• Karen E Hauer, Benjamin Chesluk, William Iobst, Eric Holmboe, Robert B Baron, Christy K Boscardin, CateOlle TenOT, and Patricia S O'Sullivan.
• K.E. Hauer is professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. B. Chesluk is clinical research associate, Evaluation, Research, and Development, American Board of Internal Medicine, Philadelphia, Pennsylvania. W. Iobst is vice president for academic and clinical affairs and vice dean, Commonwealth Medical College, Scranton, Pennsylvania. E. Holmboe is senior vice president, Accreditation Council for Graduate Medical Education, Chicago, Illinois, and adjunct professor of medicine, Yale School of Medicine, New Haven, Connecticut. R.B. Baron is professor of medicine and associate dean for graduate and continuing medical education, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. C.K. Boscardin is associate professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. O. ten Cate is professor of medical education and director, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands. P.S. O'Sullivan is professor of medicine and director of research and development in medical education, Office of Medical Education, University of California, San Francisco, School of Medicine, San Francisco, California.
• Acad Med. 2015 Aug 1; 90 (8): 1084-92.

PurposeClinical competency committees (CCCs) are now required in graduate medical education. This study examined how residency programs understand and operationalize this mandate for resident performance review.MethodIn 2013, the investigators conducted semistructured interviews with 34 residency program directors at five public institutions in California, asking about each institution's CCCs and resident performance review processes. They used conventional content analysis to identify major themes from the verbatim interview transcripts.ResultsThe purpose of resident performance review at all institutions was oriented toward one of two paradigms: a problem identification model, which predominated; or a developmental model. The problem identification model, which focused on identifying and addressing performance concerns, used performance data such as red-flag alerts and informal information shared with program directors to identify struggling residents.In the developmental model, the timely acquisition and synthesis of data to inform each resident's developmental trajectory was challenging. Participants highly valued CCC members' expertise as educators to corroborate the identification of struggling residents and to enhance credibility of the committee's outcomes. Training in applying the milestones to the CCC's work was minimal.Participants were highly committed to performance review and perceived the current process as adequate for struggling residents but potentially not for others.ConclusionsInstitutions orient resident performance review toward problem identification; a developmental approach is uncommon. Clarifying the purpose of resident performance review and employing efficient information systems that synthesize performance data and engage residents and faculty in purposeful feedback discussions could enable the meaningful implementation of milestones-based assessment.

18 keywords...

hide…