ACGME Psychiatry Milestones

Psychiatry Milestones

The Accreditation Council for Graduate Medical Education

Implementation Date: July 1, 2021 Second Revision: March 2020 First Revision: November 2013

©2020 Accreditation Council for Graduate Medical Education (ACGME) All rights reserved except the copyright owners grant third parties the right to use the Psychiatry Milestones on a non-exclusive basis for educational purposes. Psychiatry Milestones

The Milestones are designed only for use in evaluation of residents in the context of their participation in ACGME-accredited residency or fellowship programs. The Milestones provide a framework for the assessment of the development of the resident in key dimensions of the elements of physician competence in a specialty or subspecialty. They neither represent the entirety of the dimensions of the six domains of physician competence, nor are they designed to be relevant in any other context.

Elie Aoun, MD Laura Edgar, EdD, CAE Jeff Aronowitz, DO Lillian Joy Houston, MD, FAPA Adrienne Bentman, MD Furhut Janssen, DO Lynneice Bowen, MD George Keepers, MD Brittany Campbell Mark Kinzie, MD, PhD Deborah Cowley, MD Matthew Macaluso, DO Sandra DeJong, MD, MSc Patcho Santiago, MD, MPH

The ACGME would like to thank the following organizations for their continued support in the development of the Milestones: American Association of Directors of Psychiatric Residency Training American Board of Psychiatry and Neurology American College of Osteopathic Neurologists and Psychiatrists American Osteopathic Board of Psychiatry and Neurology ACGME Review Committee for Psychiatry

This document presents the Milestones, which programs use in a semi-annual review of resident performance, and then report to the ACGME. Milestones are knowledge, skills, attitudes, and other attributes for each of the ACGME Competencies organized in a developmental framework. The narrative descriptions are targets for resident performance throughout their educational program.

Milestones are arranged into levels. Tracking from Level 1 to Level 5 is synonymous with moving from novice to expert resident in the specialty or subspecialty. For each reporting period, the Clinical Competency Committee will review the completed evaluations to select the milestone levels that best describe each learner’s current performance, abilities, and attributes for each subcompetency.

These levels do not correspond with post-graduate year of education. Depending on previous experience, a junior resident may achieve higher levels early in his/her educational program just as a senior resident may be at a lower level later in his/her educational program. There is no predetermined timing for a resident to attain any particular level. Residents may also regress in achievement of their milestones. This may happen for many reasons, such as over scoring in a previous review, a disjointed experience in a particular procedure, or a significant act by the resident.

Selection of a level implies the resident/fellow substantially demonstrates the milestones in that level, as well as those in lower levels (see the diagram on page vi).

Additional Notes

Level 4 is designed as a graduation goal but does not represent a graduation requirement. Making decisions about readiness for graduation and unsupervised practice is the purview of the program director. Furthermore, Milestones 2.0 include revisions and changes that preclude using Milestones as a sole assessment in high-stakes decisions (i.e., determination of eligibility for certification or credentialing). Level 5 is designed to represent an expert resident whose achievements in a subcompetency are greater than the expectation. Milestones are primarily designed for formative, developmental purposes to support continuous quality improvement for individual learners, education programs, and the specialty. The ACGME and its partners will continue to evaluate and perform research on the Milestones to assess their impact and value.

Examples are provided for some milestones within this document. Please note: the examples are not the required element or outcome; they are provided as a way to share the intent of the element.

Some milestone descriptions include statements about performing independently. These activities must occur in conformity to ACGME supervision guidelines as described in the Program Requirements, as well as to institutional and program policies. For example, a resident who performs a procedure independently must, at a minimum, be supervised through oversight.

A Supplemental Guide is also available to provide the intent of each subcompetency, examples for each level, assessment methods or tools, and other available resources. The Supplemental Guide, like examples contained within the Milestones, is designed only to assist the program director and Clinical Competency Committee, and is not meant to demonstrate any required element or outcome.

Additional resources are available in the Milestones section of the ACGME website. Follow the links under “What We Do” at www.acgme.org.

