What is the SAM_E?
This tool facilitates reflective discussion of resident performance and planning for improvement by residents and supervisors using competency-based goals at the mid-rotation point, so that there is time for improvement by the end of the rotation. In practice, only about 10 minutes is needed.

Background:
Resident feedback often occurs too late or is too general (i.e. “Great job!”). The SAM-E tool was developed by a PGYII resident in 2003 after a discussion with fellow residents about how end-of-rotation feedback didn’t always reflect residents’ own experiences. Residents felt they knew when they were comfortable with their own knowledge and when they needed help but also needed an experienced guide to direct them. At the same time, faculty were discussing the core competencies in two departmental grand rounds. These conversations dovetailed with the implementation of this self-evaluation tool, the first of its type in the department. The tool incorporates rotation-specific outcomes for all six competency domains. Goal: Provide meaningful, timely feedback to residents directed toward developing knowledge, skills, and attitudes in all six competency domains while encouraging self-assessment and mentoring.

Directions for using SAM-E:

1. Rotation-specific competencies are listed in the first column.
   
2. SAM-E is distributed at the start of the rotation to both residents and supervisors.
   
3. TIMING IS KEY – resident and supervisor must go through the form together mid-rotation, so the resident has time to make improvements.
   
4. During the review, the resident first says how they think they are doing in a given area, and then the supervisor gives their impression. Resident and supervisor then brainstorm together ways for improvement and record them in the last column.
   
5. Both resident and supervisor keep a copy to monitor progress at the rotation’s end. This progress is then incorporated into the end-of-year final assessment. Ideally, identified short-term goals are incorporated into long-term goals and ongoing career development.
   

Experience:
We began using the form for all residents and in all psychiatry rotations in January 2005. Residents are enthusiastic about the tool and report feeling more involved in their feedback. The majority of attendings say the tool is useful, although some resist incorporating self-assessment. For this reason, we distribute the forms to residents so they may initiate discussion if the supervisor is hesitant.

References

Hutchinson L (2003) ABC of learning and teaching: educational environment. BMJ 326: 810-812.

Kaufman DM (2003) ABC of learning and teaching in medicine: applying educational theory in practice. BMJ 326: 213-216.

Newman P and Peile E (2002) Valuing learners’ experience and supporting further growth: educational models to help experienced adult learners in medicine. BMJ 325: 200-2.