Method of Recording Milestone Observations of Medical Resident Education and Calculating Achievement Levels
20170316703 · 2017-11-02
Assignee
Inventors
- Marc Lowell Schneider (Canton, OH, US)
- Roger Musa (Canton, OH, US)
- Keith Brian Werstler (Canton, OH, US)
Cpc classification
International classification
G09B19/00
PHYSICS
Abstract
A method of recording observations and calculating achievement levels is disclosed. Specifically, the method is used by two mobile applications working in conjunction with a live database on a remote server. The server communicates with the database which holds a number of tables that are related and sortable, and can be accessed by both applications. These applications read and write to the same database allowing for the sharing of data in real time. The first mobile application is used by faculty educators in residency programs or medical schools and allows for the input of resident or student data relating to the observation of milestones. The second application is used by medical residents or students to access their milestone observations and is used as a live report card documenting their current level of attainment. The live database is server based and is accessed by both the faculty/teacher and learner applications.
Claims
1. A method of recording observations and calculating achievement levels performed by one or more processing devices, said method comprising the steps of: utilizing two mobile applications working in conjunction with a live database on a remote server; the two mobile applications communicating with the live database which holds a number of tables that are related and sortable; allowing users to read and write to a live database which allows for sharing of data in real time; and allowing the two mobile applications to interact with each other via push notifications.
2. The method of claim 1, wherein the first mobile application is used by faculty educators in residency programs or medical schools and allows for the input of resident or student data relating to the observation of milestones as required by each residency specialty as mandated by The Accreditation Council of Graduate Medical Education.
3. The method of claim 1, wherein the second mobile application is used by medical residents or students to access their milestone observations and is used as a live report card documenting their current level of attainment.
4. The method of claim 1, wherein the database is accessible to a licensed individual via a web-based administrative site.
5. The method of claim 1, further comprising: allowing a program to determine a minimum number of observations required for a milestone level in order to achieve competency; allowing a program to manually establish sub-competency levels for any resident; and calculating an achievement score for a particular resident.
6. The method of claim 5, wherein general observations are not counted for completion of a particular milestone level.
7. The method of claim 5, wherein specific observations are recorded under a particular milestone description.
8. The method of claim 5, wherein milestones are organized by levels and a level requires a minimum number of observations to be considered complete.
9. The method of claim 8, further comprising: selecting a resident; selecting a competency; selecting a sub-competency; and recording an observation.
10. One or more storage devices storing instructions that are executable to perform operations, comprising: utilizing two mobile applications working in conjunction with a live database on a remote server; communicating with a database which holds a number of tables that are related and sortable; allowing users to read and write to the database which allows for sharing of data in real time; and allowing the two applications to interact with each other via push notifications.
11. The method of claim 10, wherein a first application is used by faculty educators in residency programs or medical schools and allows for input of resident or student data relating to an observation of milestones as required by each residency specialty as mandated by The Accreditation Council of Graduate Medical Education (ACGME).
12. The method of claim 10, wherein a second application is used by medical residents or students to access milestone observations and is used as a live report card documenting a current level of attainment.
13. The method of claim 10, wherein a database is accessible to licensed individuals via a web-based administrative site.
14. The method of claim 10, further comprising: allowing a program to determine a minimum number of observations required for each milestone level in order to achieve “competency”; allowing a program to manually establish sub-competency levels for any resident; and calculating an achievement score for a particular resident.
15. The method of claim 14, further comprising: to calculate an achievement score for a particular resident, sorting an observation table for those coded to that resident and for that particular sub-competency by milestone level; and walking-through resulting data by milestone level and testing against a minimum required observations for a milestone level.
16. The method of claim 15, further comprising: if a minimum observations for a level have been met, continuing to walk-through the data; at a first level where there is a shortfall between a number of observations and a number required, computing a fractional achievement score; and adding a fractional amount to previous levels for an overall achievement score.
