Evaluation

Evaluation of Fellows

The primary goal of the fellowship program is for fellows to obtain core knowledge and skill in palliative care and achieve their professional development goals. In designing our evaluation program, we have drawn upon several sources. First, we have ensured that our evaluation program includes those components required of residency training programs in the sub-specialties of internal medicine by the Accreditation Council for Graduate Medical Education. Second, we have structured our evaluation program to assess the core competency areas of palliative medicine as identified by the voluntary standards for training programs in palliative medicine. Third, we have developed our assessment program using the framework of adult learning theory such that the evaluation program itself enhances and contributes to each fellow’s education. Our evaluation process provides a structured framework for learners to establish their own goals and objectives based upon subjective and objective self-assessment, to develop an individual program to meet these goals, and provides a formal means for learners to regularly evaluate whether they are meeting their own educational objectives.

Learning Contract

One of the strengths and novel aspects of this fellowship is that it will accommodate a broad spectrum of professional goals (clinician educators, clinical researchers, clinical program leaders) and individual interests (e.g. oncology, geriatrics, other subspecialties). To allow for this breadth of experiences, a plan of individualized electives and customized areas of study will be developed for each fellow. To this end, upon entering the program each fellow will meet with the fellowship directors to develop an individual learning contract. The fellow will meet with the fellowship leadership to review and amend the contract. The document will then serve as a baseline measure for subsequent evaluation. Goal attainment will be judged by a comparison of the fellow’s skills and accomplishments to those outlined in the learning contract.

Identification and Review of Individual Goals

At the beginning of their fellowship, each new fellow will establish their career goals with the fellowship director and co-director and establish a plan to develop these goals. For example, whereas it is expected all fellows will leave the program with the core knowledge and skills in palliative care, some fellows will plan to pursue a career as a clinician educator whereas others may plan a career primarily in clinical research. Thus, each fellow will be expected to develop a plan to meet the educational needs of their chosen career path and will establish specific concrete and measurable benchmarks to mark the achievement of their goals. For example, a person pursuing a career as a clinician educator might want to develop expertise in using various teaching paradigms. Over the course of their fellowship, this fellow would be expected to develop a didactic lecture series in pain and symptom management, lead workshops in teaching communication skills, and lead bedside or clinic teaching rounds. A palliative care faculty member will observe each of these activities and give structured feedback to the fellow. Additionally, this fellow might use the research year to design and conduct a study comparing approaches to educational assessment. The fellowship leadership will meet twice each year, with the fellows to review their progress with respect to the goals and objectives outlined in the contract.

Assessment of Palliative Care Knowledge and Skills

Regular evaluations continue throughout the fellowship program. The fellow receives continuous feedback throughout the rotation as appropriate. At the conclusion of each rotation, the fellow receives both written and verbal feedback from their supervising attending physicians incorporating input from the interdisciplinary team as to their performance on the rotation. In addition, the palliative care faculty meet quarterly to complete a Clinical Competency Evaluation for each fellow. During these meetings, all palliative care attending physicians at Mount Sinai gather and discuss each fellow’s performance and specifically discuss how the fellow is meeting the required competencies. This feedback is then shared with the individual fellows.

360° Evaluation

Because working as a member of an interdisciplinary team is a core component to being a successful palliative care physician, feedback from all members of the clinical team is solicited. A formal 360° Evaluation allows the attending physicians, nurse practitioners, social workers and massage therapists to evaluate the palliative medicine fellows in the six core competencies as required by the ACGME.

Family Meetings

The family meeting has been described as the “procedure” performed by palliative care clinicians. To assure fellows have the necessary skill set to effectively and expertly conduct a family meeting, they are observed and formally evaluated at least twice a year by the fellowship leadership.

Mentorship

Each fellow is assigned one or more mentors based upon their primary area of specialty and on their career goals as outlined in the first part of the learning contract. The fellow meets regularly with their mentor(s) and the mentor(s) will be primarily responsible for overseeing the fellow’s research project and career development.

Evaluation of Faculty

Fellows have many opportunities to formally and informally evaluate the faculty members in the following manner: 1) fellows complete a written anonymous evaluation of the faculty preceptor at the completion of each rotation; 2) fellows complete a comprehensive, anonymous program evaluation form biannually which includes questions about faculty members; and 3) fellows are encouraged to provide feedback about their experiences with faculty during the monthly fellow’s meeting and during individual sessions with the directors.

Evaluation of Fellowship Program

Seminar Evaluations

Standardized seminar evaluation forms are completed by all those in attendance at didactic sessions and grand rounds. A summary of the results is provided to the speakers and are used to select speakers and topics for future seminars.

Biannual Program Evaluation

Fellows are asked to complete a Program Evaluation Form in the middle and at the end of the training year. The intent is to evaluate the quality of the fellow’s experiences and to assure the balance of clinical, teaching, and research commitments. This comprehensive form details all aspects of the program in a quantitative manner and encourages qualitative narrative. These data are used to complement the fellows’ feedback provided during the monthly fellows’ meetings and during individual sessions with the directors.

Evaluation of Graduates

After graduation, fellows will furnish information about their career development to the program on a yearly basis for 10 years following fellowship graduation. Graduating fellows will be contacted on a yearly basis through email or via a web-based form with a standardized questionnaire regarding their careers and related topics.