- Please refer to the Royal College STACER documents on one45
Residents must demonstrate competency in interviewing skills using the formal process defined by the RCPSC, which is the STACER – Standardized Assessment of a Clinical Encounter Report – in order to be eligible for their certification examination. This requires a demonstration of competence in formal interviewing on two occasions during their senior years.
Interviewing skills training is integrated to the program’s centralized teaching and to diagnostic interviewing courses given at the hospitals. Formal assessments of required interviewing skills will take place during each core rotation and twice yearly during the MOCK ORAL EXAM DAY for PGY2-PGY5 residents.
Mandatory MOCK ORAL EXAM DAY will be held on October 20, 2020, March 23, 2020 and June 1, 2020. Each resident will be scheduled for at least two of the three dates.
- MOCK ORAL EXAM DAY consists of a single long-case exam, plus two PDMs (phenomenology, diagnosis and management) stations of 20 minutes each.
- Stations are designed to evaluate multiple CanMEDS roles across the life span
- MOCK ORAL EXAM DAY is an important opportunity for residents to receive feedback regarding their interviewing and assessment skills.
- They also give residents a chance to become familiar with the procedure they must master in order to sit their Royal College exams
- Personal belongings are forbidden during mock oral examinations. This includes all electronic devices, notes and textbooks.
- The sites will provide clipboards, paper, pens and a timing device.
STACERs
A STACER is a semi-structured evaluation of a resident’s interviewing and consultancy skills. Residents complete a 50-minute diagnostic interview of a new patient for the purpose of determining a DSM-5 diagnosis and differential diagnosis, a biopsychosocial understanding of the patient’s problem, and a comprehensive treatment plan. Trainees should imagine that they are interviewing a new patient for the purpose of taking over their care, while relying as little as possible on external sources of information.
The 50-minute interview is followed by a 10-minute break, and then by a 15-minute case presentation. The examiner will then spend approximately 30 minutes asking the resident relevant questions pertaining to the case. Examples of common questions include: 1) Asking the resident to clarify their diagnostic reasoning, 2) Asking the resident to explain their understanding of factors predisposing, precipitating, and perpetuating the patient’s problems, 3) Asking the resident to analyze interpersonal dynamics during the interview, 4) Asking the resident to explain details of their proposed treatment plan, 5) Asking the resident to explain problems that may arise in their proposed treatment plan and develop reasonable alternative strategies. After this, there should be 10-15 minutes left to provide verbal feedback to the candidate regarding their respective strengths and weaknesses. Please note that there is no protected time at the beginning of the STACER to create a grid or to take notes.
Formal Assessment
The Competence Committee has developed the following procedure regarding STACERs:
- Senior residents must demonstrate competence on two STACERs, at least one of which must be completed during a MOCK ORAL EXAM DAY. Even if a resident (PGY4) passes two STACERs (at least one during MOCK ORAL EXAM DAY) they must complete the second MOCK ORAL EXAM DAY STACER during their PGY4.
- Within each core clinical rotation in the PGY1–PGY5 years the residents will have at least one interview observed by their clinical supervisor, with case presentation and discussion. The clinical supervisor will use the program’s interview assessment grid (specific assessment forms are available for both junior and senior residents as well as for geriatric and pediatric patients on one45) to evaluate the interview and provide direct feedback to the resident. The supervisor will then send the STACER feedback form, which includes the evaluative component of whether the resident’s performance meets expectations or not, to the training director, who will then forward it to the program office.
- If the residents’ (PGY4 or PGY5) performance on a given interview in their clinical rotation is felt to be sub-standard, they can repeat the process with another patient. After two consecutive sub-standard evaluations, they will be directed to a remediation process organized in conjunction with the Competence Committee and their training director. Remediation experiences, customized to try to address identified deficiencies, may include further observed interviews, reading relevant references, and specific work on selected aspects of interviewing skills, peer supervised interviews, videotaped sessions, etc.
- MOCK ORAL EXAM DAY STACERS will serve as an additional observed interview for the purpose of the STACER. The STACER feedback forms will be sent to the training director and then to the program office.