17. A method of recording observations and calculating achievement levels performed by one or more processing devices, comprising: utilizing two mobile applications working in conjunction with a live database on a remote server; communicating with a database which holds a number of tables that are related and sortable; allowing users to read and write to a database which allows for sharing of data in real time; and allowing the two applications to interact with each other via push notifications.
18. The method of claim 17, further comprising: allowing a program to determine a minimum number of observations required for each milestone level in order to achieve “competency”; allowing a program to manually establish sub-competency levels for any resident; and calculating an achievement score for a particular resident.
19. The method of claim 18, further comprising: to calculate an achievement score for a particular resident, sorting an observation table for those coded to that resident and for that particular sub-competency by milestone level; and walking-through resulting data by milestone level and testing against a minimum required observations for a milestone level.
20. The method of claim 19, further comprising: if a minimum observations for a level have been met, continuing to walk-through the data; at a first level where there is a shortfall between a number of observations and a number required, computing a fractional achievement score; and adding a fractional amount to a previous level for an overall achievement score.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
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DETAILED DESCRIPTION
[0042] The innovation is now described with reference to the drawings, wherein like reference numerals are used to refer to like elements throughout. In the following description, for purposes of explanation, numerous specific details are set forth in order to provide a thorough understanding thereof. It may be evident, however, that the innovation can be practiced without these specific details. In other instances, well-known structures and devices are shown in block diagram form in order to facilitate a description thereof.
[0043] A method of recording observations and calculating achievement levels is disclosed. Specifically, the method utilizes a mobile application working in conjunction with a remote server. The server communicates with a database that holds a number of tables that are both related and sortable.
[0044] This method of recording milestone observations disclosed utilizes two mobile applications accessible on both Apple iOS and Android platforms and a live database on servers accessed by both applications. These applications read and write to the same database allowing for the sharing of data in real time or substantially real time. The first mobile application is used by faculty educators, for example, in residency programs or medical schools and allows for the input of resident or student data relating to the observation of milestones as required by each residency specialty as mandated by The Accreditation Council of Graduate Medical Education (ACGME). The second application is used by medical residents or students to access their milestone observations, and is used as a live report card documenting their current level of attainment. These two applications also interact with each other via push notifications. This method is applicable to faculty, educators, residents, residencies, medical students, medical schools, and medical education, as well as in other educational and/or training settings. When mentioned below, educator, teacher, and faculty are interchangeable and all represent the same person. Learner, student, and resident are also interchangeable and all represent the same person.
[0045] The live database is server based and is accessed by both the faculty/teacher and learner applications. This database is also accessible to licensed individuals via the web-based administrative site. This web-based access allows for the addition of faculty, learners, photos, email addresses, phone numbers and other information. It also allows the program or school to customize the application features. The database is unique in its customization features allowing for the full functionality of the applications as described. Individual programs or schools have access only to their secure database, whether using the web-based administration and customization site, or the mobile applications licensed to their institution and users.
[0046] The administrative site allows each program to determine the minimum number of observations required for each milestone level in order to achieve “competency” for that particular milestone level. The administrative site also has a feature that allows each program to manually establish sub-competency levels for any resident. This particular feature is useful for establishing the initial baseline for senior residents and transfer residents who have already achieved some milestones.
[0047] As shown in
[0048] All previously submitted observations and data are live and accessible to the faculty/educator within the milestone submission portion of the faculty application. This allows previously submitted data to be visible to the faculty while making a new milestone submission. Beside each milestone is a number that indicates the number of previous submissions for that milestone. If the number is in a yellow box, the resident is not yet competent in that milestone. If the number is in a green box, the resident has been determined to be competent in that milestone by the program. This live data feedback loop informs the educator how many submissions have already been reported for each milestone and if that particular student has already been determined to be competent in that particular milestone. In other words, the faculty is able to determine, using live data embedded within the milestone submission form itself, if that observation needs to be submitted or if it will be a duplicate, unnecessary submission due to information that is already in the database from past observations.
