Jon+Karnes+SOAP+8.31.09


 * Resident Semi Annual Evaluation **
 * Maine-Dartmouth Family Medicine Residency Program **


 * Resident: ****Jon Karnes **** Advisor:  ****Colt ****  Date of Review: **  8/31/09

Jon is starting his third year. Originally from Knoxville, TN. He is married, wife is currently working as a teacher. Both families are from TN and he is unlikely to stay in ME. He is currently at a major cross roads in thinking about what he wants to do after residency with his possibilities ranging from staring a new residency in Derm, to training in ER, to working in a micropractice, doing full spectrum family practice. Ultimately, they would like to return to TN.
 * Subjective/ Individualized Education Plan **

**Rotations since that review:** - Nashua, NF/community medicine, ortho, NF/fmi, FPC (the guinea pig on this rotation) ENT Concerns brought up in last review /Strategies for working on competencies – progress in this area – had done well in all competencies – with exceeds expectations, except in Professionalism where he had a 3, with areas to work on being: updating procedure lists, keeping current on medical records, work hour documentation.
 * Objective **:
 * Date of last review ** – 3/25/09

**Curriculum Requirements:** Required supplemental study completed? Has completed all □ ** Outpatient visits – ** o PGY1 326 (of 150 needed) o PGY 2 – 626 (of 500 needed) o PGY 3 – no data yet, but can presume this won’t be an issue □ **Continuity OB** – 6 (of 10 needed) – has 7 pregnant patients □ **Deliveries** – 82 ( of 40 needed) □ **Home Visits** – none documented □ **Nursing Home patients** – no nursing home visits documented, has two NH patients □ **ICU visits** - 3 (of 15 needed) – done, but not documented □ **Conferences –** 7 through Block 1 – had 100 last year. □ **Progress towards scholarly project –** implications of open access on our practice - he has obtained data on a large number of patients with type of insurance and is interested in looking at rates of cancellations and no shows before open accessed and after open access. Hasn't collated data at this point □ **Presentations –** Occupational therapy, Itching - per advisor has had favorable reviews □ **Step III/COMLEX** - scheduled for Step III **Areas of Concern**: non **Competencies**: **1) Patient Care:** · __Rotation Evaluations__ (3=meets expectations): Nashua – meets expectations in history and physical, collects data, exceeds in evaluating patient, management plans and able to handle 5 patients – ER/Ortho – Exceeds in all of above //** No evaluations from NF, FMI, FPC – which arguably should be the base of this evaluation **// verbal reports of FPC - Jon is very competent in inpatient medicine. Good relationship with patients, he is thorough, has excellent grasp of big picture, triages well, works efficiently - maybe needs to pay more attention to details.

· __Out patient chart audits__: - about 20 from last two months. - reoccurring themes in patient care are, heath maintenance is not documented as up to date, overdue for WCC, Elevated blood sugar not addressed · Pace (pts/hr): about 7/session, but occasionally up to 9 or 10 · __Sign Out__ - no info recently, but comment from previous OB that he gives very good phone presentations · __Observations__: two observations – one pregnant woman with some anxiety, excellent report, good exam, good interaction, no concerns, the other with a post-partum mom. Apparently much more difficult visit, frustrated patient, involved suboxone, subutex and usage. Jon was observed to withdraw from the patient's frustration, not meet it head on, but the visit went well overall and ended well. · Precepting Feedback: none currently

**2) Medical Knowledge:** __· Rotation Evaluations__ (3=meets expectations): Exceeds expectations to exceptional performance in ortho, ED and Nashua : able to analyze and look up data, knowledge specific to rotation · __Specific topics not being met__: none · __In-training exam scores__: 1st year 65% (57NA), 2nd year 70 % (60% NA) 3rd year pending No concerns about medical knowledge

**3) Practice-based Learning and Improvement:** Rotation Evaluations (3=meets expectations): EMR skills: meets expections  Resident evaluations – none (?)  Conference attendance – on target  Scholarly project - working on this

