title: Resident self-assessment and self-reflection: University of Wisconsin-Madison's Five-Year Study.
abstract: BACKGROUND
  Chart review represents a critical cornerstone for practice-based learning and improvement in our internal medicine residency program.
  
  
  OBJECTIVE
  To document residents' performance monitoring and improvement skills in their continuity clinics, their satisfaction with practice-based learning and improvement, and their ability to self-reflect on their performance.
  
  
  METHODS
  Retrospective longitudinal design with repeated measures.
  
  
  METHODS
  Eighty Internal Medicine residents abstracted data for 3 consecutive years from the medical records of their 4,390 patients in the University of Wisconsin-Madison (UW) Hospital and Clinics and William S. Middleton Veterans Administration (VA) outpatient clinics.
  
  
  METHODS
  Logistic modeling was used to determine the effect of postgraduate year, resident sex, graduation cohort, and clinic setting on residents' "compliance rate" on 17 nationally recognized health screening and chronic disease management parameters from 2003 to 2007.
  
  
  RESULTS
  Residents' adherence to national preventive and chronic disease standards increased significantly from intern to subsequent years for administering immunizations, screening for diabetes, cholesterol, cancer, and behavioral risks, and for management of diabetes. Of the residents, 92% found the chart review exercise beneficial, with 63% reporting gains in understanding about their medical practices, 26% reflecting on specific gaps in their practices, and 8% taking critical action to improve their patient outcomes.
  
  
  CONCLUSIONS
  This paper provides support for the feasibility and practicality of this limited-cost method of chart review. It also directs our residency program's attention in the continuity clinic to a key area important to internal medicine training programs by highlighting the potential benefit of enhancing residents' self-reflection skills.
authors.affiliation: William S. Middleton Veterans Administration Hospital, Madison, WI, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Hildebrand
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Trowbridge
authors.forename: Mary A
authors.initials: MA
authors.lastname: Roach
authors.forename: Anne Gravel
authors.initials: AG
authors.lastname: Sullivan
authors.forename: Aimee Teo
authors.initials: AT
authors.lastname: Broman
authors.forename: Bennett
authors.initials: B
authors.lastname: Vogelman
mesh_terms: D002983:Clinical Competence; D005240:Feasibility Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency; D008297:Male; D008485:Medical Audit; D010044:Outpatient Clinics, Hospital; D018794:Problem-Based Learning; D012189:Retrospective Studies; D012577:Schools, Medical; D012647:Self-Assessment; D014922:Wisconsin