The diagram below presents an example set of milestones for one sub-competency in the same format as the ACGME Report Worksheet. For each reporting period, a resident’s performance on the milestones for each sub-competency will be indicated by selecting the level of milestones that best describes that resident’s performance in relation to those milestones.

Selecting a response box in the Selecting a response box on the line in middle of a level implies that between levels indicates that milestones milestones in that level and in lower in lower levels have been substantially levels have been substantially demonstrated as well as some demonstrated. milestones in the higher level(s).

Version 2 Psychiatry Milestones, ACGME Report Worksheet

Patient Care 1: Psychiatric Evaluation A: Gathers and organizes findings from the patient interview and mental status examination B: Gathers and organizes data from collateral sources C: Screens for risk and integrates risk assessment into the patient evaluation Level 1 Level 2 Level 3 Level 4 Level 5 Collects general medical Efficiently acquires an Uses hypothesis-driven Elicits and observes and psychiatric history accurate and relevant information gathering to subtle and unusual and completes a mental history and performs a obtain complete, findings status examination targeted examination accurate, and relevant Serves as a role model customized to the history for gathering subtle and patient's presentation accurate findings from the patient and collateral Collects relevant Selects appropriate Interprets collateral Interprets collateral sources information from laboratory and diagnostic information and test information and test collateral sources tests results to determine results to determine necessary additional necessary additional steps steps in the evaluation of complex conditions

Screens for risk of harm Engages in a basic risk Incorporates risk and Incorporates risk and Serves as a role model to self, to others, or by assessment and basic protective factors into protective factors into the for risk assessment others safety planning the assessment of assessment of complex imminent, short, and patient presentations, long-term patient including eliciting safety and the safety information not readily of others offered by the patient

Comments: Not Yet Completed Level 1 Not Yet Assessable

Patient Care 2: Psychiatric Formulation and Differential Diagnosis A: Organizes and summarizes findings and generates differential diagnosis B: Identifies contributing factors and contextual features and creates a formulation C: Uses the emotional responses of clinician and patient as diagnostic information Level 1 Level 2 Level 3 Level 4 Level 5 Organizes and Integrates information Develops a thorough and Develops differential Serves as a role model accurately summarizes from the most relevant prioritized differential diagnoses in complex in the development of information obtained sources to develop a diagnosis while avoiding cases and incorporates accurate and complete from the patient basic differential premature closure for a subtle, unusual, or differential diagnoses evaluation to develop a diagnosis for common range of patient conflicting findings and formulations clinical impression patient presentations presentations

Recognizes that Identifies the biological, Synthesizes all Develops formulations biological, psychosocial, psychosocial, and information into a based on multiple and developmental/life developmental/life cycle concise but conceptual models cycle factors play a role factors that contribute to comprehensive in a patient’s a patient’s presentation formulation, taking into presentation account biological, psychosocial, and developmental/life cycle factors

Recognizes that Recognizes that Begins to use the Integrates clinician’s and clinicians have emotional clinicians’ emotional clinician's emotional patient’s emotional responses to patients responses have responses to the patient responses into the diagnostic value to aid formulation diagnosis and formulation

Comments: Not Yet Completed Level 1 Not Yet Assessable

Patient Care 3: Treatment Planning and Management A: Creates treatment plan B: Monitors and revises treatment when indicated C: Incorporates the use of community resources Level 1 Level 2 Level 3 Level 4 Level 5 Identifies potential Engages the patient in Applies an Devises individualized Supervises treatment biopsychosocial the selection of understanding of treatment plan for planning of other treatment options evidence-based psychiatric, neurologic, complex presentations; learners and biopsychosocial and medical integrates multiple multidisciplinary treatment, recognizing comorbidities in the modalities and providers providers that comorbid conditions management of common in a comprehensive and side effects impact presentations approach treatment

Recognizes that acuity Selects the most Selects the most Selects the most affects level of care and appropriate level of care appropriate appropriate treatment monitoring based on acuity and interventions, interventions, monitors treatment treatments, and treatments, and adherence and response adjustments in treatment adjustments in treatment in common presentations in complex presentations based on consideration based on consideration of patient factors and of patient factors and acuity acuity