- For PGY4 and PGY5, there will be two assessors conducting the STACER on MOCK ORAL EXAM DAY but only one assessor for the clinical STACER.
- Residents (PGY2 – PGY5) whose performance on a STACER is felt to be substandard will be encouraged to discuss this with their training director and clinical rotation supervisor to see if there are specific ways to address the deficiencies observed during the MOCK ORAL EXAM DAY.
- If the combination of MOCK ORAL EXAM DAY and clinical rotation interviews observed during the PGY4 to PGY5 years are felt to meet the Royal College guidelines of “at least two successful demonstrations of competence by the resident,” residents will be considered as having “passed” this component of their overall evaluation. They will continue to have observed interviews on their clinical rotations (up to the first six months of their PGY5 year) but not on MOCK ORAL EXAM DAY during PGY5.
- Residents who have not attained the minimal requirement of 2 satisfactory performances (including one during MOCK ORAL EXAM DAY) by the end of their PGY4 year will be offered the opportunity of doing up to 3 additional STACERs. One of these can be during the first MOCK ORAL EXAM DAY (late summer/early fall) in their PGY5 and two others will be organized by the competence committee and its Chair, with the residents’ input regarding site and potential examiners. The competence committee will review the performance of residents unable to pass at least one of these three STACERs, and they may be put under academic probation and may not be allowed to present themselves to the Royal College exams (depending on the nature and the severity of competence deficits).
- A comprehensive remediation plan will be available to residents encountering difficulties in their STACERs to help them achieve competence in their interviewing skills.
The process outlined above should provide for up to five STACER-type observed interviews in the PGY4 (where residents do CL, shared care, SPMI, and addictions) and up to three observed interviews in the first six months of the PGY5, giving at least 8 separate occasions when interviews are observed, rated in a structured manner, and specific feedback given to the resident by the midpoint of the PGY5.
The following are broad guidelines, suggested for the clinical rotation observed interviews:
- That they occur approximately midway through the rotation
- That the case be, whenever possible, new to both resident and supervisor
- That the process be structured so that the administrative realities of the clinical setting are addressed, including not imposing undue delays on the patient
- The training directors will send reminders to the chiefs of service/rotation coordinators early on reminding them that a STACER needs to be set up. It is up to the clinical service to decide who will be the assessor(s) and how the STACERs will be set up while ensuring that they follow the RCPSC’s “Procedure for the Conduct of the STACER” (document to be distributed to concerned staff by the training director)
Organization of STACERs may require the assistance of designated residents in finding suitable patients.
Failures and appeals
Residents will have passed a STACER if their interviewing and consultancy skills are found to be at a level of competency expected for their level of residency training. On MOCK ORAL EXAM DAY, both examiners must agree on a resident’s passing grade (if they cannot agree the result will automatically be a fail) and must inform residents of their results at the beginning of their deliberations.
The most common reasons for failure include:
1) An interpersonal style that is hostile or non-empathetic
2) Serious difficulty structuring the interview or eliciting a valid information database
3) Serious difficulty developing an understanding of the HPI, psychiatric history or key medical information
4) Serious omission of relevant questions or concerns regarding safety
5) An inadequate integration of information collected into a reasonable diagnosis and case formulation
6) Unsafe or inappropriate treatment plans
7) Moderate weaknesses in several of the above domains
Residents may ONLY appeal a failure when the process was not followed properly. For example, if the interview needed to be cut short because of a fire alarm. Residents may NOT appeal in cases where the examiner decides that the quality of the interview, presentation, or treatment plan did not meet expectations for the resident’s level. All appeals must be submitted in writing within 24 hours to the training director.
Phenomenology / Diagnosis / Management (PDM) Initiative
Residents will create new PDMs to be added to our existing bank and used during their training. Each cohort (PGY2, 3 and 4) will create a PDM. The program office will supply a few examples as models and will provide instructions on how to make a good PDM. Each cohort will develop a subject, congruent to their training level, and submit it to the program office for approval. Each cohort will have until the end of period 7 to submit their PDM. The PGY5s will have two months to review the PDMs and submit their corrections and comments. Once they submit the edited PDMs, the RPC committee will review them.
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