Behind My Back
It doesn’t matter what I hear them saying… I hate it when people talk about me behind my back. I think this probably stems from a scarring slight during my middle school days – the incident I don’t recall, but the emotional memory of learning that I was the subject of another’s conversation is still visceral. I don’t think that I am unique in this – far from it. Few of us like to be the subject of gossip or even innocent conversation that we are excluded from.
This desire for transparency and inclusion is a key factor in many of the decisions I make and many of my behaviors. For example, I am pretty passionate about rounding at the bedside. There are some clear gains with bedside rounding – the patient is available for questioning and examination, the entire team is engaged and focused, the presenter has to ‘put their nickel down’ on their plan (yes – this is an educational win!), and patient and family satisfaction is greatly increased. Another important win is that the patient doesn’t hear us talking, or laughing, about them outside the room – they are included in the discussion.
I suspect it will not shock you to hear that faculty talk about residents on a regular basis. In fact, we are required to do so. At the insistence of the ACGME, the organization that accredits all residency programs in the US, we assemble six times a year for what we call the QACCC (Quality Assurance protected Clinical Competency Committee). We (me, your APDs, clinic directors, chiefs, and select non-physicians) discuss you twice yearly. We talk about your research, your career goals, your participation in conferences, your ITE performance and your performance in clinic and on the wards. Your data is presented by the physician who conducts your semi-annual reviews, and then a discussion ensues. We wrap up by noting strengths and areas for improvement, and often make recommendations to the presenting physician. Recommendations might include allowing a board review study block, suggesting a particular mentor work with a resident on an issue, or recommending increased follow-up on well being. We are doing all of this already, and have been for years.
We then rely on your advisor to relay information back to you and on the two of you to act on that information. I think we can do better with this part of the process. Five years ago, I spilled diet Coke on my QACCC notes and had to reconstruct them from memory – were all of the recommendations passed on? I am not sure. Sometimes your meeting is months after we QACCC – so we have to keep track of a set of notes with your sensitive information on our desks for months. This system feels more filled with holes than Swiss cheese.
Dave Haughey and I have been working on a system to make sure that you get the information from the QACCC in a timely fashion so that you can then think about and discuss QACCC recommendations with your advisor. Right now, we are piloting creating the letter. In the next couple of weeks, you should receive, electronically, a PDF copy of the letter. For many of you, this will happen after your review (we’re piloting the process one piece at a time). In spring, we’re hoping the process will be QACCC-> letter to you -> semi-annual review. As you read your letter, I want to make clear that the only difference here is transparency – I want you to know what we are talking about and saying. My hope is that this increased transparency will enable you to better understand the next steps for your education and move through them more quickly. This is a QI project, so your feedback is welcome!
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