Gives examples of Coordinates care with Incorporates support and Locates and connects Participates in the community resources community resources advocacy groups in patients to community creation or treatment planning resources in complex administration of and difficult situations community-based programs

Comments: Not Yet Completed Level 1 Not Yet Assessable

Patient Care 4: Psychotherapy A: Establishes therapeutic alliance and manages boundaries B: Selects, sets goals, and provides psychotherapies including supportive, psychodynamic, and cognitive-behavioral C: Manages therapeutic process Level 1 Level 2 Level 3 Level 4 Level 5 Establishes a working Establishes a bounded Establishes and maintains Establishes and maintains Assesses and can help relationship with patients therapeutic alliance with a therapeutic alliance with therapeutic alliance with repair troubled alliances demonstrating interest patients with patients with patients with complicated and/or boundary and empathy uncomplicated problems uncomplicated problems, problems, and can difficulties between junior and can recognize and anticipate and residents and their avoid boundary violations appropriately manage patients boundary violations

Lists the three core Uses the common factors Provides selected Selects appropriate Tailors psychotherapeutic psychotherapies of psychotherapy in psychotherapies psychotherapeutic treatment based on providing supportive (including supportive, modality based on case awareness of own skill therapy to patients psychodynamic, and formulation, tailors the sets, strengths, and cognitive-behavioral), sets therapy to the patient, and limitations goals and integrates provides psychotherapy therapy with other (at least supportive and treatment modalities one of psychodynamic or cognitive-behavioral) to complex patients

Accurately identifies Identifies and reflects the Identifies and reflects the Identifies and reflects the Links feelings, patient emotions, core feelings and key core feelings, key issues core feelings, key issues, recurrent/central particularly sadness, issues for the patient and what the issues mean and what the issues mean themes/schemas and their anger, and fear during the session to the patient during the to the patient within and meaning to the patient as session, while managing across sessions they shift within and the emotional content and across sessions feelings elicited

Comments: Not Yet Completed Level 1 Not Yet Assessable

Patient Care 5: Somatic Therapies (including Psychopharmacology and Neurostimulation Therapies) A: Understands the mechanisms of action, indications, and evidence base for somatic therapies and appropriately applies them to patient care B: Educates patients about somatic therapies including access to accurate psychoeducational resources C: Appropriately monitors patient’s response to treatment Level 1 Level 2 Level 3 Level 4 Level 5 Lists commonly used Appropriately prescribes Researches, cites, and Consistently applies the Manages complex somatic therapies and commonly used somatic starts to apply the evidence base when combinations of somatic their indications to target therapies and evidence base when developing treatment therapies and considers specific psychiatric understands their developing treatment plans that include novel approaches symptoms mechanism of action plans that include somatic therapies, somatic therapies including with complex or treatment-refractory cases

Reviews with the patient Appropriately uses Explains mechanisms of Explains less common Leads the development general indications and educational and other action and the body’s somatic treatment of novel patient common adverse effects resources to support the response to commonly choices to educational processes or for commonly prescribed patient and optimize prescribed drugs and patients/families in terms materials drugs and other somatic understanding and other somatic treatments of proposed mechanisms treatments adherence (including drug of action, potential risks metabolism) to and benefits, and the patients/families evidence base

Lists key baseline Obtains baseline Monitors relevant Manages adverse effects Incorporates new assessments necessary assessments necessary assessments and and safety concerns in developments in the before initiating somatic before initiating adverse effects complex or treatment evidence base into treatments to ensure treatment with commonly throughout treatment refractory cases treatment to optimize patient safety used somatic therapies and incorporates findings safety, minimize adverse from the literature into effects, and improve treatment strategy response

Comments: Not Yet Completed Level 1 Not Yet Assessable

Patient Care 6: Clinical Consultation

Level 1 Level 2 Level 3 Level 4 Level 5 Respectfully requests a Clearly and concisely Applies consultant Critically appraises and Contributes to identifying consultation requests a consultation recommendations integrates diverse and rectifying flaws of judiciously to patient recommendations consultation system care

Respectfully receives a Clearly and concisely Assists consulting team Manages complicated Leads consultation- consultation request responds to a in identifying and challenging liaison psychiatry teams consultation request unrecognized clinical consultation requests care issues and provides relevant recommendations, checking for understanding

