Evaluation of clinical competency is an essential function of the teaching faculty. Each faculty member is required to be familiar with the six core competencies and must strive in all educational efforts to assess for the resident is progressing in each area. The following are descriptions of the most common methods faculty members use in assessment of resident knowledge.

Supervisory Reports

Supervisors may use personal notes about a resident‚ performance. Such notes may be based on personal observation of the resident with patients, ongoing case discussions and review of medical records or written patient evaluations.

Patient Care Observation

The Training Program encourages faculty to observe residents caring for patients. This should be done in all clinical settings. In some services this is easier than others. For example, there are many opportunities for direct observation in inpatient, partial hospital and consultation services to pediatrics. In outpatient care, each clinical supervisor is expected to observe resident interviews with as many patients possible. Faculty may sit in the same room with residents and their patients, watch the resident through the one-way mirror or have the resident videotape an interview or session with a patient or family.

Following an observed interview or treatment session, the supervisor should discuss communication and interviewing techniques, clinical reasoning, case formulation and differential diagnosis, treatment planning and therapeutic skill used for that particular case.

Record Review

This method involves a faculty member reviewing a resident‚ written medical record of a patient. It is useful for evaluating skill in documenting care, clinical reasoning, data gathering and synthesis, treatment planning, use of ancillary testing, use of hospital and community resources, communication with other professionals and use of best practice standards in clinical care.

Chart Stimulated Patient Presentations

This method may be done in supervision, in clinical examinations or at the close of a rotation. The resident brings in one or more charts of patients he or she has treated and uses chart documentation to describe and discuss patient care issues, including data gathering, clinical reasoning, methods of clinical care, prevention and educational methods, patient outcome, use of resources and use of systems of care in disposition planning. Formal discussions may also help evaluate the resident‚ knowledge base and method of self-monitoring for practice-based learning and improvement

Case Reports

Residents may be asked to present a case report in individual supervision, on rounds in hospital-based care or in clinical conferences. They may be written or oral. The case report is intended to allow a resident to present a comprehensive history and clinical evaluation of a patient. The evaluation should also include a thorough differential diagnosis, formulation, treatment plan and prognosis. In some cases, a case report may serve to highlight a particular diagnosis, clinical problem or treatment. In these situations, residents may supplement the case report with an article or brief literature review. The case report may be useful in assessing data gathering and synthesis, knowledge-base, clinical reasoning, methods of clinical pare, use of ancillary tests and systems of care and prevention methods.

Evaluation of Live Performance

This method of evaluation is typically known as the ‚”Mock Board Examination.” It is used with the resident evaluating a patient for a specified period of time (typically 30 minutes), followed by a complete discussion of the case, including a presentation of clinical findings, formulation, differential diagnosis, treatment planning and prognosis. The fellow is responsible for presenting 4 such evaluations annually to the training director, assessed by a qualified attending physician, using the Clinical Skills Assessment Form.

Written Examinations

The Training Program administers the CHILD PRITE examination annually. All trainees are also required to participate in the General Psychiatry PRITE examination, annually.

Written Reports

Supervisors should routinely review written clinical evaluations prepared by residents. Some of these should include a review of formal diagnostic evaluations, while others may include a review of emergency assessments or consultation reports. Some of these may have specific functions. For example residents should prepare a forensic evaluation and a school report and have them assessed by specialists on their clinical rotations. Other specialized evaluations, such as those used for adoption and custody, sexual or physical abuse or disability determination should be reviewed by supervisors. Reports are helpful in evaluating a resident‚ data collection, use of medical knowledge, clinical reasoning, communication of findings appropriate to the reader, understanding of systems and professionalism.

Patient Logs

The resident patient logs should be reviewed by service chiefs and/or the training director to ensure an adequate volume and variety of patients on each clinical service.

Portfolios

A portfolio is a collection of products prepared by the resident that provides evidence of learning and achievement related to a learning plan. The resident can include video or audio recordings, self-reports of experiences or other documents that demonstrate such competencies as therapeutic effectiveness, ethical integrity, professionalism, self-directed learning and skill development, lectures given and continuing education experiences and written documents, such as review or research papers or case formulations. Patient logs may be included in portfolios.

Other Methods That Involve Outside Evaluations

Professionalism, patient care, interpersonal skills and communication, practice-based learning and improvement and systems-based care can all be assessed by additional measures such as:

Patient satisfaction surveys

These may be based on samples of satisfaction with crisis intervention, consultations, psychotherapy, psychopharmacology, inpatient or partial hospital care. They are done confidentially and are done at the initiation of patients and thus occur sporadically. The program is also working on implementing the Working Alliance Inventory (WAI) in the assessment of treatment alliance.

Evaluations by unit staff

These may be done in inpatient, partial hospital or outpatient rotations. They are also referred to as 360-degree evaluations, as they provide feedback from all who surround you. They are done confidentially and are integrated into the bi-annual evaluation completed by the supervisors of the resident.