Resident Performance Research Articles

Comparing performances of french orthopaedic surgery residents with the artificial intelligence ChatGPT-4/4o in the French diploma exams of orthopaedic and trauma surgery

Comparing performances of french orthopaedic surgery residents with the artificial intelligence ChatGPT-4/4o in the French diploma exams of orthopaedic and trauma surgery

Radiology resident proficiency in pediatric trauma cases: a comparative analysis based on trauma center status using the WIDI SIM exam.

To investigate the correlation between pediatric and adult trauma center status and radiology resident performance on pediatric trauma cases using the WIDI SIM exam. The WIDI SIM is a validated computer-aided simulation that assesses radiology residents' preparedness for independent call duty. It includes 65 cases across various imaging modalities derived from actual patient encounters. Faculty score free-text responses using a standardized 0-10 scale rubric. We analyzed 8,488 WIDI SIM exam scores from 35 pediatric trauma cases across 52 programs. A negative binomial regression model adjusting for resident level, imaging modality, and case specialty was employed to evaluate the impact of pediatric and adult trauma center status on resident performance. Both pediatric trauma center status (p = 0.0005) and adult trauma center status (p = 0.0003) were significant predictors of higher resident scores. Resident level was also significant, with higher-level residents performing better than first-year residents (p < 0.001). Residents performed worse on MR and US modalities compared to CT, and performance varied by case specialty. Radiology residents' pediatric trauma imaging skills are significantly linked to pediatric and adult trauma center status. Given most pediatric traumas occur outside pediatric trauma centers, targeted training strategies should be considered to ensure residents develop essential diagnostic skills.

Factors associated with eating performance in nursing home residents living with dementia and other comorbidities

BackgroundEating performance is the functional ability to get food into the mouth and chew/swallow it. Nursing home residents with dementia commonly experience compromised eating performance and subsequent consequences. Prior work examined the association between resident eating performance and their cognitive and functional ability. Yet, the associations between resident eating performance and behavioral and psychological symptoms, psychotropic medication use, and comorbidities are less studied. This study aimed to examine the association between eating performance and cognition, functional ability, behavioral and psychological symptoms, psychotropic medication use, and comorbidities in nursing home residents with dementia.MethodsThis was a secondary analysis using baseline data from two randomized controlled trials, testing the impact of Function Focused Care on function and behavioral symptoms in 882 residents with moderate-to-severe dementia (mean age 86.55 years, 71% female, 30% non-white, 68.5% severe dementia) from 67 nursing homes in two states between 2014 and 2020. Eating performance (dependent variable) was measured using the single self-feeding item of Barthel Index. Independent variables included cognitive impairment, functional ability (Barthel Index total score excluding the self-feeding item score), behavioral and psychological symptoms (agitation, depression, resistiveness-to-care), psychotropic medication use (anti-depression, sedative, anti-psychotics, anti-seizure, anti-anxiety), and comorbidities.ResultsNearly 39% of residents were dependent in eating. On average, residents had five documented comorbidities (SD = 3.06, range = 0–12) and were on approximately one psychotropic medication (SD = 1.25, range = 0–5). Eating performance was associated with cognitive impairment (OR = 0.53, 95% CI = 0.35, 0.79, p = .002), functional ability (OR = 1.05, 95% CI = 1.04, 1.06, p < .001), depressive symptoms (OR = 0.94, 95% CI = 0.89, 0.98, p = .007), and anxiolytic use (OR = 0.64, 95% CI = 0.42, 0.99, p = .046).ConclusionsFindings supported that better eating performance was associated with less cognitive impairment, higher functional ability, fewer depressive symptoms, and less anxiolytic use. Targeted interventions to accommodate to cognitive function, optimize functional ability, minimize anxiolytic use, and manage depressive symptoms are encouraged to support eating performance in residents with dementia.

Just In Time! Assessment of Internal Medicine Resident Point of Care Ultrasound (POCUS) Attitudes and Behaviors After Spaced Intervention at Two Residency Programs.

