Using PIMs in Residency & Fellowship Programs
Residency and fellowship programs have the opportunity to address proficiency with two ACGME competencies – systems-based practice and practice-based learning and improvement – by using the ABIM PIMsm Practice Improvement Module (PIM). These interactive educational tools allow faculty members, residents and fellows to analyze and evaluate practice performance to improve the quality of their patient care. Completion of a PIM familiarizes residents and fellows with key process and outcome measures used in disease treatment and prevention, in addition to best practices in communication and clinical systems.
Faculty and trainees who use PIMs can expect to experience improvement on two levels:
- Individual improvement through reflective practice
- Systems improvement as an active group participant
- PIMs for Residency and Fellowship Training
- PIMs for Faculty Only
- How Faculty and Fellows Earn Maintenance of Certification Credit Through PIM Completion
- How the Program Works
- How to Place a PIM Order and Associated Fees
- Supervising Physician's Role
- Institutional Review Board (IRB) Review not necessary
PIMs for Residency and Fellowship Training
A variety of PIMs are available for residency and fellowship training. These PIMs address self-assessment proficiency in a variety of quality improvement categories, including chronic conditions, skills unique to specific care environments; e.g. hospitals, and communication to patients and/or peers.
Residency programs can choose any PIM to work on with the exception of the Communication with Referring Physicians PIM, the Self-Directed PIM and the Essential of Quality Improvements module. To learn more information about individual PIMs, view PIM demonstrations or review PIM options.
TopPIMs for Faculty Only
While Program Directors, Supervising Physicians, and Attending Physicians enrolled in the ABIM MOC Program can use any ABIM PIM to maintain their ABIM certification, there is one ABIM PIM especially for them. The Clinical Supervision PIM is a reflective PIM that helps faculty gain the skills necessary for observing and evaluating trainees. It allows faculty to print out trainee evaluations and form an improvement plan.
TopHow Faculty and Fellows Earn Maintenance of Certification Credit Through PIM Completion
Faculty and fellows who complete a PIM and who are enrolled in ABIM's Maintenance of Certification program at the time the PIM is ordered, may receive up to 40 points toward the self-evaluation of practice performance requirement as well as 20 AMA PRA Category 1 Credits™. When the PIM is ordered, the faculty member's ABIM candidate number must be provided and the "Issue MOC Credit" button must be checked in order for the credit to be issued.
To receive credit, the supervisor should be actively involved in the PIM project with the residents. At a minimum, the supervisor should help in implementing the PIM with the residents, review PIM data from the Patient Surveys and Chart Reviews, help the residents complete the Examine Systems survey, and actively participate in planning and implementing the Improvement Plan.
The number of Maintenance of Certification self-evaluation of practice performance points awarded depends on the PIM selected. Choose any PIM in the Available PIM list and the information on the number of Maintenance of Certification and AMA PRA Category 1 Credits™ is shown.
TopHow the Program Works
Improvement Group Organization
Participants in the program work as an improvement group. Because each residency program is unique, it is difficult to provide any “rules” for organizing improvement groups. However, we suggest you consider the following when organizing your improvement group:
- The improvement group should share patients, a clinical setting and support staff. This is particularly important when completing the Examine Systems portion of the PIM, so that the survey results are for a common practice system.
- Organize improvement groups around a single preceptor or a dedicated group of preceptors who can act as the leader(s) on the PIM.
- Organize improvement groups around block rotations.
- PIM registration is limited to faculty and residents, but ABIM encourages involving all members of the clinical staff in the process. A kick-off meeting, including the physician, nursing and medical assistance staff, could help educate all parties on the goal of the PIM and create a sense of ownership and responsibility. This can be especially useful in making sure that Patient Surveys are handed out and completed, and for gathering data for the Exam Systems Survey.
Data Collection
Working as an improvement group, participants use the PIM to collect practice data to calculate performance measures. These performance measures will be used to conduct several rapid cycle tests to improve performance. Data collection involves two or three of the following activities, depending on the selected PIM*:
- Survey: ABIM recommends receiving a number of completed surveys equal to five times the number of participants. If this number is not feasible, ABIM will accept a minimum of 25 survey responses from the improvement group. If the group has four participants or fewer, a minimum of 25 completed surveys must be received by ABIM. Patients who complete the survey do not have to be the same patients for whom chart reviews are performed.