[0049] Furthermore as shown in
[0050] Additionally as shown in
[0051] As shown in
[0052] Also as shown in
[0053] Additionally as shown in
[0054] As shown in
[0055] The second application is the learner application that enables the learner to access their live database. By use of the application, the learner receives push notifications of submissions by teachers and is able to receive instantaneous feedback. The learner is also able to view all of his/her own observations submitted by the learner's various teachers. This may be categorized several different ways including by date or by sub-competency. Learners are not able to access other learners' data. Another feature enables the learner to see what milestones are needed to achieve the next attainment level for each sub-competency. Finally, the learner is able to view his/her live sub-competency report card. The learner application does not allow for the submission of milestone observations.
[0056] As shown in
[0057] As shown in
[0058] The mobile applications work in conjunction with a remote server. The server communicates with a database that holds a number of tables that are related and sortable. The tables hold hierarchical information that allows for the efficient computing of a medical resident's achievement levels within a particular sub-competency.
[0059] In
[0060] Specific observations are recorded under a particular milestone description. Milestones are organized by levels and each level requires a minimum number of observations to be considered complete. This grading practice is performed in accordance with guidelines set forth by ACGME.
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[0062] Furthermore, during the checkout process, a JSON data array of milestones, observations, faculty, device ID and resident information is transmitted via HTTPS to a computer server that in addition to checking the validity of the device, saves the data into a SQL database. The data is indexed by resident, by milestone, by faculty and by date and time. Upon a successful save to the database, a semaphore is sent back to the application signaling its completion. Also a push notification is sent to the registered devices of the particular resident, notifying the resident that one or more observations have been recorded by the faculty member.
[0063] Specifically, the process begins at 2300, then at 2302 a resident is selected. At 2304, a competency is selected and at 2306 a sub-competency is selected. At 2308 it is determined if a general observation is being entered, if yes, then at 2310 the general observation is entered and the process is completed and/or started from the beginning depending on a user's need. If the observation is not general, then at 2312 the milestone is added to the observation list. At 2314, it is determined whether to add more milestones. If yes, then the process returns to 2312 to add the milestones to the observation list. If no, then at 2316 the observation is entered and the milestones reviewed. Once the selection of milestones has been completed, the application will take the user to a checkout screen where the observation can be entered and the milestones selected can be reviewed and edited. The process is then completed and/or started from the beginning depending on a user's need.
[0064] Because of the use of both general and specific observations, a method for calculating achievement scores for sub-competencies 2400 was devised and is shown in
[0065] To calculate an achievement score for a particular resident, the observation table is sorted for those coded to that resident and for that particular sub-competency by milestone level. The resulting data is then walked-through by milestone level and tested against the minimum required observations for that milestone level. If the minimum observations for that level have been met the algorithm continues to walk through the data. At the first level where there is a shortfall between the number of observations and the number required, the system will then compute the fractional achievement score. The formula for this fraction is the following:
Fractional Achievement=(floor(2*(attained observations/required observations))/2)
[0066] The fractional amount is then added to the previous levels for an overall achievement score. See Example 1 below for a complete description of this computation method using sample data.
[0067] Furthermore, the data to compute the scores is extracted from a cloud-based SQL database that holds the milestone and observation data by resident, by sub-competency and competency. The data is extracted by a networked computer server and the scoring takes place as a server-side activity. The scores, after computation, are then transmitted via a JSON data array to the appropriate application.
[0068] Additionally, the method of computing the achievement score and recording the observations has been implemented and tested using mobile devices running an application that communicates with one or more remote servers. The servers are storing the information recorded in a database that allows for convenient and efficient sorting and indexing. An administrative web server is also utilized to allow for table updates and various maintenance and administrative functions.