Point of care ultrasound (POCUS) is a complex psychomotor skill that requires scaffolded support for skill acquisition. However, the effect of spaced curricular elements on learner POCUS behaviors are not clearly understood. Using a multi-site observational cross-sectional survey study, we measured resident baseline POCUS use, behaviors, and attitudes and then implemented POCUS workflow and just-in-time POCUS curricula during internal medicine resident ward rotations and assessed changes. Self-reported personal and team POCUS use and documentation habits all improved between baseline and the just-in-time teaching. Personal POCUS use correlated with team POCUS use (ρ=0.431; p<0.001) and co-resident POCUS use (ρ=0.242; p=0.035). Attending POCUS use correlated with team POCUS use (ρ=0.523; p< 0.001), but not personal use. Overall, we found moderate, but statistically significant, improvements in reported resident and team performance of POCUS and documentation habits, suggesting that just-in-time interventions may promote POCUS use. Co-learning also appears to be a key influencer for POCUS use.

Bias Sensitivity in Diagnostic Decision-Making: Comparing ChatGPT with Residents.

Diagnostic errors, often due to biases in clinical reasoning, significantly affect patient care. While artificial intelligence chatbots like ChatGPT could help mitigate such biases, their potential susceptibility to biases is unknown. This study evaluated diagnostic accuracy of ChatGPT against the performance of 265 medical residents in five previously published experiments aimed at inducing bias. The residents worked in several major teaching hospitals in the Netherlands. The biases studied were case-intrinsic (presence of salient distracting findings in the patient history, effects of disruptive patient behaviors) and situational (prior availability of a look-alike patient). ChatGPT's accuracy in identifying the most-likely diagnosis was measured. Diagnostic accuracy of residents and ChatGPT was equivalent. For clinical cases involving case-intrinsic bias, both ChatGPT and the residents exhibited a decline in diagnostic accuracy. Residents' accuracy decreased on average 12%, while the accuracy of ChatGPT 4.0 decreased 21%. Accuracy of ChatGPT 3.5 decreased 9%. These findings suggest that, like human diagnosticians, ChatGPT is sensitive to bias when the biasing information is part of the patient history. When the biasing information was extrinsic to the case in the form of the prior availability of a look-alike case, residents' accuracy decreased by 15%. By contrast, ChatGPT's performance was not affected by the biasing information. Chi-square goodness-of-fit tests corroborated these outcomes. It seems that, while ChatGPT is not sensitive to bias when biasing information is situational, it is sensitive to bias when the biasing information is part of the patient's disease history. Its utility in diagnostic support has potential, but caution is advised. Future research should enhance AI's bias detection and mitigation to make it truly useful for diagnostic support.

Performance of Chatgpt in ophthalmology exam; human versus AI.

This cross-sectional study focuses on evaluating the success rate of ChatGPT in answering questions from the 'Resident Training Development Exam' and comparing these results with the performance of the ophthalmology residents. The 75 exam questions, across nine sections and three difficulty levels, were presented to ChatGPT. The responses and explanations were recorded. The readability and complexity of the explanations were analyzed and The Flesch Reading Ease (FRE) score (0-100) was recorded using the program named Readable. Residents were categorized into four groups based on their seniority. The overall and seniority-specific success rates of the residents were compared separately with ChatGPT. Out of 69 questions, ChatGPT answered 37 correctly (53.62%). The highest success was in Lens and Cataract (77.77%), and the lowest in Pediatric Ophthalmology and Strabismus (0.00%). Of 789 residents, overall accuracy was 50.37%. Seniority-specific accuracy rates were 43.49%, 51.30%, 54.91%, and 60.05% for 1st to 4th-year residents. ChatGPT ranked 292nd among residents. Difficulty-wise, 11 questions were easy, 44 moderate, and 14 difficult. ChatGPT's accuracy for each level was 63.63%, 54.54%, and 42.85%, respectively. The average FRE score of responses generated by ChatGPT was found to be 27.56 ± 12.40. ChatGPT correctly answered 53.6% of questions in an exam for residents. ChatGPT has a lower success rate on average than a 3rd year resident. The readability of responses provided by ChatGPT is low, and they are difficult to understand. As difficulty increases, ChatGPT's success decreases. Predictably, these results will change with more information loaded into ChatGPT.

Resident Performance on the Obstetrics and Gynecology In-Training Examination After Implementation of a New Academic Curriculum.