**4) Interpersonal and Communication Skills:** · __360s__: 4/5’s on a 5 point scale. “fabulous resident, fun to work with, great asset, very responsive to his patients, incredibly respectful of his patients, skilled, knowledgeable, his enthusiasm is a welcome trait” To work on: “needs to check email more regularly, takes too much time with procedures, needs to continue to work organizational skills”

**5) Professionalism:** · __Rotation Evaluations__ (3=meets expectations): Meets or exceeds expectations – honest, responsible, arrives on time, appropriate with patients – from a previous period – “he came in this morning to call in sick and be sure his patients were attended to. A sign of his great professionalism” - Alto · __Individualized Education Plan (IEP__): Has completed, clearly put in a lot of thought and effort. __Medical records__ – currently only two dictations outstanding, at medical records last week.  Currently has 6 tasks all from last day. All non-urgent

__Patient evaluations__ – was specifically mentioned in a Press Ganey evaluation, has an evaluation in his chart from John Richardson - Jon worked a patient into an already booked schedule (not his patient, and a “very challenging” situation) did this with grace and willingness. __Coding evaluation of notes__ – from 20 most recent outpatient evaluations – only 2 mentioned that the coding could be higher, two mentioned there was no review of systems, several comments that the level was appropriate. Evaluation of a recent half day – (coding information to follow). □ EMR use – meets expectations (needs to clean up problem lists, med lists, not using ROS sections or even separating ROS, but definitely readable notes) <span style="font-family: 'Courier New'; mso-fareast-font-family: 'Courier New'; msofareastfontfamily: 'Courier New'; msolist: Ignore;">□ Not surprisingly difficult half day – two drug abuses, one self abuser, a previously abused child, a morbidly obese child, some one with head and neck cancer – sigh – <span style="font-family: 'Courier New'; mso-fareast-font-family: 'Courier New'; msofareastfontfamily: 'Courier New'; msolist: Ignore;">□ All signed with in 24 hours <span style="font-family: 'Courier New'; mso-fareast-font-family: 'Courier New'; msofareastfontfamily: 'Courier New'; msolist: Ignore;">□ One needed precepting for Medicare/Fed Group – was 99213, had precepted this patient in the past for WCC
 * 6) Systems-based Practice: **


 * Assessment: Competency level (compared to peers):  **

□ Exceeding Expectations in all competencies except the issues involving paperwork for the residency and use of EMR– meets expectations

Jon is profecient resident Jon is

Jon is a

** GOALS FOR FUTURE ** as indicated on IEP Plan: survey various clinical settings including family practice, derm residency, ED work inc possible moonlighting.
 * Goal 1: explore practice options. **

discussed derm plans - has a sense that he will be evaluating extensively in next three weeks. Feels like it will either come together by then or possibly be off the table. Would, in Jon's opinion, require something of a miracle for it to all come together.

Feeling of the group - Jon should not feel beholden to Family Practice - definately needs to put his energy into finding out how he would be most happy, no matter what he does, he will be an excellent contributer to the feild of family medicine --> and once he does decide which direciton he would like to head, there are multiple faculty members who may be able to assist him in reaching goals.

