Evaluation and Promotion

Evaluation of the fellows’ progress toward competence as independently practicing neurologists is an extremely important component of residency and fellowship training. Our program employs an array of evaluation methods as described below.

Latest revision: 06/27/2023, Smitha Holla, MD

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End-of-Rotation Evaluations

At the end of each rotation, supervising faculty complete electronic surveys via a website called MedHub. The evaluations include both narrative comments and quantitative assessments of the degree to which the faculty trust fellows to carry out certain key responsibilities in each rotation. These key responsibilities are called entrustable professional activities (EPAs). For example, a stroke service EPA is “Can the fellow respond to a stroke code and differentiate a true stroke from a stroke mimic?”

Faculty grading of entrustment is then mapped to the various milestones based on the method published by the University of Washington’s internal medicine residency. For example, differentiating a true stroke from a mimic involves history-taking, neurological exam, knowledge of cerebrovascular disease, skill at imaging interpretation, etc.

Note that early in training, it is expected that fellows will need greater supervision and that the faculty will trust the fellows to function more independently over time as they demonstrate the skills necessary for independent practice.

Fellows are evaluated on the ACGME core competencies:

Clinical Neurophysiology Milestones
CodeMilestone 2.0Core Competency
PC1HistoryPatient Care
PC2Neurological ExaminationPatient Care
PC3Electroencephalogram (EEG)Patient Care
PC4Nerve Conduction Studies (NCS)Patient Care
PC5Needle EMGPatient Care
PC6Intra-operative Monitoring (IOM)Patient Care
PC7Evoked Potential (EP)Patient Care
PC8PolysomnographyPatient Care
PC9TelemedicinePatient Care
MK1LocalizationMedical Knowledge
MK2Neuromuscular (NM) DisordersMedical Knowledge
MK3EpilepsyMedical Knowledge
MK4Sleep DisordersMedical Knowledge
MK5EP / IOMMedical Knowledge
SP1Patient SafetySystems-based Practice
SP2Quality ImprovementSystems-based Practice
SP3System Navigation for Patient-Centered CareSystems-based Practice
SP4Physician Role in Health Care SystemsSystems-based Practice
PL1Evidence-Based and Informed PracticePractice-based Learning and Improvement
PL2Reflective Practice and Commitment to Personal GrowthPractice-based Learning and Improvement
PR1Professional Behavior and Ethical PrinciplesProfessionalism
PR2Accountability / ConscientiousnessProfessionalism
PR3Self-Awareness and Well-BeingProfessionalism
IC1Patient- and Family-Centered CommunicationInterpersonal and Communication Skills
IC2Barrier and Bias MitigationInterpersonal and Communication Skills
IC3Patient and Family EducationInterpersonal and Communication Skills
IC4Interprofessional and Team CommunicationInterpersonal and Communication Skills
IC5Communication within Health Care SystemsInterpersonal and Communication Skills

Multi-Source (360⁰) Evaluations

Fellow professionalism and interpersonal and communication skills are evaluated via electronic survey by patients, other resident colleagues, medical students, and a wide variety of co-workers. This latter category includes nurses, therapists, social workers, case managers, neurodiagnostic technicians, and schedulers.

Fellow Self-Assessment

In preparation for the semi-annual review with the program director, each fellow is asked to complete a brief self-assessment survey. This is used to develop an individualized learning plan, help the fellow keep track of various requirements such as QI projects, and guide the subsequent discussion with the program director.

Semi-Annual Reviews

At mid-year and year-end, the fellowships program’s Clinical Competency Committee (CCC) will meet to evaluate fellows performance across the various core competencies and milestones; see the CCC description. In these meetings, the CCC will recommend one of the following actions:

  • No action (for mid-year fellows in good standing)
  • Promotion (or graduation from the program)
  • Promotion contingent upon remediation
  • Remediation without promotion
  • Warning
  • Probation
  • Suspension
  • Termination

Subsequent to the CCC meeting, the program director will meet with the fellow to discuss his or her progress individually. The fellow’s self-assessment will be reviewed, along with the various evaluations detailed above and the CCC’s report.

Final (Summative) Evaluation

In addition to the usual six-month evaluation for the final six months of training, an additional form is completed by the Program Director attesting that the fellow has “demonstrated sufficient competence to enter practice without direct supervision”.

All reports, evaluations, and correspondence will become part of the fellow’s permanent personnel file.

Fellow Evaluation of Program and Faculty

Feedback regarding the fellowship program and its faculty is derived from several sources. Each year, fellows complete via MedHub a survey regarding:

  • The program: This includes an overall rating and ratings of the clinical, educational, and scholarly components of the program, as well as the facilities and the culture. Each question has a free text comment field as well.
  • The rotations: Every rotation is listed, along with a comment field.
  • The people: This includes an evaluation of the faculty as a whole, the program director and coordinator, and each attending physician. Again, there’s a comment field for each one.

In addition, as part of the Program Evaluation Committee’s Annual Program Evaluation, the fellow presents rotation feedback, highlighting and expanding on whichever aspects the fellow believes deserve the most attention.

Twice each year, each fellow meets with the program director to discuss their progress through the program, career goals, and other fellow-specific matters. In addition, those meetings serve as another venue for fellows to provide confidential (in the sense that they don’t have to speak in front of their colleagues) feedback regarding the program.