Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Learning Objectives: Utilizing a PGY-specific, ACGME milestone based standardized direct observation tool, feedback will be improved. This will improve the quality of feedback residents receive and increase the objective data for the clinical competency committee to assist in resident evaluation.

Introduction/Background: The standardized direct observation tool (SDOT) is one of the most common ways to provide emergency medicine residents feedback. There are various SDOTs available on the CORD website but not a comprehensive emergency department based clinical SDOT. With the introduction of the new ACGME milestones in July 2021, these were incorporated to create PGY-specific clinical SDOTS.

Educational Objectives: Utilizing ACGME milestone based SDOTS that are PGY-specific for PGY-1, PGY-2, or PGY-3/4 this will improve feedback. The objectives are to improve quality of resident feedback and to increase objective feedback for the clinical competency committee to assist in resident evaluation.

Curricular Design: Attending physicians performed one SDOT on every emergency medicine resident in a community academic hybrid residency program of 36 residents using the PGY-specific SDOT form. The PGY-1 SDOT focuses on interns taking an accurate history and physical exam (PC2), ordering appropriate diagnostic studies (PC3) and formulating differential diagnoses (PC4). The PGY-2 SDOT focuses on capturing more upper level responsibilities such as emergency stabilization (PC1) and reassessment and task switching (PC6, PC7). The PGY-3 SDOT focuses on emergency stabilization (PC1) and systems based practice (SBP). All three SDOTs contain Pharmacology (PC5), Medical Knowledge, Professionalism and Interpersonal and Communication Skills.

Impact/Effectiveness: The PGY-year specific milestone based SDOT was implemented in July 2021. This is applicable not only to emergency medicine but to other residency training specialties as well. Attendings (n=15) who have completed these SDOTs so far have rated this form as easy to use with an average of 4.5 on a 5 point Likert scale (1-not easy to use, 5-very easy to use). One limitation is the lack of objective data to accompany this and resident perception of quality and usefulness of feedback.