Clinical Performance Of Residents Research Articles

Utility of clinical‐focused multiple mini interviews during postgraduate year one pharmacy residency interviews

AbstractIntroductionDetermining a candidate's clinical skills from an interview can be challenging with traditional interviewing techniques. Identifying techniques to objectively, reliably, and efficiently screen candidates is critical given the increasing number of postgraduate year one (PGY1) pharmacy residency applicants. Multiple mini interviews (MMIs) are one technique shown to correlate with clinical performance in the medical field; however, limited data exists for evaluating pharmacy residency candidates.ObjectivesTo determine if incorporating a clinical‐focused MMI would distinguish candidates who demonstrate stronger clinical skills during their PGY1 residency.MethodsThis retrospective review compared the clinical MMI and traditional interview scores of all interviewed candidates from January 2015 to March 2017 and clinical performance of residents who matched at our institution. For candidates who matched at our institution, a clinical performance ranking (CPR) of each resident was determined by the PGY1 Residency Program Director based on a subjective rank of overall clinical skills. All candidates who matched at our institution had clinical MMI and traditional interview scores compared with the CPR using Pearson's correlation coefficients. Clinical MMI and traditional interview scores were also compared with the final rank list quartiles for all candidates with a one‐way ANOVA and Wilcoxon rank sum test, respectively.ResultsFor candidates matching at our institutions, clinical MMI scores strongly correlated with their CPR during the residency year (R2 = 0.7149), while traditional interview scores were very weak (R2 = 0.0818). Both clinical MMI and traditional interview scores of all candidates differed significantly between each quartile on the final rank list (P < .05 for all comparisons).ConclusionFor residency candidates that matched at our institution, clinical MMI interview performance strongly correlated with CPR while traditional interview scores did not. Data from multiple centers is needed to better assess if clinical MMI scores can reliably predict a residency candidate's future clinical performance.

Using conversation analysis to explore feedback on resident performance

Feedback on clinical performance of residents is seen as a fundamental element in postgraduate medical education. Although literature on feedback in medical education is abundant, many supervisors struggle with providing this feedback and residents experience feedback as insufficiently constructive. With a detailed analysis of real-world feedback conversations, this study aims to contribute to the current literature by deepening the understanding of how feedback on residents’ performance is provided, and to formulate recommendations for improvement of feedback practice. Eight evaluation meetings between program directors and residents were recorded in 2015–2016. These meetings were analyzed using conversation analysis. This is an ethno-methodological approach that uses a data-driven, iterative procedure to uncover interactional patterns that structure naturally occurring, spoken interaction. Feedback in our data took two forms: feedback as a unidirectional activity and feedback as a dialogic activity. The unidirectional feedback activities prevailed over the dialogic activities. The two different formats elicit different types of resident responses and have different implications for the progress of the interaction. Both feedback formats concerned positive as well as negative feedback and both were often mitigated by the participants. Unidirectional feedback and mitigating or downplaying feedback is at odds with the aim of feedback in medical education. Dialogic feedback avoids the pitfall of a program director-dominated conversation and gives residents the opportunity to take ownership of their strengths and weaknesses, which increases chances to change resident behavior. On the basis of linguistic analysis of our real-life data we suggest implications for feedback conversations.

Development and Implementation of a Novel HIV Primary Care Track for Internal Medicine Residents.

Declining mortality has led to a rising number of persons living with HIV (PLWH) and concerns about a future shortage of HIV practitioners. To develop an HIV Primary Care Track for internal medicine residents. Academic hospital and community health center with a history of caring for PLWH and lesbian, gay, bisexual, and transgender (LGBT) patients. Internal medicine residents. We enrolled four residents annually in a 3-year track with the goal of having each provide continuity care to at least 20 PLWH. The curriculum included small group learning sessions, outpatient electives, a global health opportunity, and the development of a scholarly project. All residents successfully accrued 20 or more PLWH as continuity patients. Senior residents passed the American Academy of HIV Medicine certification exam, and 75% of graduates took positions in primary care involving PLWH. Clinical performance of residents in HIV care quality measures was comparable to those reported in published cohorts. We developed and implemented a novel track to train medical residents in the care of PLWH and LGBT patients. Our results suggest that a designated residency track can serve as a model for training the next generation of HIV practitioners.