Background The goals of the annual Council on Resident Education in Obstetrics and Gynecology In-Training Examination (CREOG-ITE) are to provide residents with an assessment of their knowledge and program directors an assessment of their residency programs. Research has shown that a score greater than 200 is correlated with passing the qualifying board examination. We observed a substantial number of our residents were not performing well on the exam, which prompted the implementation of a new academic program aimed at determining the impact of an academic curriculum addition on CREOG-ITE scores in an American College of Graduate Medical Education (ACGME) accredited obstetrics and gynecology (OB/GYN) residency program. Methods We performed a prospective cohort study of residents at a single institution to evaluate the effect of a remediation course for residents identified as "at risk." Residents with CREOG-ITE scores of <180 were placed into the experimental group who underwent a year-long remediation programand were compared to the control group (those with scores >180 who did not undergo remediation).Each resident in the experimental group served as their internal control by comparing their pre-intervention score to their post-remediation score. Results Themean improvement of the experimental group of the remediation programwas 23.2 points. After controlling for post-graduate year (PGY), their score improvement remained significant and was not simply a by-product of the inherent academic knowledge of a resident further along in training. Conclusions This scholastic remediation program was associated with a statistically significant improvement in CREOG-ITE scores, even when accounting for PGY level. This program may serve as a model for improving OB/GYN resident education.

PP456 Topic: AS16–Medical, Nursing and AHP Workforce &amp; Education: Staff Education and Development/Equity, Diversity, Inclusion/Other: EFFECTS OF JUST IN TIME SIMULATION ON RESIDENT COMFORT AND PERFORMANCE DURING MOCK CODES

PP456 Topic: AS16–Medical, Nursing and AHP Workforce &amp; Education: Staff Education and Development/Equity, Diversity, Inclusion/Other: EFFECTS OF JUST IN TIME SIMULATION ON RESIDENT COMFORT AND PERFORMANCE DURING MOCK CODES

The Importance of a Champion in Leading Major Improvements in Residency Programs.

Residency programs are expected to meet many requirements in training their residents, including providing adequate numbers of pediatric visits and procedures opportunities. In the residency program studied here, these numbers were inadequate, despite the efforts of faculty members over the years. A self-designated faculty champion (with traits including vision, persuasiveness, proactivity, and tenacity) launched a series of clinical initiatives to combat these problems. The number of pediatric visits in the Family Medical Center (FMC) were tracked and compared from 2012, prior to the intervention led by the faculty champion, through 2023. The number of procedures performed in the FMC were tracked and compared from 2015, when the procedures-only clinic was launched by the faculty champion, through 2023. The number of pediatric visits in the FMC in 2012-2013 was a total of 12. By 2022-2023, that number had grown to 1,454. The number of procedures in the FMC was four in 2015-2016, but by 2022-2023 had grown to 470. The improved numbers support competency-based medical education, with increased faculty observation, teaching, and evaluation. For procedures training, the improved numbers support faculty members in using the Procedural Competency Assessment Tools to evaluate resident performance. A faculty champion who is interested, self-motivated, persistent, and focused on leading the project from beginning to end can bring about significant improvements in a residency program, despite the program's track record of difficulty in making such improvements.

Assessing the Role of Social Studies Curricula in Enhancing Tourism Awareness among High School Students: A Student Perspective

Tourism awareness plays a pivotal role in promoting cultural understanding and supporting economic growth, especially in regions with rich heritage and tourism potential. This study aims to evaluate the effectiveness of social studies curricula in fostering tourism awareness among high school students in the Irbid region of northern Jordan. The research addresses the problem of limited integration of tourism-related topics within the existing curricula, which tend to prioritize general knowledge over specialized subjects such as sustainable tourism and cultural diversity. A total of 979 students were randomly selected to participate in the study, and data were gathered using a structured survey designed to assess how well the curricula promote tourism awareness. The research employed a quantitative approach to examine relationships between tourism awareness and variables such as gender, residence, and academic achievement. The results showed significant gaps in the curricula, with minimal focus on hands-on learning experiences like field trips or interactive projects, leading to generally low levels of tourism awareness among students. Furthermore, the lack of career guidance related to tourism hinders students from exploring potential tourism-related career paths. There were no significant differences in tourism awareness based on gender, residence, or academic performance. The study concludes by recommending a comprehensive revision of the social studies curricula to include more specialized tourism concepts, practical learning opportunities, and career exploration activities. Such changes would enhance students’ understanding of the tourism industry and its importance, preparing them for future roles in this sector.