Demonstrates Demonstrates Collaborates skillfully Serves as a leader of understanding of the understanding of models with practitioners from integrated care teams or consultation model, of integrated other disciplines in implementation projects including liaison function multidisciplinary mental medical settings health and primary care

Comments: Not Yet Completed Level 1 Not Yet Assessable

Medical Knowledge 1: Development through the Life Cycle (including the Impact of Psychopathology on the Trajectory of Development and Development on the Expression of Psychopathology) A: Knowledge of human development B: Knowledge of pathological and environmental influences on development Level 1 Level 2 Level 3 Level 4 Level 5 Conceptualizes Describes the basic Explains developmental Articulates an integrated Incorporates new development as stages of typical tasks and transitions understanding of typical knowledge into own occurring in stages biological, sociocultural, throughout the life cycle, development understanding of typical throughout the life cycle sexual, and cognitive using multiple and atypical development throughout conceptual models development the life cycle

Recognizes major Gives examples of Describes the influence Describes how acquiring deviations from typical biological, psychological, of biological, and losing specific development sociocultural, cognitive, psychological, capacities can influence and sexual factors that sociocultural, cognitive, the expression of contribute to a shift and sexual factors on psychopathology towards an atypical atypical personality developmental trajectory development and psychopathology

Comments: Not Yet Completed Level 1 Not Yet Assessable

Medical Knowledge 2: Psychopathology (includes Knowledge of Diagnostic Criteria, Epidemiology, Pathophysiology, Course of Illness, Comorbidities, and Differential Diagnosis of Psychiatric Disorders, including Substance Use Disorders and Presentation of Psychiatric Disorders across the Life Cycle and in Diverse Patient Populations) A: Knowledge to identify and treat psychiatric conditions B: Knowledge at the interface of psychiatry and the rest of medicine Level 1 Level 2 Level 3 Level 4 Level 5 Identifies the major Demonstrates sufficient Demonstrates sufficient Demonstrates sufficient psychiatric diagnostic knowledge to identify knowledge to identify knowledge to identify categories and assess common and treat common and treat atypical and psychiatric conditions psychiatric conditions complex psychiatric throughout the life cycle conditions throughout the life cycle

Gives examples of Demonstrates sufficient Applies knowledge to Applies knowledge to Applies knowledge to interactions between knowledge to identify identify and treat identify and treat a wide identify and manage medical and psychiatric common medical common psychiatric range of psychiatric uncommon conditions at symptoms and disorders conditions in psychiatric symptoms due to other conditions in patients the interface of patients medical illness with comorbid medical psychiatry and medicine disorders and ensures treatment of medical conditions in psychiatric patients

Comments: Not Yet Completed Level 1 Not Yet Assessable

Medical Knowledge 3: Clinical Neuroscience (includes Knowledge of Neurology, Neuropsychiatry, Neurodiagnostic Testing, and Relevant Neuroscience and their Application in Clinical Settings) A: Neurodiagnostic and neuropsychological testing B: Neuropsychiatric comorbidity C: Application of neuroscientific findings in psychiatry

Level 1 Level 2 Level 3 Level 4 Level 5 Lists commonly available Describes indications for Identifies the significance Correlates the Integrates recent neuroimaging, common neuroimaging, of findings in routine significance of neuroimaging, neurophysiologic, and neurophysiologic, and neuroimaging, neuroimaging, neurophysiologic, and neuropsychological tests neuropsychological tests neurophysiologic, and neurophysiological, and neuropsychological tests neuropsychological tests neuropsychological research into testing results to case understanding of formulation and psychopathology treatment planning

Describes basic Describes major Explains how Correlates Engages in scholarly components and neurobiological neurobiological neurobiological activity related to functions of the nervous processes underlying processes are included processes into case neuroscience and system common psychiatric in a case formulation formulation and psychiatric disorders illness treatment planning

Describes basic features Describes with the Identifies common Synthesizes knowledge Integrates recent of common neurologic interplay between comorbidities of between of psychiatric and research into disorders psychiatric and psychiatric and neurologic comorbidities understanding of the neurologic disorders neurologic disorders for case formulation and interface between treatment neurology and psychiatry