discussed some options for exploring different practice styles. **Goal 2: Develop procedural skills**: including line, airway, endoscopy/colonoscopy, ? plastics. Plan: (per Jon) colonoscopy training with Farmington docs, airway course, ? trauma rotation. ATLS, ALSO, PALS, wilderness training Plan (per committee, advisor, resident): - need updated information on scholarly project Satisfactory completion of 3rd year rotations, as determined by MDFMR faculty || ||   ||   Manage patients with multiple interacting morbidities  || ||   ||   ||    ||    ||    ||    ||    ||  Demonstrate awareness of own ethical and moral biases and their relation to patient interactions and act to facilitate patient’s values  || ||   ||    ||  Demonstrate sensitivity regarding culture, age, gender, sexual orientation and/or disabilities  || ||   ||  Adherence to rules and regulations of program (i.e., immunizations, time off requests)  || ||   ||    ||    ||    ||    ||    ||    ||  Demonstrate adequate knowledge base and level of skills consistent with the level of training as documented in PGY-3 rotation evaluations  || ||   ||   Attendance at 85 teaching conferences (morning, noon, Tuesday p.m., or Grand Rounds) by the end of the 10th month of the 3rd year; 100 by the end of the year. ||   ||    ||   Passing grade on all three years of the Comlex for osteopathic residents and USMLE for allopathic residents. ||   ||    ||    ||    ||    ||    ||    ||    ||  Involvement in a community project/ activity  || ||   ||  Participate in management of resident affairs including curriculum and office practice. Participation in at least 1 curricular or practice related committee during 3 years of training || ||   ||    ||  Strive/ work to affect public health and policy  || ||   ||    ||   ||    ||    ||    ||   ||    ||    ||  Use the EMR and IT to educate patients and evaluate and enhance the quality of medical care  || ||   ||    ||  Provide effective and thoughtful feedback to peers  || ||   ||    ||  Scholarly/ PI project completed by 10th month of 3rd year  || ||   ||    ||  Show readiness to supervise and teach students and residents with attending supervision  || ||   ||    ||    ||    ||   ||    ||    ||  Deliver a clear, fully detailed and concise case presentation  || ||   ||  Notes ensure communication w/ PCP and longitudinal charts incorporate all aspects of care  || ||   ||  Effectively manage family conflict, disruptive behavior and /or potentially litigious situations  || ||   ||  Manage a family meeting and inform family members of bad news in empathetic and receptive fashion  || ||   ||    ||  Work constructively and effectively with members of the medical team  || ||   ||    ||    ||    ||   ||    ||    ||  Understand a variety of modalities for whole person care and consistently apply those and/or refer appropriately  || ||   ||    ||   ||    ||    ||    ||
 * PATIENT CARE ** ||
 * YES ** ||
 * NO ** ||
 * COMMENTS: ** ||
 * COMMENTS: ** ||
 * Not yet, no issues with PGY2 rotations ** ||
 * x ** ||
 * COMMENTS: **
 * COMMENTS: **
 * For next evaluation will need **
 * - FMI/NF/FPC evaluations **
 * - precepting evalus **
 * - generally, no concerns ** ||
 * PROFESSIONALISM ** ||
 * PROFESSIONALISM ** ||
 * x ** ||
 * No data on this – chiefs? Nancy? ** ||
 * COMMENTS: **
 * COMMENTS: **
 * Comments in multiple places about Jon’s respect for patients, his eagerness to work and help  ** ||
 * MEDICAL KNOWLEDGE ** ||
 * MEDICAL KNOWLEDGE ** ||
 * Evaluate at next rotation, no concerns at this point ** ||
 * Met target last year ** ||
 * Scheduled  ** ||
 * COMMENTS: **
 * COMMENTS: **
 * Generally, medical knowledge on rotation evaluations meets/exceeds/outstanding ** ||
 * SYSTEMS-BASED PRACTICE ** ||
 * SYSTEMS-BASED PRACTICE ** ||
 * x ** ||
 * COMMENTS: **
 * COMMENTS: **
 * PRACTICE-BASED LEARNING ** ||
 * PRACTICE-BASED LEARNING ** ||
 * x ** ||
 * Student commented that the FPC rotation was the best when Jon was the resident ** ||
 * COMMENTS: **
 * COMMENTS: **
 * INTERPERSONAL & COMMUNICATION SKILLS ** ||
 * INTERPERSONAL & COMMUNICATION SKILLS ** ||
 * x ** ||
 * x ** ||
 * x ** ||
 * x ** ||
 * Multiple examples of working with social services, investigating resources in community ** ||
 * COMMENTS: **
 * COMMENTS: **
 * OSTEOPATHIC PHILOSOPHY/INTEGRATIVE MEDICINE (DOs & MDs) ** ||
 * OSTEOPATHIC PHILOSOPHY/INTEGRATIVE MEDICINE (DOs & MDs) ** ||
 * COMMENTS: **
 * COMMENTS: **

Type in the content of your page here.