Sustained effect of simulation-based ultrasound training on clinical performance: a randomized trial.

ObjectiveTo study the effect of initial simulation-based transvaginal sonography (TVS) training compared with clinical training only, on the clinical performance of residents in obstetrics and gynecology (Ob-Gyn), assessed 2 months into their residency.MethodsIn a randomized study, new Ob-Gyn residents (n = 33) with no prior ultrasound experience were recruited from three teaching hospitals. Participants were allocated to either simulation-based training followed by clinical training (intervention group; n = 18) or clinical training only (control group; n = 15). The simulation-based training was performed using a virtual-reality TVS simulator until an expert performance level was attained, and was followed by training on a pelvic mannequin. After 2 months of clinical training, one TVS examination was recorded for assessment of each resident's clinical performance (n = 26). Two ultrasound experts blinded to group allocation rated the scans using the Objective Structured Assessment of Ultrasound Skills (OSAUS) scale.ResultsDuring the 2 months of clinical training, participants in the intervention and control groups completed an average ± SD of 58 ± 41 and 63 ± 47 scans, respectively (P = 0.67). In the subsequent clinical performance test, the intervention group achieved higher OSAUS scores than did the control group (mean score, 59.1% vs 37.6%, respectively; P < 0.001). A greater proportion of the intervention group passed a pre-established pass/fail level than did controls (85.7% vs 8.3%, respectively; P < 0.001).ConclusionSimulation-based ultrasound training leads to substantial improvement in clinical performance that is sustained after 2 months of clinical training. © 2015 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Filling in the gaps of clerkship with a comprehensive clinical skills curriculum

Although the clinical clerkship model is based upon sound pedagogy, including theories of social learning and situated learning, studies evaluating clinical performance of residents suggests that this model may not fully meet the learning needs of students. Here our objective was to design a curriculum to bridge the learning gaps of the existing clerkship model and then evaluate the impact of this on performance on clerkship summative evaluations. We followed Kern's framework to design our curriculum and then compared performance on the clerkship objective structured clinical examination (OSCE), all summative clerkship multiple choice question (MCQ) examinations, and the Medical Council of Canada Qualifying Examination (MCCQE) Part 1 before and after the introduction of our curriculum. In the 2 years following the introduction of our clinical skills curriculum the mean score on the clerkship OSCE was significantly higher than in the 2 years prior to our curriculum [67.12 (5.3) vs. 62.44 (4.93), p < 0.001, d = 0.91]. With the exception of the surgical clerkship MCQ, performance on all clerkship summative MCQ examinations and MCCQE Part 1 was significantly higher following the introduction of our curriculum. In this study we found a significant improvement in the performance on clerks on summative evaluations of knowledge and clinical skills following the introduction of our clinical skills curriculum. Given the unpredictable nature of clinical rotations, the clerkship will always be a risk of failing to deliver the intended curriculum-so medical schools should continue to explore and evaluate ways of changing the delivery of clerkship training to improve learning outcomes.

Aging Q3

A growing number of older adults coupled with a limited number of physicians trained in geriatrics presents a major challenge to ensuring quality medical care for this population. Innovations to incorporate geriatrics education into internal medicine residency programs are needed. To meet this need, in 2009, faculty at the Medical University of South Carolina developed Aging Q(3)-Quality Education, Quality Care, and Quality of Life. This multicomponent initiative recognizes the need for improved geriatrics educational tools and faculty development as well as systems changes to improve the knowledge and clinical performance of residents. To achieve these goals, faculty employ multiple intervention strategies, including lectures, rounds, academic detailing, visual cues, and electronic medical record prompts and decision support. The authors present examples from specific projects, based on care areas including vision screening, fall prevention, and caring for patients with dementia, all of which are based on the Assessing Care of Vulnerable Elders quality indicators. The authors describe the principles driving the design, implementation, and evaluation of the Aging Q(3) program. They present data from multiple sources that illustrate the effectiveness of the interventions to meet the knowledge, skill level, and behavior goals. The authors also address major challenges, including the maintenance of the teaching and modeling interventions over time within the context of demanding primary care and inpatient settings. This organized, evidence-based approach to quality improvement in resident education, as well as faculty leadership development, holds promise for successfully incorporating geriatrics education into internal medicine residencies.

