Peer Evaluations

[periopdoc]

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So I had a meeting with my PD and fellow chiefs yesterday and my PD mentioned that ACGME will be requiring us to do "peer evaluations" of our fellow residents.

This makes sense in medicine and surgical rotations where there is a traditional hierarchical setup for rounding and you can get a sense of your colleagues capabilities. It makes a lot less sense in our field where I could go for months without actually observing one of my resident colleagues in action.

We figured that we can do fair evaluations on ICU and pain rotations where we work side by side on a daily basis. Any ideas on how to do this in the OR?

Evaluating simply based on the hand-off you receive when you take over a case is one thought, but this is problematic in that there are so many variables that can effect the quality of the handoff.

- pod

 

[2ndyear]

Usually there is some hierarchy of teaching by senior residents right? We used to routinely assign cases to juniors while on call, supervise floor intubations, make sure the preops were done, or sometimes bring a junior into an upper level case to have them start learning the basics of cardiac, complex pedi, transplant, etc. Plenty of opportunities to evaluate not only clinical skills, but also work ethic, interpersonal skills, and how they interact with patients.

 

[Bertelman]

Usually there is some hierarchy of teaching by senior residents right? We used to routinely assign cases to juniors while on call, supervise floor intubations, make sure the preops were done, or sometimes bring a junior into an upper level case to have them start learning the basics of cardiac, complex pedi, transplant, etc. Plenty of opportunities to evaluate not only clinical skills, but also work ethic, interpersonal skills, and how they interact with patients.

That's not the case in many smaller programs. I pull a call night, the attending runs the board. I may never see the senior.

 

[periopdoc]

Even in bigger programs it works like Bertelman describes. (I assume everyone would categorize UW as a bigger program.)

If you look at our schedule for Monday it will give you a pretty good idea of the problem I have. This is a very slow day for us because of surgeon absence for spring break so some of our ORs, our EP lab, and our interventional labs are closed for the day. I have a pretty normal complement of anesthesia residents tomorrow.

Still, I have 17 ORs and 2 offsite anesthesia locations running at our main institution. I have about 9-10 residents available for staffing these ORs. The remainder will be staffed by CRNAs or solo attendings. As a chief resident, I usually try to stop in to one or two of the other ORs to see how things are going, but I doubt I get a real picture of how things are going since these are informal meetings while I am on break from my own room.

So no, we don't have any particular overlap of residents or any scheduled junior/ senior "moments." Occasionally we get that opportunity on the floor with urgent/ emergent intubations. I try to make the opportunity available for the junior residents to stop by and see how a cardiac case runs if I am working one at night while they are on call. However, they are usually running their own cases and can't come.

I think the only real teaching I have done in residency is for med studs, paramedics, and medicine interns on their airway management month.

- pod

 

[OB1🤙]

I think there can be some legitimacy in seniors evaluating juniors, but this isn't exactly "peer" evaluation, is it?

I don't think there's a shred of legitimacy in evaluating others in your own class, especially if this is based on handoffs.

 

[coprolalia]

Asinine.

That's all I'm going to say.

Pitting residents against residents, which is the only thing that this will accomplish, is purely asinine. When you finish your training and are board certified, then you're partly qualified to evaluate residents.

Then, AFTER you receive formal training in how to effectively evaluate adult learners, and there is some form of 360-degree review process involved, then you are fully qualified to evaluate residents. If you are not board certified by the ABA, I don't give a **** what you think about my ability.

Asinine.

-copro

 

[periopdoc]

Asinine.

That's all I'm going to say.

but that isn't all you said!?!?!?

...and there is some form of 360-degree review process involved...

That is exactly what this whole ACGME push is about, a 360 degree review process. I just don't see how that is feasible in an anesthesia residency in the same way that it would be in other residencies.

That being said, I am looking for ways to implement what ACGME wants. We can bitch about it all day long but it doesn't change the fact that we are going to have to come up with some process to fulfill the ACGME requirements.

- pod

 

[coprolalia]

We can bitch about it all day long...

That's what I prefer to do.

-copro

 

[periopdoc]

That's what I prefer to do.

-copro

You wouldn't be a real resident if you didn't.

- pod

 

[coprolalia]

You wouldn't be a real resident if you didn't.

- pod

You're a thinker. I like that. Keep it up.

-copro