EVALUATION PROCESS 

I. Tools Used to Evaluate Fellows In The Six General Competencies.

To ensure that trainees possess the knowledge, skills and attitudes essential for the provision of excellent care, the faculty members formally and regularly evaluate them. At the end of the rotation, and based on a close observation of the trainee, faculty members fill out an evaluation form that specifically addresses the following characteristics: patient care, medical knowledge, practice-based learning, interpersonal and communication skills, professionalism, and systems-based practice.

The monthly evaluations are written by using the New Innovations Residency Management suite.  The attending also meet with the fellow prior to each rotation to discuss expectations for the rotation.  The attending also meets with the fellow mid-rotation in order to discuss the performance and identify any deficiencies that may be present. 

In addition to the written evaluation, the performance of the fellows is verbally discussed during a monthly faculty meeting in which minutes are recorded.  Any problems identified are addressed with specific plans as to how their training can be altered in order to correct the underlying problem.  We have found that having an open discussion oftentimes brings issues to bear that were not mentioned in a written evaluation.  In this manner, a more complete evaluation of the fellow’s performance can be obtained. 

The fellowship program director meets with the fellows on a one-on-one basis and goes over the written evaluations.  This is done at least two times per year.  In addition, any time a fellow receives an unsatisfactory evaluation, that fellow also meets with the program director immediately in order to address the current concern and to devise an action plan as to how to correct the underlying problem.

            In event that a fellow persistently performs in an unacceptable level, the training program follows the policies and procedures of the University of Texas Southwestern Medical Center described in the next section.

II. 360 Degree Evaluations

The training program in nephrology requires its fellows to obtain competence in the six competencies as defined by the ACGME and as stated above.  As part of the performance improvement process to improve competency in professionalism, systems based practice and communication skills, we have started the process of 360 degree evaluations of fellows.  This is a work in progress. We have initiated the evaluation of fellows by the charge nurse in the PMH acute dialysis rotation and the charge nurse on the PMH transplant rotation.  Over time we will expand this process.

II. Evaluations of Attending Physicians

            The fellow is asked to fill out an anonymous faculty evaluation form for each rotation.  The MyEvaluations.com tool is utilized for this purpose.  The faculty are evaluated with regard to their availability, teaching skills and abilities, faculty/fellow rapport and quality of patient care.  The division chief counsels faculty who consistently perform poorly on their evaluation and formulates a remediation plan. If no improvement is observed in their overall teaching skills, they will be removed from their teaching responsibilities.

III. Evaluation of the Nephrology Fellowship Program

            We have mechanisms in place, by which the fellow can evaluate the overall quality and content of the Nephrology Fellowship Program.  Two times per year, the renal fellows meet with the fellowship program director in order to evaluate each rotation and give input into the content of the rotations.  This also includes the content of the didactic lectures.   In addition, the fellowship program director meets one-on-one with the fellows in order to gain their input as to suggestions for the nephrology fellowship.

IV. Problem remediation policy

The program director is responsible for implementing fair policies, grievance procedures and due process as established by the University of Texas Southwestern Medical Center.  In the event of an unsatisfactory evaluation, the fellow is warned verbally and in writing and corrective action is instituted and documented. The warning includes evidence of deficiency such as letters of complaint, attendance records or other documentation of unsatisfactory performance.  Specific plans for remediation are documented, which may include repeat of rotations, additional supervision or referral for counseling.  The goals of remediation, designation of responsible faculty members and description of the outcome are described.  Fellows may appeal decisions to suspend, place on probation, deny credit or dismiss from the program.  Fellows are advised and given written documentation of these policies during orientation.