A qualitative assessment of behavioral interview method among anesthesiology residency applicants

Background The objective of residency recruitment is to select the most appropriate candidate. While cognitive skills are identified before an interview and can be measured objectively, non-cognitive skills can be harder to discern. These non-cognitive skills though are a good predictors of future residency performance. A structured behavioral interview is better at identifying noncognitive skills compared to a traditional interview. Objective Compare the noncognitive traits identified in the interviews with those identified in resident evaluations Methods Using the semi-annual evaluations 6 residents were split between satisfactory group and excellent group. Behavioral-based interviews and traditional unstructured interviews conducted on the same individual were compared and the results of the interview were compared to the semi-annual and annual evaluations submitted by the teaching faculty and the program directors. The interviews were analyzed for non-cognitive skills. Results Qualitative analysis of behavioral interview narratives and the narrative part of the semiannual evaluations independently identified the non-cognitive characteristics of adaptability, decisiveness, time management, judgment, and the ability to work in a team. It also identified other essential non-cognitive skills necessary for an anesthesiologist, such as ability to prioritize, study techniques, ability to destress. Conclusion The noncognitive traits found in the excellent group response to the structured interview match those found in the semi-annual evaluations. In this case individuals who are suited to the field of anesthesiology are adaptable, decisive, team-players with excellent judgment.

Bridging the Gap: A Pilot Study of a Health Care Transition Podcast Curriculum and Standardized Patient Case for Graduate Medical Education Trainees.

Introduction Pediatric to adult health care transition (HCT) is critical to maintaining the health and wellness of patients, and pediatric and adult providers often do not feel prepared to shepherd patients through this process. Methods We designed an HCT curriculum consisting of nine podcasts paired with existing ambulatory experiential learning opportunities for internal medicine-pediatric residents (n=6). Before and after the curriculum we evaluated resident HCT self-assessment and resident performance working with a standardized patient (SP) and standardized parent in a novel objective structured clinical examination (OSCE) station designed to assess HCT skills. Results Residents improved in all HCT self-assessment goals (Likert 1-5; average score increasing from 2.4 to 3.93; p= 0.0002) and in their overall OSCE performance (Likert 1-5; average score increasing from 2.6 to 4.1; p=0.002). Conclusion By combining portable didactic educational materials with intentional experiential learning opportunities, the HCT curriculum herein described improved residents' knowledge and skills related to helping adolescent and young adult patients through HCT. This curriculum could be easily adapted for implementation at other institutions and across disciplines. In addition, we offer a standardized patient case for use in assessing HCT skills.

Resident performance and program perception following merger of surgical residencies

PurposeThe primary objective of this study was to gauge resident and faculty sentiments surrounding a general surgery program merger between two programs, and to assess the effect on workplace morale and productivity. Secondarily, the authors sought to objectively examine the impact program expansion had on in-service training exam results and operative volumes.MethodsThis was a single-center, prospective, observational study that evaluated surgical resident and faculty feedback pertaining to the merger of two regional general surgery residency programs. The survey utilized the Likert scale at merger onset and post-merger to gather responses from residents and faculty from July 2020 to August 2021. Secondary outcomes evaluated case volume and ABSITE performance pre- and post-merger.ResultsA total of 27 residents and 31 faculty participated in the initial survey. The merger onset and post survey investigation found that there was increased workplace efficiency (78% onset, 96% post; p = 0.004), and increased comfort with effectively triaging patients (41% onset, 83% post; p = 0.001). Satisfaction levels regarding research infrastructure and mentorship also increased significantly (63% onset, 83% post; p = 0.03). ABSITE performance and operative volumes were not significantly changed post-merger.ConclusionThe merging of two academic programs led to feelings of increased mentorship, operative competency, and workplace efficiency among the residents. This was achieved without significant detriment to resident case volume or ABSITE performance. Our investigation also identified legitimate challenges that speak to the need for fluidity in a residency program and the constant need for continued growth and development.

Outcomes of Accelerated 3-Year MD Graduates at NYU Grossman School of Medicine During Medical School and Early Residency.

