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.
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.
| Neuromuscular Milestones | ||
| Code | Milestone 2.0 | Core Competency |
| PC1 | History | Patient Care |
| PC2 | Neuromuscular Examination | Patient Care |
| PC3 | Management and Treatment | Patient Care |
| PC4 | Nerve Conduction Studies (NCS) | Patient Care |
| PC5 | Electromyography (EMG) | Patient Care |
| PC6 | Anterior Horn Cell Disorders | Patient Care |
| PC7 | Root, Plexus, and Peripheral Nerve Disorders | Patient Care |
| PC8 | Neuromuscular Junction Disorders | Patient Care |
| PC9 | Myopathies | Patient Care |
| PC10 | Digital Health | Patient Care |
| MK1 | Localization | Medical Knowledge |
| MK2 | Formulation | Medical Knowledge |
| MK3 | Diagnostic Investigation | Medical Knowledge |
| MK4 | Muscle and Nerve Pathology | Medical Knowledge |
| SP1 | Patient Safety and Quality Improvement | Systems-Based Practice |
| SP2 | System Navigation for Patient-Centered Care | Systems-Based Practice |
| SP3 | Population Health and Advocacy | Systems-Based Practice |
| SP4 | Physician Role in Health Care Systems | Systems-Based Practice |
| PL1 | Evidence-Based and Informed Practice | Practice-based Learning and Improvement |
| PL2 | Reflective Practice and Commitment to Personal Growth | Practice-based Learning and Improvement |
| PR1 | Professional Behavior and Ethical Principles | Professionalism |
| PR2 | Accountability / Conscientiousness | Professionalism |
| PR3 | Well-Being | Professionalism |
| IC1 | Patient- and Family-Centered Communication | Interpersonal and Communication Skills |
| IC2 | Barrier and Bias Mitigation | Interpersonal and Communication Skills |
| IC3 | Interprofessional and Team Communication | Interpersonal and Communication Skills |
| IC4 | Communication within Health Care Systems | Interpersonal and Communication Skills |
| IC5 | Communication within Health Care Systems | Interpersonal and Communication Skills |
Fellows are evaluated on the ACGME core competencies:
Multi-Source (360⁰) Evaluations
Fellow professionalism and interpersonal and communication skills are evaluated via electronic survey by patients, other resident and fellow 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 resident / 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 fellow’s performance across the various core competencies and milestones. 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.
Latest revision: 12/4/2023, Michael Hansen, MD
