Clinical Supervision Practice Improvement Module Introduction

This module will help you as a supervising attending to improve the quality of care your trainees provide to their patients and help trainees to improve their clinical skills. A large body of research evidence has demonstrated trainees lack competence in the important clinical skills of medical interviewing, physical examination and informed decision making. For example, poor communication and physical examination skills often lead to diagnostic and/or management errors. In addition, many basic quality and safety processes of care are not adequately performed. To complete this module, follow the steps described in the following slides. The first step is to access the module instructions page.

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Clinical Supervision Practice Improvement Module Module Instructions

At the bottom of the instructions page you will be able to acknowledge that you have read and understand the instructions. Clicking on the button will enable the observation and medical record audit sections of the module.

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Clinical Supervision Practice Improvement Module Status Page

After acknowledging that the instructions have been read, the Observation/Audit section of the module becomes available as indicated above. To complete this section you must document a minimum of 10 trainee observations and corresponding medical record audits. The following pages illustrate the Observation/Audit section of the module.

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Clinical Supervision Practice Improvement Module Data Collection: Trainee Observation

To begin the Observation/Audit section you must enter a trainee ID. Although you may enter the trainees name in the ID box, the ABIM will automatically convert any information provided in this box to a number so as to protect trainee confidentiality. You may then begin to work on the first observation by clicking on the Work on Observation link.

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Clinical Supervision Practice Improvement Module Trainee Observation Form

In either the inpatient or outpatient setting, perform a direct observation of a clinical interaction between your trainee and a patient. You can observe as many different trainees as you wish; however, we strongly recommend that you observe each trainee with at least two different patients to see if the trainee made improvements after receiving feedback from you. An observation can involve a complete outpatient visit, portions of an outpatient visit, a hospital admission history and physical, a daily inpatient assessment, an end-of-life discussion, discharge counseling or an informed consent discussion. You are required to observe the trainee for a minimum of 5 minutes, and then provide the trainee with your assessment and feedback. Be attentive to the implications of the trainee's level of performance on the quality of care the patient is receiving. We recommend using an assessment tool during the observation exercise such as the mini Clinical Evaluation Exercise (mini-CEX) form and make brief notes to guide your feedback. You will complete a mini-CEX for all observations as part of the module. Answer the basic demographic characteristics about the trainee. Nothing you enter will be used by the ABIM regarding the trainees performance. It will be your decision as to whether to share your assessments with the program, but these observations could be very useful for both the trainee and program to help meet the competency assessment requirements.

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Clinical Supervision Practice Improvement Module Data Collection: Work on Audit

Once the Trainee Observation Form has been completed the link to the Medical Record Audit (Work on Audit) will become active. Since the audit form relies on information you enter into the Trainee Observation Form, you must complete the Trainee Observation Form first and it cannot be changed once complete. Clicking the Work on Audit link will take you to the next page.

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Clinical Supervision Practice Improvement Module Medical Record Audit

The next step is to review the medical record note of the encounter you just observed. If the observation did not require a note, then review the appropriate sections of the medical record. You will be prompted to evaluate the note for accuracy and internal consistency. To complete the Medical Record Audit, you will be required to review the chart for important quality performance measures involving preventive care (e.g. immunizations), discharge planning and safety (e.g. medications, urinary catheters and falls). These measures have all been tested and validated by national quality organizations. You should provide feedback to your trainee about the results of your medical record review.

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Clinical Supervision Practice Improvement Module Data Collection Complete

After you have completed at least 10 observation and audit combinations, the Summary Report link will become available in the navigation section on the left. Clicking the Summary Report link will prompt you to indicate that you have finished recording all observations and audits. Once you proceed to view the report you will no longer have the option to add additional trainees to the list.

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Clinical Supervision Practice Improvement Module Summary Report: Section 1

The Summary Report consists of two sections. The first is a review of each trainee observation and includes the ratings on the mini-CEX form and the action plan that you specified for each trainee. There is also summary level data for all of your observations (minimum of 10 required) as seen on the next page.

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Clinical Supervision Practice Improvement Module Summary Report: Section 2

Section two of the report provides summary results for the medical record audit form.

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Clinical Supervision Practice Improvement Module Develop Improvement Plan

After reviewing and reflecting on the report you can use the Develop Improvement Plan link to document your learning gained from the module. This is the first section of the improvement plan form.

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Clinical Supervision Practice Improvement Module Supervisor Self-assessment

The second section of the improvement plan form asks you to perform an assessment of your performance as an attending physician before starting the module and after completing it. Completing all fields on this form is required. Once the form is completely filled out, you can return to the Main Menu to submit your module for credit.

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Clinical Supervision Practice Improvement Module Submit Completed Module

When all Improvement Plan questions have been answered and you are satisfied with the results of the module, you may click the Submit Completed Module button to receive MOC credit. You will then be directed to a post-module survey where your responses will help inform our product planning and development processes in the future.

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