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Open Access Publications from the University of California

A Longitudinal Performance Portfolio Combining Real-Time Clinical Outcomes Data with Narrative Self-Reflection for Emergency Medicine Residents

Creative Commons 'BY' version 4.0 license

Learning Objectives: To describe a unique data-informed structured portfolio which encourages EM residents to intentionally self-evaluate, develop goals tailored to educational priorities, reflect on clinical rotations, and plot longitudinal progress to gain competency in practice-based learning and improvement.

Introduction: Self-evaluation is a key component of emergency medicine residents’ growth and an important element of the ACGME practice-based learning and improvement (PBLI) sub-competencies, but is infrequently structured and rarely incorporates objective data on clinical outcomes.

Educational Objectives: To facilitate proficiency in PBLI, we aim to provide residents with a data-informed structured portfolio to encourage intentional self-evaluation, develop goals tailored to educational priorities, provide a space to reflect on clinical rotations and plot longitudinal progress.

Curricular Design: We developed Growth Charts for residents to reflect on patient outcomes drawn from a novel feedback platform: Linking Outcomes Of Patients (LOOP). LOOP uses EHR data to generate unbiased daily reports of individual clinicians’ patient outcomes including 72-hour return ED visits, 48-hour inpatient level-of-care escalations and in-hospital deaths. Growth Charts encourage narrative reflection after each rotation with open-ended prompts targeting strengths, areas for improvement, clinical self-perception, goals for subsequent rotations, and strategies for achieving goals. Additional prompts querying unexpected patterns in patient outcomes, potential contributing factors and intended future practice modifications promote the incorporation of LOOP data into narrative reflections.

Impact/Effectiveness: A pilot cohort of ten PGY1-4 residents volunteered in AY2020-21. To date, participants have reflected on 67% of potential rotations (range 0-100%; median 88%), analyzing unexpected outcomes, practicing goal setting and developing strategies to achieve goals. Pilot participation was associated with a nearly 4-fold increase in LOOP engagement compared to non-participants (RR 3.68; 95%CI 1.75-7.73). A hybrid structured narrative reflection combined with objective outcomes data demonstrates promise in furthering EM residents’ PBLI competency.

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