TABLE-US-00001 TABLE 1 Example 1 Sample Achievement Level Table for a Particular Specialty Minimum Number of Milestone Levels Observations per Milestone 1 1 2 2 3 3 4 3 5 1
TABLE-US-00002 TABLE 2 Sample Observation Table for a Particular Resident for a Sub-Competency Observation ID Milestone ID Milestone Level 1 22 1 2 23 2 3 23 2 4 24 3 5 24 3
[0069] For this particular example, in the sample observation table (Table 2) there are five observations attributed to three milestones. Using the computation method as described in
[0070] There is one observation for milestone level 1 and the achievement table requires 1 for completion, so level 1 is complete and the achievement score is set to 1.
[0071] There are two observations for milestone level 2 and the achievement table requires 2 for completion, so level 2 is complete and the achievement score is incremented by 1 to a total of 2.
[0072] There are two observations for milestone level 3 and the achievement table requires 3 for completion, so level 3 is not complete and according to the formula, the fractional remainder is (floor(2*(2/3))/2) or 0.5. Since level 3 was not completed, there will be no additional consideration of observations beyond this level. The fractional amount is added to the achievement score for a total of 2.5. This value is returned to the user as the achievement score for this particular sub-competency.
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[0074] Furthermore, the above-described system was conceived primarily as a cloud-based platform. Thus, the computation instances are virtual machines that are running with thousands of other virtual machines inside of a rack-based server cluster.
[0075] Computing device 1400 includes a processor 1402, memory 1404, a storage device 1406, a high-speed interface 1408 connecting to memory 1404 and high-speed expansion ports 1410, and a low speed interface 1412 connecting to low speed bus 1414 and storage device 1406. Each of the components 1402, 1404, 1406, 1408, 1410, and 1412 are interconnected using various busses, and may be mounted on a common motherboard or in other manners as appropriate. The processor 1402 can process instructions for execution within the computing device 1400, including instructions stored in the memory 1404 or on the storage device 1406 to display graphical information for a GUI on an external input/output device, such as display 1416 coupled to high speed interface 1408. In other implementations, multiple processors and/or multiple busses may be used, as appropriate, along with multiple memories and types of memory. Also, multiple computing devices 1400 may be connected, with each device providing portions of the necessary operations (e.g., as a server bank, a group of blade servers, or a multi-processor system).
[0076] The memory 1404 stores information within the computing device 1400. In one implementation, the memory 1404 is a volatile memory unit or units. In another implementation, the memory 1404 is a non-volatile memory unit or units. The memory 1404 may also be another form of computer-readable medium, such as a magnetic or optical disk.
[0077] The storage device 1406 is capable of providing mass storage for the computing device 1400. In one implementation, the storage device 1406 may be or contain a computer-readable medium, such as a floppy disk device, a hard disk device, an optical disk device, or a tape device, a flash memory or other similar solid state memory device, or an array of devices, including devices in a storage area network or other configurations. A computer program product can be tangibly embodied in an information carrier. The computer program product may also contain instructions that, when executed, perform one or more methods, such as those described above. The information carrier may be a non-transitory computer- or machine-readable storage medium, such as the memory 1404, the storage device 1406, or memory on processor 1402.
[0078] The high speed controller 1408 manages bandwidth-intensive operations for the computing device 1400, while the low speed controller 1412 manages lower bandwidth-intensive operations. Such allocation of functions is exemplary only. In one implementation, the high-speed controller 1408 is coupled to memory 1404, display 1416 (e.g., through a graphics processor or accelerator), and to high-speed expansion ports 1410, which may accept various expansion cards (not shown). In the implementation, low-speed controller 1412 is coupled to storage device 1406 and low-speed expansion port 1414. The low-speed expansion port 1414, which may include various communication ports (e.g., USB, Bluetooth, Ethernet, wireless Ethernet), may be coupled to one or more input/output devices, such as a keyboard, a pointing device, a scanner, or a networking device such as a switch or router, e.g., through a network adapter. Furthermore, given the cloud-based nature of the server and database, the administrative and user websites are only available via an internet browser connection and any end-user peripherals would be connected to the PC that is the browser and not to the server.
