Each fellow is formally approached at the start of the rotation and informed of expectations in terms of learning objectives and performance.
The nature of the rotations, which involves long hours and fairly intense one-on-one interactions between the fellows and the faculty, generates immediate and constant evaluation and feedback.
Performance is evaluated by the attending physician with frequent feedback throughout the rotation, as to whether the learning goals are being achieved, and with formal review at the end of the rotation, the content of which is recorded through a web based evaluation process at www.myevaluations.com. These are maintained in the trainee’s record.
Specifically, the trainee's knowledge base in cardiovascular diseases, skills in history taking and physical examination, clinical judgment, clinical management and consultation are assessed. In addition, the technical proficiency with respect to specialized cardiac procedures is documented. Finally, communication skills, humanistic qualities, professional attitudes and behavior, and commitment to scholarship are evaluated.
There are separate competency-focused forms developed to assess specific competencies relevant to the clinical experience. A formal evaluation is generated after every clinical rotation using a standardized form through myevaluations.com. This evaluation takes into account, as appropriate, the 6 specified core competencies, and is designed from a modified American Board of Internal Medicine evaluation form (see appendix). In most instances, this evaluation is reviewed in person with the trainee.
The program director reviews the compiled evaluations with the trainee during a regularly scheduled private conference. Most fellows’ numerical evaluation falls within the 6-8 range (on a scale of 1 to 9). When fellows score consistently below this level, appropriate remedial work is usually advised.
The program director meets privately with all trainees periodically to discuss issues related to their clinical competence.
On an alternate monthly basis, the performance of the fellows is discussed with the attending physicians during a scheduled faculty meeting.
Specific, competency-based evaluations of the principle skills required as a clinical cardiologist are made with specifically developed instruments. These include evaluations of each of the several core competencies in the areas most applicable to the practice of cardiologic medicine.
- an authentic (i.e. by observation of performance in actual cases) set of “rubrics” for invasive cardiologic patient care skills
- an in-service examination for medical knowledge
- a 360 degree assessment for the definition of the fellow’s professionalism
- an assessment tool for effectiveness of communication and practice based learning as demonstrated at professional conferences
- a tool to assess proficiency of systems based practice in complex clinical situations such as the heart failure service
Each of these is reviewed with the fellow on a timely basis—monthly for the assessments to be entered into myevaluations.com, and at least twice yearly as a summary evaluation with the specific competency targeted instruments.
Moreover, there is bi-directional evaluation, with an anonymous evaluation by the fellow of the faculty and by the fellow of the learning experience.