Today is Tuesday, Oct. 23, 2018

Department of

Department of Internal Medicine

Residency Programs

Evaluations & Procedure Training

Success has to do with deliberate practice.  Practice must be focused, determined, and in an environment where there is feedback.”  -Malcolm Gladwell

Practice doesn’t make perfect, practice makes permanent.  That is why deliberate practice is so important.  Having robust assessment systems that are focused on learner improvement are key to becoming great at anything.  This is the over-arching philosophy of our assessment and procedure training systems.

Resident Assessment

At UC you will benefit from one of the most robust GME assessment and feedback systems in the world.1-5 Learners are assessed and receive feedback on discrete skills called Observable Practice Activities (OPAs) which are connected to the ACGME milestones. These OPAs are used in both adult and pediatric inpatient rotations, as well as in our Med-Peds clinic. Residents receive assessments from multiple sources - attendings, peers, nurses, other allied health professionals, and learners. Our focus is on using assessment data for formative purposes (assessment FOR learning) rather than only using it for summative purposes (assessment OF learning). Med-Peds education faculty members meet in our clinical competency committee to review and synthesize the data, and identify ways all learners can improve. Our residents meet with program leadership to review their data, set goals, and develop personalized improvement plans to become the best physician possible.

Procedure Training

Procedure MP photo

It has become clear that "see one, do one, teach one" is a flawed approach to procedure training that is not optimal for patients or trainees.6,7 Therefore, we have begun developing systems of procedure training based on sound procedural and assessment principles.8 There are simulation labs at both the College of Medicine, VA Medical Center, and Cincinnati Children’s Hospital Medical Center where the residents are provided with many opportunities to learn. Residents have opportunities to perform procedures on numerous inpatient rotations (general wards, CVICU, MICU, PICU, NICU, ED) as well as in Med-Peds clinic. Focused procedural experiences include procedure shifts in the Pediatric ED and during ambulatory months. We also have a newly-developed joint-injection simulation curriculum designed specifically for Med-Peds residents. Our program ensures our residents meet the ACGME procedure requirements, while striving to be flexible and meet each resident’s individual procedural training needs.


  1. Warm EJ. Observable Practice Activity Assessment System  https://www.youtube.com/watch?v=t5JVRZrXBbU&spfreload=102014.
  2. Warm EJ, Mathis BR, Held JD, et al. Entrustment and mapping of observable practice activities for resident assessment. Journal of general internal medicine. 2014;29(8):1177-1182.
  3. Warm EJ, Held J, Hellman M, et al. Entrusting Observable Practice Activities and Milestones Over the 36 Months of an Internal Medicine Residency. Academic Medicine. 2016;91(10):1398-1405.
  4. Kinnear B, Bensman R, Held J, O'Toole J, Schauer D, Warm E. Critical Deficiency Ratings in Milestone Assessment: A Review and Case Study. Academic medicine : journal of the Association of American Medical Colleges. 2017;92(6):820-826.
  5. Warm EJ, Kelleher M, Kinnear B, Sall D. Feedback on Feedback as a Faculty Development Tool. Journal of graduate medical education. 2018;In press.
  6. Sawyer T, White M, Zaveri P, et al. Learn, see, practice, prove, do, maintain: an evidence-based pedagogical framework for procedural skill training in medicine. Academic medicine : journal of the Association of American Medical Colleges. 2015;90(8):1025-1033.
  7. Wigger G, Kelleher M, Kinnear B, O'Toole J, Warm EJ, Sall D. Paracentesis Simulation: A Comprehensive Approach to Procedural Education. Accepted for publication and in press for MedEdPORTAL, July 2018.
  8. Sall D, Kelleher M, Kinnear B, Warm EJ, O'Toole J. A Single Method of Assessment is Not Enough: Development, Pilot Testing and Validity Evidence for a Novel Paracentesis Competency Assessment Tool. Under revision.

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More Information

For more information on the Medicine-Pediatrics Residency Program, please contact us at:

Medicine-Pediatrics Residency Program
UC Department of Internal Medicine
231 Albert Sabin Way
Mail Location 0535
Cincinnati, OH 45267-0535

Phone: 513-584-0397
Fax: 513-584-0369
Email: ucintmed@uc.edu

Program Director:
Jennifer K. O’Toole, MD, MEd
Associate Professor of Internal Medicine and Pediatrics