Experience has shown that patients are more likely to submit a survey response if they can anonymously submit the response by telephone or complete the survey on paper at the clinic. Staff can enter the paper surveys themselves at www.abim.org/survey or by calling the number on the first page of the survey.
- Patient medical record audit or performance data entry form: To complete a PIM, ABIM will need to receive a number of chart reviews equal to five times the number of participants. If the improvement group has four participants or fewer, a minimum of 25 charts must be reviewed. Tips for selecting a sample of charts to review can be found inside each PIM by selecting the module requirements and instructions link at the top of the Main Menu. All patient data are completely anonymous, confidential and HIPAA-compliant.
- Systems examination: The group is required to complete one Examine Systems Survey in this section and respond to questions about how the practice is currently structured and how care is delivered to patients. Ideally, all clinical staff should meet to discuss the questions raised in the survey. At a minimum, as many participants as possible participating in the group should meet to discuss the survey. Having nursing and administrative staff present will add value to this section of the PIM.
While there is no stated deadline, the data collection portion of the PIM should be completed within 90 to 120 days of placing the PIM order.
* The Hepatitis C, HIV and Colonoscopy modules do not include a patient survey. The Hospital-Based Patient Care module uses data collected by hospitals for CMS/JCAHO, and does not include a medical record audit or a patient survey.
Improvement Plan Design and Implementation
After data are submitted to ABIM, an aggregate report is provided to the group as a guide in developing and implementing its own plan for improving one or more aspects of the practice. The Improvement Plan portion of the PIM consists of the following steps:
- Request Report: When data collection is complete, request a summary report from the PIM Main Menu. The report will be available within 48 hours of your request.
- Develop Improvement Plan: Review the summary report and develop a quality Improvement Plan. ABIM needs to receive one Improvement Plan from each group. (Note: Residency Programs running multiple PIMs for multiple improvement groups can develop a unified plan. This Improvement Plan, however, must be submitted in each PIM.)
- Pilot Improvement Plan and Report Results: ABIM must receive one report results impact statement from each group. Pilot test your Improvement Plan and report the results of one of the changes you made in your practice. Implementing a change in your practice and measuring the selected outcome may take from six months to one year.
- Submit Completed Module: Submit your completed module to ABIM. (Program directors, faculty and fellows who participated in the PIM and were enrolled in ABIM Maintenance of Certification when the PIM was ordered will receive credit toward Maintenance of Certification and 20 AMA PRA Category 1 Credits™.
While there is no stated deadline, the Improvement Plan should be developed and submitted to ABIM within 30 to 60 days of downloading the summary report. The residency program has up to two years to pilot the improvement plan, measure the intervention impact, and report the results. We encourage residency programs to complete the impact statement and report their results at the time they assess the results of their intervention.
TopHow to Place a PIM Order and Associated Fees
To order a PIM for use in Residency or Fellowship Training, login to Order and Administor PIMs for Residents and Fellows as a Program Director or Administrator. The ordering process is driven by your institution's FasTrack number, account name, and password. Check with your Program Director or Program Coordinator for more information on FasTrack.
The cost of the PIM is $100 per module plus $25 per participant and can be paid by check or credit card. Supervising attending physicians and those enrolled in Maintenance of Certification can participate at no charge.
Participants cannot be added to the PIM once the order is placed. All PIMs in Residency orders are final. Cancelled modules or deleted participants are not refunded. Please be sure about your choices and list of participants before placing your order. Please call 1-800-441-2246 x4125 if you have any questions about using ABIM's PIM products with your trainees.
TopSupervising Physician's Role
Supervising Physician's Role
Supervisors in the PIM should be actively involved in the PIM project with the residents. At a minimum, the supervisor should help in implementing the PIM with the residents, review PIM data from the Surveys and Chart Reviews, help the residents complete the Examine Systems Survey, and actively participate in planning and implementing the Improvement Plan. During the ordering process, physicians taking a supervisory role in the PIM should have the "Attending" box next to their name checked.
Supervising physicians can participate (i.e., review their own charts)
During the ordering process, physicians who are supervising the PIM and want to enter their own charts need to make sure the "Attending" button next to their name is not checked.
TopInstitutional Review Board (IRB) Review not necessary
Because the PIM is primarily a Quality Improvement Tool rather than a Research tool, no IRB review is necessary. In order to comply with HIPPA, participants are asked to enter a "generic" patient identifier when entering patient chart data (e.g. P1 for the first patient chart).
