or transfer of critical patients

Diagnostic studies: Applies the results of diagnostic testing based on the probability of disease and the likelihood of test results altering management

1. Determines the necessity of diagnostic studies

2. Orders appropriate diagnostic studies; performs appropriate bedside diagnostic studies and procedures

3. Prioritizes essential testing; interprets results of diagnostic study, recognizing limitations and risks; seeks interpretive assistance when appropriate

4. Uses diagnostic testing based on pre-test probability of disease and likelihood of test results altering management; appropriately practices cost effective ordering of diagnositc studies

5. Discriminates between subtle and/or conflicting diagnostic results in the context of the patient presentation

Observation and reassessment: Re-evaluates patients undergoing ED observation (and monitoring) and, using appropriate data and resources, determines the differential diagnosis, treatment plan and disposition

1. Recognizes need for patient re-evaluation

2. Monitors that necessary interventions are performed during a patient’s ED stay

3. Identifies which patients require observation in the ED; evaluates effectiveness of therapies provided; monitors patient’s clinical status at timely intervals

4. Considers additional diagnoses and therapies for patients being observed in the ED and changes treatment plans as necessary

5. Develops protocols to avoid potential complications of interventions and therapies

Disposition: Establishes and implements a comprehensive disposition plan that uses appropriate consultation resources, provides patient education regarding diagnosis/ treatment plan, and time/location specific disposition instructions

1. Describes basic resources available for care of the ED patient

2. Formulates a specific follow-up plan for patients with common ED complaints and utilizes resources appropriately

3. Formulates and provides patient education regarding diagnosis, treatment plan, and post ED care; involves appropriate resources for ED care in a timely manner; correctly discharges and admits patients

4. Formulates sufficient admission plans or discharge instructions; engages patient or surrogate to effectively implement post ED plans

5. Works within the institution to develop hospital systems that enhance safe patient disposition and maximizes resource utilization

General approach to procedures: Performs the indicated procedure on all appropriate patients, takes steps to avoid potential complications, and recognizes the outcome and/or complications resulting from the procedure

1. Identifies pertinent anatomy and physiology for common ED procedures and uses universal precautions

2. Performs patient assessment, obtains informed consent, and ensures appropriate monitoring equipment in place; knows indications, contraindications, potential complications, anatomic landmarks, and procedural techniques for common ED procedures; performs common ED procedures with help from supervisors

3. Competently performs common ED procedures with minimal to no help from supervisors; determines back-up strategy if initial attempts to perform a procedure are unsuccessful

4. Proficiently and independently performs common ED procedures, takes steps to avoid potential complications and recognizes outcomes and/or complications resulting from performed procedure

5. Teaches procedural competency and corrects mistakes