Practice-Based Learning

Practice-based learning includes ability of physicians to use information systems to maximize patient care and the degree to which we are able to learn from past cases and/or our errors.

1. Continuity Clinic Records Reviews - A program instituted by Dr. Paramanathan in our clinics, each resident performs a review of his/her own medical records for documentation of interventions/measures that are proven to enhance patient outcomes for a number of illnesses. Examples include screening for the 8 elements of diabetes longitudinal care and maintenance of comprehensive problem lists in the ambulatory record. Trainees examine medical records of 5 of their patients for these elements using the attached worksheets. They repeat the exercise after 6 months to determine the degree to which they learned from their previous performance.

Diabetes Management Checklist

• Resident Self Evaluation - Diabetes

Comprehensive Problem Checklist
This system provides real-time evaluation of the quality of patient care in the chosen areas. Each year, new evidence-based measures will be added to the areas of assessment.

• Resident Self Evaluation - Problem List

2. Attending Rounds - During daily Work and Teaching Attending Rounds, attending physicians note the degree to which trainees learn from previous cases and whether they use the medical literature to inform patient care.

• General Competency Evaluation 

3. The 6-Competency OSCE - Every other year, trainees perform an objective structured clinical examination (OSCE) comprised of 6 stations (one for each ACGME competency). The station for practice-based learning examines ability to access the medical literature to inform care of a patient case.

4. Quality-Assurance/Errors Management - In a program, since learning from medical errors is also an important facet of practice-based learning, a PGY-2 module includes 3 sessions spent at hospital quality management meetings, reading several chapters from the Institute of Medicine work on improving quality and reducing errors, and completion of a short quiz. These materials can be obtained in the Department of Medicine Program Director's office.

5. Regular Conferences (Morning Report, CPC) - In addition, Morning Report, which occurs every weekday, begins with a review of deaths and the degree to which medical decision-making and/or errors contributed. New cases are also "Q-A'ed" in similar fashion. Each month, at the Case Presentation Conference (CPC), the clinical course of a recently deceased patient is presented and discussed emphasizing medical decision-making and errors that may have contributed to death. A full-time Yale pathologist presents the (gross and microscopic) autopsy findings to examine the degree to which pre-mortem diagnoses are reflected in the post-mortem findings.

6. Journal Club and Scientific Methods Lecture Series - Each year, a series of lectures, for all residents, reviews scientific methods, statistical techniques and how to examine the validity of a published medical study. These skills are then practiced in monthly journal clubs and in smaller "break-out sessions" with a faculty member (once or twice/year).

• Critical Review of Literature

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A summary of all six ACGME competencies may be downloaded from the following link.

• Evaluation of the ACGME Competencies