[0079] Furthermore as shown in
[0080] Additionally as shown in
[0081] Computing device 1450 includes a processor 1452, memory 1464, an input/output device such as a display 1454, a communication interface 1466, and a transceiver 1468, among other components. The device 1450 may also be provided with a storage device, such as a micro-drive or other device, to provide additional storage. Each of the components 1450, 1452, 1464, 1454, 1466, and 1468 are interconnected using various busses, and several of the components may be mounted on a common motherboard or in other manners as appropriate.
[0082] The processor 1452 can execute instructions within the computing device 1450, including instructions stored in the memory 1464. The processor may be implemented as a chipset of chips that include separate and multiple analog and digital processors. The processor may provide, for example, for coordination of the other components of the device 1450, such as control of user interfaces, applications run by device 1450, and wireless communication by device 1450.
[0083] Processor 1452 may communicate with a user through control interface 1458 and display interface 1456 coupled to a display 1454. The display 1454 may be, for example, a TFT LCD (Thin-Film-Transistor Liquid Crystal Display) or an OLED (Organic Light Emitting Diode) display, or other appropriate display technology. The display interface 1456 may comprise appropriate circuitry for driving the display 1454 to present graphical and other information to a user. The control interface 1458 may receive commands from a user and convert them for submission to the processor 1452. In addition, an external interface 1462 may be provided in communication with processor 1452, so as to enable near area communication of device 1450 with other devices. External interface 1462 may provide, for example, for wired communication in some implementations, or for wireless communication in other implementations, and multiple interfaces may also be used.
[0084] The memory 1464 stores information within the computing device 1450. The memory 1464 can be implemented as one or more of a computer-readable medium or media, a volatile memory unit or units, or a non-volatile memory unit or units. Expansion memory 1474 may also be provided and connected to device 1450 through expansion interface 1472, which may include, for example, a SIMM (Single In Line Memory Module) card interface. Such expansion memory 1474 may provide extra storage space for device 1450, or may also store applications or other information for device 1450. Specifically, expansion memory 1474 may include instructions to carry out or supplement the processes described above, and may include secure information also. Thus, for example, expansion memory 1474 may be provide as a security module for device 1450, and may be programmed with instructions that permit secure use of device 1450. In addition, secure applications may be provided via the SIMM cards, along with additional information, such as placing identifying information on the SIMM card in a non-hackable manner.
[0085] The memory may include, for example, flash memory and/or NVRAM memory, as discussed below. In one implementation, a computer program product is tangibly embodied in an information carrier. The computer program product contains instructions that, when executed, perform one or more methods, such as those described above. The information carrier is a computer- or machine-readable medium, such as the memory 1464, expansion memory 1474, memory on processor 1452, or a propagated signal that may be received, for example, over transceiver 1468 or external interface 1462.
[0086] Device 1450 may communicate wirelessly through communication interface 1466, which may include digital signal processing circuitry where necessary. Communication interface 1466 may provide for communications under various modes or protocols, such as GSM voice calls, SMS, EMS, or MMS messaging, CDMA, TDMA, PDC, WCDMA, CDMA2000, or GPRS, among others. Such communication may occur, for example, through radio-frequency transceiver 1468. In addition, short-range communication may occur, such as using a Bluetooth, Wi-Fi, or other such transceiver (not shown). In addition, GPS (Global Positioning System) receiver module 1470 may provide additional navigation- and location-related wireless data to device 1450, which may be used as appropriate by applications running on device 1450.
[0087] Device 1450 may also communicate audibly using audio code 1460, which may receive spoken information from a user and convert it to usable digital information. Audio code 1460 may likewise generate audible sound for a user, such as through a speaker, e.g., in a handset of device 1450. Such sound may include sound from voice telephone calls, may include recorded sound (e.g., voice messages, music files, etc.) and may also include sound generated by applications operating on device 1450.