Comments: Not Yet Completed Level 1 Not Yet Assessable

Medical Knowledge 4: Psychotherapy A: Fundamentals B: Practice and indications C: Evidence base Level 1 Level 2 Level 3 Level 4 Level 5 Identifies psychotherapy Describes the common Identifies the central Explains the theoretical Incorporates new as an effective modality elements across theoretical principles mechanisms of theoretical developments of treatment psychotherapeutic across the three core therapeutic change in into knowledge base modalities psychotherapeutic each of the three core modalities: supportive, modalities psychodynamic, cognitive-behavioral

Describes the basic Lists the basic Identifies the techniques Compares the selection Demonstrates sufficient framework of a indications and benefits of the three core criteria and potential evidence-based psychotherapeutic of using psychotherapy individual risks, and benefits of the knowledge of core experience psychotherapies three core individual individual therapies to psychotherapies teach others

Lists the three core Describes the evidence Summarizes the Analyzes the evidence psychotherapy for one core evidence base for the base for combining modalities psychotherapy modality three core individual psychotherapy and psychotherapies pharmacotherapy

Comments: Not Yet Completed Level 1 Not Yet Assessable

Systems-Based Practice 1: Patient Safety and Quality Improvement A: Analyzes patient safety events B: Appropriately discloses patient safety events C: Participates in quality improvement Level 1 Level 2 Level 3 Level 4 Level 5 Demonstrates Identifies system factors Participates in analysis Conducts analysis of Actively engages teams knowledge of common that lead to patient safety of patient safety events patient safety events and and processes to patient safety events events (simulated or actual) offers error prevention improve systems to strategies (simulated or prevent patient safety actual) events

Demonstrates Reports patient safety Participates in disclosure Discloses patient safety Role models or mentors knowledge of how to events through of patient safety events events to patients and others in the disclosure report patient safety institutional reporting to patients and families families (simulated or of patient safety events events systems (simulated or (simulated or actual) actual) actual)

Demonstrates Describes local quality Participates in local Demonstrates the skills Creates, implements, knowledge of basic improvement initiatives quality improvement required to identify, and assesses quality quality improvement (e.g., reduced restraint initiatives develop, implement, and improvement initiatives methodologies and rates, falls risk, suicide analyze a quality at the institutional or metrics rates) improvement project community level

Comments: Not Yet Completed Level 1

Systems-Based Practice 2: System Navigation for Patient-Centered Care A: Coordinates patient care B: Safely transitions care C: Population and community health needs Level 1 Level 2 Level 3 Level 4 Level 5 Demonstrates Coordinates care of Coordinates care of Role models effective Analyzes the process of knowledge of care patients in routine clinical patients in complex coordination of patient- care coordination and coordination situations effectively clinical situations centered care among leads in the design and using the roles of the effectively using the different disciplines and implementation of interprofessional teams roles of their specialties improvements interprofessional teams

Identifies key elements Performs safe and Performs safe and Role models and serves Improves quality of for safe and effective effective transitions of effective transitions of as a patient advocate for transitions of care within transitions of care and care/hand-offs in routine care/hand-offs in safe and effective and across health care hand-offs clinical situations complex clinical transitions of care/hand- delivery systems to situations offs within and across optimize patient health care delivery outcomes systems including outpatient settings

Demonstrates Identifies specific Uses local resources Participates in changing Leads innovations and knowledge of population population and effectively to meet the and adapting practice to advocates for and community health community health needs needs of a patient provide for the needs of populations and needs and disparities and inequities for their population and specific populations communities with health local population community care inequities

Comments: Not Yet Completed Level 1

Systems-Based Practice 3: Physician Role in Health Care Systems A: Understanding and working within the health care system B: Health care financing and advocacy C: Transition to practice Level 1 Level 2 Level 3 Level 4 Level 5 Identifies key Describes how Discusses how individual Manages various Advocates for or leads components of the components of a practice affects the components of the systems change that complex health care complex health care broader system complex health care enhances high-value, system system are interrelated, system to provide high- efficient, and effective and how this impacts value, efficient, and patient care and patient care effective patient care and transition of care transition of care

