Resident Self-Assessment and Self-Reflection: University of Wisconsin-Madison’s Five-Year Study

• Published in: Journal of general internal medicine : JGIM 2009-03, Vol.24 (3), p.361-365
• Main Authors: Hildebrand, Christopher, Trowbridge, Elizabeth, Roach, Mary A., Sullivan, Anne Gravel, Broman, Aimee Teo, Vogelman, Bennett
• Format: Article
• Language: English
• Subjects: Ambulatory care; Biological and medical sciences; Clinical Competence; Feasibility Studies; Female; General aspects; Guideline Adherence; Health participants; Humans; Internal Medicine; Internal Medicine - education; Internship and Residency; Male; Medical Audit; Medical residencies; Medical schools; Medical sciences; Medicine; Medicine & Public Health; Miscellaneous; Original; Original Article; Outpatient Clinics, Hospital; Problem-Based Learning; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; Schools, Medical; Self evaluation; Self-Assessment; Wisconsin
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-009-0904-1

BACKGROUND Chart review represents a critical cornerstone for practice-based learning and improvement in our internal medicine residency program. OBJECTIVE To document residents’ performance monitoring and improvement skills in their continuity clinics, their satisfaction with practice-based learning and improvement, and their ability to self-reflect on their performance. DESIGN Retrospective longitudinal design with repeated measures. PARTICIPANTS Eighty Internal Medicine residents abstracted data for 3 consecutive years from the medical records of their 4,390 patients in the University of Wisconsin-Madison (UW) Hospital and Clinics and William S. Middleton Veterans Administration (VA) outpatient clinics. MEASUREMENT Logistic modeling was used to determine the effect of postgraduate year, resident sex, graduation cohort, and clinic setting on residents’ “compliance rate” on 17 nationally recognized health screening and chronic disease management parameters from 2003 to 2007. RESULTS Residents’ adherence to national preventive and chronic disease standards increased significantly from intern to subsequent years for administering immunizations, screening for diabetes, cholesterol, cancer, and behavioral risks, and for management of diabetes. Of the residents, 92% found the chart review exercise beneficial, with 63% reporting gains in understanding about their medical practices, 26% reflecting on specific gaps in their practices, and 8% taking critical action to improve their patient outcomes. CONCLUSIONS This paper provides support for the feasibility and practicality of this limited-cost method of chart review. It also directs our residency program’s attention in the continuity clinic to a key area important to internal medicine training programs by highlighting the potential benefit of enhancing residents’ self-reflection skills.