[0088] The computing device 1450 may be implemented in a number of different forms, as shown in the figure. For example, it may be implemented as a cellular telephone 1480. It may also be implemented as part of a smartphone 1482, personal digital assistant, or other similar mobile device.
[0089] Various implementations of the systems and techniques described here can be realized in digital electronic circuitry, integrated circuitry, specially designed ASICs (application specific integrated circuits), computer hardware, firmware, software, and/or combinations thereof. These various implementations can include implementation in one or more computer programs that are executable and/or interpretable on a programmable system including at least one programmable processor, which may be special or general purpose, coupled to receive data and instructions from, and to transmit data and instructions to, a storage system, at least one input device, and at least one output device.
[0090] These computer programs (also known as programs, software, software applications or code) include machine instructions for a programmable processor, and can be implemented in a high-level procedural and/or object-oriented programming language, and/or in assembly/machine language. As used herein, the terms “machine-readable medium” “computer-readable medium” refers to any computer program product, apparatus and/or device (e.g., magnetic discs, optical disks, memory, Programmable Logic Devices (PLDs)) used to provide machine instructions and/or data to a programmable processor, including a machine-readable medium that receives machine instructions as a machine-readable signal. The term “machine-readable signal” refers to any signal used to provide machine instructions and/or data to a programmable processor.
[0091] To provide for interaction with a user, the systems and techniques described here can be implemented on a computer having a display device (e.g., a CRT (cathode ray tube) or LCD (liquid crystal display) monitor) for displaying information to the user and a keyboard and a pointing device (e.g., a mouse or a trackball) by which the user can provide input to the computer. Other kinds of devices can be used to provide for interaction with a user as well; for example, feedback provided to the user can be any form of sensory feedback (e.g., visual feedback, auditory feedback, or tactile feedback); and input from the user can be received in any form, including acoustic, speech, or tactile input.
[0092] The systems and techniques described here can be implemented in a computing system that includes a back end component (e.g., as a data server), or that includes a middleware component (e.g., an application server), or that includes a front end component (e.g., a client computer having a graphical user interface or a Web browser through which a user can interact with an implementation of the systems and techniques described here), or any combination of such back end, middleware, or front end components. The components of the system can be interconnected by any form or medium of digital data communication (e.g., a communication network). Examples of communication networks include a local area network (“LAN”), a wide area network (“WAN”), and the Internet.
[0093] The computing system can include clients and servers. A client and server are generally remote from each other and typically interact through a communication network. The relationship of client and server arises by virtue of computer programs running on the respective computers and having a client-server relationship to each other.
[0094] A number of implementations have been described. Nevertheless, it will be understood that various modifications may be made without departing from the spirit and scope of the invention.
[0095] In addition, the logic flows depicted in the figures do not require the particular order shown, or sequential order, to achieve desirable results. In addition, other steps may be provided, or steps may be eliminated, from the described flows, and other components may be added to, or removed from, the described systems. Accordingly, other implementations are within the scope of the following claims.
[0096] Elements of different implementations described herein may be combined to form other implementations not specifically set forth above. Elements may be left out of the processes, computer programs, Web pages, etc. described herein without adversely affecting their operation. Furthermore, various separate elements may be combined into one or more individual elements to perform the functions described herein.
[0097] Other implementations not specifically described herein are also within the scope of the following claims.
[0098] What has been described above includes examples of the claimed subject matter. It is, of course, not possible to describe every conceivable combination of components or methodologies for purposes of describing the claimed subject matter, but one of ordinary skill in the art may recognize that many further combinations and permutations of the claimed subject matter are possible. Accordingly, the claimed subject matter is intended to embrace all such alterations, modifications and variations that fall within the spirit and scope of the appended claims. Furthermore, to the extent that the term “includes” is used in either the detailed description or the claims, such term is intended to be inclusive in a manner similar to the term “comprising” as “comprising” is interpreted when employed as a transitional word in a claim.