Impact of stress on resident performance in simulated trauma scenarios

Training and practice in medicine are inherently stressful. The effects of stress on performance in clinical situations are poorly understood. The purpose of this study was to examine the stress responses and clinical performance of residents during low and high stress (HS) simulated trauma resuscitations. Thirteen emergency medicine and general surgery residents were evaluated in HS and low stress (LS) trauma resuscitation simulations. Subjective and physiologic (heart rate, salivary cortisol) responses were measured at baseline and in response to the scenarios. Performance was assessed with global rating and checklist scores of technical performance, time to record critical information, and the Anesthesia Non-Technical Skills tool. Post-scenario recall was assessed with the completion of a standardized trauma history form. Post-scenario subjective stress and cortisol levels were higher in the HS scenario compared with the LS scenario (p < 0.05). Checklist performance scores and post-scenario recall were significantly lower in the HS compared with the LS condition (p < 0.05). In trainees, some aspects of performance and immediate recall appear to be impaired in complex clinical scenarios in which they exhibit elevated subjective and physiologic stress responses. The findings of this study highlight a potential threat to patient safety and demand further investigation. Future studies should strive to further elucidate the effects of stress on specific components of performance and investigate ways to reduce its negative impact.

A feasibility study comparing checklists and global rating forms to assess resident performance in clinical skills

This study evaluated the feasibility of two different scoring forms for assessing the clinical performance of residents in anaesthesiology. One of the forms had a checklist format including task-specific items and the other was a global rating form with general dimensions of competence including ‘clinical skills’, ‘communication skills’ and ‘knowledge’. Thirty-two clinicians representing 25 (83%) of the 30 training hospitals in the country participated in the study. The clinicians were randomized into two groups, each of which used one of the scoring formats to assess a resident’s performance in four simulated clinical scenarios on videotape. Clinicians’ opinions about the appropriateness of the scoring forms were rated on a scale of 1–5. The checklist format was rated significantly higher compared with the global rating form (mean 4.6, sd 0.5 vs. mean 3.5, sd 1.4, p < 0.001). The inter-rater agreement regarding pass/fail decisions was poor irrespective of the scoring form used. This was explained by clinicians’ leniency as assessors rather than by lack of vigilance in the observations or disagreements on standards for good performance.

A new method to evaluate clinical performance and critical incidents in anaesthesia: quantification of daily comments by teachers

We have found that the Clinical Anesthesia System of Evaluation (CASE) method provides information regarding clinical performance of residents and critical incidents that is not available from other sources. As a result, it expands the dimensions of the evaluation process and improves validity. In addition, the technique has helped address the concerns of many investigators. (1) It provides specific, real-time evaluations that permit early intervention, improve feedback and guide remediation; (2) it improves sampling techniques by increasing the breadth and volume of evaluators and settings; (3) it enhances the discriminatory power of the evaluation process; and (4) it improves documentation.

Reliability and Validity of an Objective Structured Clinical Examination for Assessing the Clinical Performance of Residents

Clinical performance of residents should be assessed as reliably and validly as possible. This study investigated the reliability and validity of an objective structured clinical examination (OSCE) for assessing clinical performance of internal medicine residents. Residents were required to take a 17-patient OSCE in their first and second year. Reliability of the OSCE was 0.40. Validity studies indicated second-year students were significantly better than third-year students for five of six OSCE skill scores; first-year students were significantly better for three scores. Resident's scores for diagnosis, plan, and total significantly increased on their second OSCE. Generally faculty overall ratings of residents' clinical performance did not correlate with OSCE scores. American Board of Internal Medicine certifying examination scores were consistently positively correlated only with diagnosis. This 17-case OSCE is a feasible method for obtaining moderately reliable, valid data not available from other sources about the clinical performance of residents. More cases should be added to increase its reliability.