Demonstration of portfolios to assess competency of residents.

Residency educators are identifying approaches to measure resident competence. Portfolios are well suited since they require work already completed as part of patient care where competency must be demonstrated. This paper describes assessment of the reliability and validity of portfolios in a psychiatry residency program. This was a cross-sectional study across 4years of residency education. Using guidelines, 18 residents assembled portfolios containing five entries chosen from 13 skills. Trained raters scored the portfolios. Residents and faculty were interviewed about their perceptions. Generalizability results indicated five entries and two raters were sufficient for relative decisions. Six entries or a third rater would be sufficient for absolute decisions. Portfolio scores tended to improve with years of training and correlated with psychiatric knowledge but not clinical performance. Residents and faculty identified benefits to assembling a portfolio. Portfolios incorporate tasks embedded in the residency to provide evidence of resident competency. The results support that the score is reliable and valid.

Implementing a mandatory geriatrics clerkship.

Due to the rapid growth in the proportion of U.S. citizens aged 65 and older (20% by 2030) it is imperative that U.S. medical schools train students who can provide quality care to the older population. Consequently, the objective of this paper is to report the experience of creating a 4-week, mandatory geriatrics clerkship for junior medical students. Funded by a grant from the Donald W. Reynolds Foundation, the University of Arkansas for Medical Sciences developed a mandatory, third-year clerkship in geriatric medicine. The clerkship included clinical experiences in outpatient clinics, transitional care units, nursing homes, hospice programs, and core didactic sessions. The sites for the clerkship were the University of Arkansas for Medical Sciences Hospital, the Central Arkansas Veterans Healthcare System Hospital, community nursing homes, and community hospice programs in Little Rock, Arkansas. The entire junior class of 135 students participated in the new clerkship. Students were assessed through a three-station Objective Structured Clinical Examination followed by a brief post- encounter examination and faculty preceptor evaluations collected from each clinical site. Students evaluated the clerkship through written evaluations and focus group discussions. This paper demonstrates that students acquired sufficient cognitive knowledge to satisfactorily complete the clerkship but did not highly value the experience.