Describes practice Identifies barriers to care Engages with patients in Advocates for patient Participates in advocacy models and basic mental in different health care shared decision making care needs including activities for access to health payment systems systems and advocates for mobilizing community care in mental health appropriate care and resources and reimbursement parity

Identifies basic Demonstrates use of Describes core Analyzes individual Educates others to knowledge domains for information technology administrative practice patterns and prepare them for effective transition to and documentation knowledge needed for professional transition to practice residency required for medical transition to practice requirements in practice preparation for practice

Comments: Not Yet Completed Level 1

Practice-Based Learning and Improvement 1: Evidence-Based and Informed Practice

Level 1 Level 2 Level 3 Level 4 Level 5 Demonstrates how to Articulates clinical Locates and applies the Critically appraises and Coaches others to access and summarize questions and initiates best available evidence applies evidence even in critically appraise and available evidence for literature searches to to the care of patients the face of uncertainty apply evidence for routine conditions provide evidence-based applying a hierarchy of and conflicting evidence complex patients; and/or care evidence to guide care, tailored to participates in the the individual patient development of guidelines

Comments: Not Yet Completed Level 1

Practice-Based Learning and Improvement 2: Reflective Practice and Commitment to Personal Growth

Level 1 Level 2 Level 3 Level 4 Level 5 Accepts responsibility for Demonstrates openness Seeks performance data Intentionally seeks Role models consistently personal and to performance data episodically, with performance data seeking performance professional (feedback and other openness and humility consistently with data with openness and development by input) in order to inform openness and humility humility establishing goals goals

Identifies the factors Analyzes and reflects on Analyzes, reflects on, Challenges one’s own Coaches others on which contribute to the factors which and institutes behavioral assumptions and reflective practice gap(s) between one’s contribute to gap(s) change(s) to narrow the considers alternatives in expected and actual between one’s expected gap(s) between one’s narrowing the gap(s) performance and actual performance expected and actual between their expected performance and actual performance

Actively seeks Designs and implements Independently creates Uses performance data Facilitates the design opportunities to improve a learning plan, with and implements a to measure the and implementation of prompting learning plan effectiveness of the learning plans for others learning plan and when necessary, improves it

Comments: Not Yet Completed Level 1

Professionalism 1: Professional Behavior and Ethical Principles

Level 1 Level 2 Level 3 Level 4 Level 5 Identifies and describes Demonstrates Demonstrates Recognizes situations Role models core professional professional behavior in professional behavior in that may trigger professional behavior behavior routine situations complex or stressful professionalism lapses and ethical principles situations and intervenes to prevent lapses in self and others

Recognizes that one’s Takes responsibility for Describes when and how Responds appropriately Identifies and seeks to behavior in professional own professionalism to appropriately report to professionalism address system-level settings affects others lapses and responds professionalism lapses in lapses of colleagues factors that induce or appropriately others, including exacerbate ethical strategies for addressing problems or impede their common barriers to resolution reporting

Demonstrates Analyzes straightforward Analyzes complex Recognizes and uses knowledge of core situations using ethical situations using ethical appropriate resources for ethical principles principles principles and managing and resolving recognizes when help is ethical dilemmas as needed needed. (e.g., ethics consultations, literature review, risk management/legal consultation)

Comments: Not Yet Completed Level 1

Professionalism 2: Accountability/Conscientiousness

Level 1 Level 2 Level 3 Level 4 Level 5 Takes responsibility to Performs tasks and Performs tasks and Recognizes when others Takes ownership of complete tasks and responsibilities in a responsibilities in a are unable to complete system outcomes responsibilities, identifies timely manner with timely manner with tasks and responsibilities potential contributing appropriate attention to appropriate attention to in a timely manner and factors for lapses, and detail in routine detail in complex or assists in problem describes strategies for situations stressful situations solving ensuring timely task completion in the future

