How to Identify Internal Medicine Trainees who are not Meeting Milestones and How to Intervene: A Novel Protocol

Safdar, Komal; Hamdan, Ameer; Roomiany, Pahresah; Hilbert, Doug

How to Identify Internal Medicine Trainees who are not Meeting Milestones and How to Intervene: A Novel Protocol

Background/Purpose: Learners not meeting clinical care milestones on academic medical teams often negatively affect clinical effectiveness, team dynamics, and contribute to burnout among both learners and faculty. Our prior surveys of Internal Medicine attendings and senior residents revealed discomfort and unfamiliarity with strategies to manage these learners. Challenges in identifying and addressing deficiencies are compounded by the absence of standardized early reporting systems and validated tools to evaluate performance in real time. This project seeks to implement a standardized reporting system to identify and remediate struggling learners early and in an informal way, thereby enhancing care delivery and reducing cognitive strain on both teachers and learners. Objectives: 1. Increase early reporting of learners not meeting clinical milestones. 2. Boost confidence among faculty and senior residents in managing struggling learners through evidence-based interventions. 3. Develop a four-part standardized protocol for in-situ remediation based on prior work Methods: Our prior surveys evaluated specific ACGME requirements with which interns often have difficulty. From this, a Qualtrics tool was developed to facilitate the identification and categorization of deficiencies. This tool will provide targeted intervention guidelines based on the identified deficiencies. It will be distributed to Internal Medicine attendings, junior and senior residents at DUH, DRH and the VAMC where they have interns on the team. Faculty and residents will be surveyed to assess their usage of the reporting tool and whether it improved their comfort in managing struggling learners. Program directors will also be surveyed to evaluate whether the reports generated by the Qualtrics tool aligned with official MedHub evaluations of interns. Data is being collected through the Qualtrics platform and includes both qualitative and quantitative metrics on tool usage and perceived efficacy. Trends in reporting and intervention success will be analyzed to identify strengths and areas for improvement. Follow-up surveys will be conducted to measure changes in comfort levels and evaluate the overall impact of the reporting system on remediation practices. We will also survey program directors to see if they felt that the reports generated by the tool were helpful in identifying interns who could use extra support. Results/Outcomes/Improvements or Evaluation: Our data collection is ongoing but we will have mid-study data by mid-spring. Expected outcomes include: increased reporting of struggling learners by faculty and residents; enhanced confidence in utilizing the reporting and intervention system; as well as preliminary data to refine and expand the remediation protocol. Metrics will include survey responses and the number of reports generated as well as if attendings and residents felt they had tools necessary to help interns not meeting clinical care milestones in real time. Additionally, qualitative feedback will help assess user experience and system efficacy. Significance/Implications/Relevance: Addressing struggling learners is critical for maintaining high standards in medical education and clinical care. Early identification and intervention reduce burnout, enhance team dynamics, and improve patient outcomes. This project aligns with ACGME core competencies while adapting them to practical and comprehensible terms for faculty and residents. By tackling barriers to reporting and remediation, such as lack of documentation and intervention clarity, this initiative offers a replicable model for other departments and institutions. Success in this endeavor could lead to broader adoption of similar systems, ultimately improving the training of future clinicians and fostering a culture of accountability and support within medical education. References: 1. Lurie SJ, Mooney CJ, Lyness JM. Measurement of the general competencies of the accreditation council for graduate medical education: a systematic review. Acad Med. 2009 Mar;84(3):301-9. doi: 10.1097/ACM.0b013e3181971f08. PMID: 19240434. 2. Accreditation Council for Graduate Medical Education. Milestones Guidebook for Residents and Fellows. Available at https://www.acgme.org/globalassets/pdfs/milestones/milestonesguidebookforresidentsfellows.pdf. Accessed December 2, 2022. 3. Dudek NL, Marks MB, Regehr G. Failure to fail: the perspectives of clinical supervisors. Acad Med. 2005 Oct;80(10 Suppl):S84-7. doi: 10.1097/00001888-200510001-00023. PMID: 16199466. 4. Dudek et al. 2005. 5 Hauer KE, Ciccone A, Henzel TR, Katsufrakis P, Miller SH, Norcross WA, Papadakis MA, Irby DM. Remediation of the deficiencies of physicians across the continuum from medical school to practice: a thematic review of the literature. Acad Med. 2009 Dec;84(12):1822-32. doi: 10.1097/ACM.0b013e3181bf3170. PMID: 19940595. 5. Wu JS, Siewert B, Boiselle PM. Resident evaluation and remediation: a comprehensive approach. J Grad Med Educ. 2010 Jun;2(2):242-5. doi: 10.4300/JGME-D-10-00031.1. PMID: 21975628; PMCID: PMC2930314. 6. Hauer KE, Ciccone A, Henzel TR, Katsufrakis P, Miller SH, Norcross WA, Papadakis MA, Irby DM. Remediation of the deficiencies of physicians across the continuum from medical school to practice: a thematic review of the literature. Acad Med. 2009 Dec;84(12):1822-32. doi: 10.1097/ACM.0b013e3181bf3170. PMID: 19940595.

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