Introduces self as Accepts the role of the Is recognized by self, Displays increasing Serves as a role model patient’s resident patient’s physician and patient, patient’s family, autonomy and in demonstrating physician takes responsibility and medical staff leadership in taking responsibility for (under supervision) for members as the patient’s responsibility for ensuring that patients ensuring that the patient primary psychiatric ensuring the patients receive the best possible receives the best provider receive the best possible care possible care care

Comments: Not Yet Completed Level 1

Professionalism 3: Well-Being

Level 1 Level 2 Level 3 Level 4 Level 5 Recognizes the Lists available resources With assistance, Independently develops Creates institutional level importance of for personal and proposes a plan to a plan to promote interventions that addressing personal and professional well-being promote personal and personal and promote colleagues’ professional well-being professional well-being professional well-being well-being Describes institutional resources designed to Recognizes which Describes institutional Describes institutional promote well-being institutional factors affect factors that positively programs designed to well-being and/or negatively affect examine systemic well-being contributors to burnout

Comments: Not Yet Completed Level 1

This subcompetency is not intended to evaluate a resident’s well-being. Rather, the intent is to ensure that each resident has the fundamental knowledge of factors that affect well-being, the mechanisms by which those factors affect well-being, and available resources and tools to improve well-being.

Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication

Level 1 Level 2 Level 3 Level 4 Level 5 Uses language and Establishes a therapeutic Establishes a therapeutic Effectively establishes Mentors others in nonverbal relationship in relationship in and sustains therapeutic situational awareness communication to straightforward challenging patient relationships, with and critical self-reflection demonstrate empathic encounters using active encounters; uses attention to patient/family to consistently develop curiosity, respect, and to listening and clear nonverbal concerns and context, positive therapeutic establish rapport language communication skills regardless of complexity relationships effectively

Identifies common Identifies complex When prompted, reflects Independently Role models self- barriers to effective barriers to effective on personal biases that recognizes personal awareness practice while communication; communication may contribute to biases and attempts to identifying and teaching accurately communication barriers proactively minimize a contextual approach to communicates own role their contribution to minimize communication within the health care communication barriers barriers system

Recognizes Organizes and initiates With guidance, Independently, uses Role models shared communication communication with sensitively and shared decision making decision making in strategies may need to patient/family by compassionately delivers to align patient/family patient/family be adjusted based on introducing stakeholders, medical information, values, goals, and communication including clinical context setting the agenda, elicits patient/family preferences with those with a high degree clarifying expectations, values, goals and treatment options to of uncertainty/conflict and verifying preferences; make a personalized understanding of the acknowledges care plan clinical situation uncertainty and conflict

Comments: Not Yet Completed Level 1

Interpersonal and Communication Skills 2: Interprofessional and Team Communication

Level 1 Level 2 Level 3 Level 4 Level 5 Uses language that Communicates Uses active listening to Coordinates Role models flexible values all members of information effectively adapt communication recommendations from communication the health care team with all health care team style to fit team needs different members of the strategies that value members health care team to input from all health care optimize patient care team members, resolving conflict when needed

Recognizes the need for Solicits feedback on Communicates concerns Respectfully Facilitates regular health ongoing feedback with performance as a and provides feedback to communicates feedback care team-based the health care team member of the health peers and learners and constructive criticism feedback in complex care team to superiors situations

Comments: Not Yet Completed Level 1

Interpersonal and Communication Skills 3: Communication within Health Care Systems

Level 1 Level 2 Level 3 Level 4 Level 5 Accurately records Demonstrates organized Concisely reports Communicates clearly Contributes to information in the patient diagnostic and diagnostic and and concisely, in an departmental or record therapeutic reasoning therapeutic reasoning in organized written form, organizational initiatives through notes in the the patient record including anticipatory to improve patient record guidance communication systems

Safeguards patient Uses documentation Appropriately selects Achieves written or personal health shortcuts accurately and forms of communication verbal communication information appropriately to enhance based on context that serves as an efficiency of example for others to communication follow

Communicates about Respectfully Uses appropriate Initiates difficult Facilitates dialogue administrative issues communicates concerns channels to offer clear conversations with regarding systems through appropriate about the system and constructive appropriate stakeholders issues among larger channels, as required by suggestions to improve to improve the system community stakeholders institutional policy the system

Comments: Not Yet Completed Level 1