For accelerated 3-year MD (3YMD) pathways to be fully adopted in medical education, a comprehensive analysis of outcome data is needed. This study includes 7 accelerated 3YMD graduating classes at NYU Grossman School of Medicine (NYUGSOM) and reports on outcomes from both medical school and internship compared to their 4-year MD (4YMD) counterparts. Outcomes across the undergraduate-graduate medical education continuum for the first 7 classes of NYUGSOM graduates (matriculated from 2013-2019) from the accelerated 3YMD (n = 136) and 4YMD pathways (n = 681) were compared. For the internship outcomes, 3YMD interns were compared with 4YMD interns who graduated from NYUGSOM and all 4YMD interns (4YMD graduates from NYUGSOM and any other medical school) at NYUGSOM residencies. Accelerated 3YMD students were approximately 5 months older at admission and had higher multiple mini-interview scores than 4YMD students. Overall, accelerated 3YMD students performed similarly to 4YMD students during medical school and internship. Significant differences included higher performance by 3YMD students on preclerkship exams and lower performance on Steps 1 and 2 (average: 5.6 and 8.3 fewer points, respectively) and the physical examination portion of the NYUGSOM Comprehensive Clinical Skills Exam. Internship data indicated comparable team assessments across all residencies, statistically significant higher performance on Step 3 when compared to all 4YMD interns, and, in internal medicine, comparable clinical reasoning between 3YMD and all 4YMD interns. When comparing 3YMD interns to all 4YMD interns in the internal medicine residency program, 3YMD interns had a statistically significantly higher performance on milestones. The outcomes from 7 years of graduating accelerated 3YMD students at NYUGSOM show similar performance in medical school and early residency to 4YMD graduates. Long-term study of accelerated 3YMD students from NYUGSOM and other medical schools is needed to further validate the success of this innovative medical education pathway.

Video Review Can Measure Surgical Robotic Skill Development in a Resident Robotic Hernia Curriculum: A Retrospective Cohort Study

Background: Hernia repairs are one of the most common general surgery procedures and an essential part of training for general surgery residents. The widespread incorporation of robotic hernia repairs warrants the development of a procedure-specific robotic curriculum to assist novice surgeons in improving technical skills. Objective: To evaluate a robotic hernia simulation-based curriculum for general surgery residents using video review. Methods: Retrospective cohort study of PGY-3 general surgery residents from the University of Chicago from 2019 to 2021. The residents completed inguinal hernia repair (IHR) and ventral hernia repair (VHR) drills as part of a robotic simulation curriculum. The drills were recorded and graded according to the modified objective structured assessment of technical skills (OSATS) and time to completion. The drills were completed by 3 attending surgeons to establish gold-standard benchmarks. Results: In total, 20 residents started the curriculum, 19 completed all IHR drills and 17 completed all VHR drills. Attending surgeon total OSATS scores and time to completion were significantly better than the trainees on the first attempt (P &lt; 0.05). When comparing 1st to 4th attempt, resident OSATS scores improved significantly for IHR (15.5 vs 23.3; P &lt; 0.001) and VHR (16.8 vs 23.3; P &lt; 0.001). Time also improved over 4 attempts (IHR: 28.5 vs 20.5 minutes; P &lt; 0.001 and VHR: 29.6 vs 21.2 minutes; P &lt; 0.001). Residents achieved attending-level OSATS scores by their fourth attempt for VHR, but not for IHR. Residents did not achieve attending-level times for either hernia drills. Conclusions: The robotic hernia curriculum improved resident performance on hernia repair drills and was well-received by the residents.

Utilizing a surgical sabermetrics framework to assess the impact of trainer behavior on trainee cognitive load during vascular surgery simulation

Abstract Surgical training programs lack data-driven, objective feedback of resident surgeon technical performance, non-technical skill and intraoperative cognitive load (CogL). Cognitive load is the working memory resource required to perform a task. When capacity is exceeded, cognitive overload occurs, which can negatively affect fine motor and communication skills. Surgical sabermetrics is an emerging field, which focuses on advanced analytics of data derived from audiovisual recordings of operations and non-invasive physiological sensors measuring surgeon CogL. Incivility is prevalent across surgical specialties and has been shown to negatively influence morale, teamwork and performance. Little is known about the impact of CogL on trainee surgeon development, and a gap in knowledge is the impact of intraoperative trainer teaching style and behavior on trainee CogL. Simulation models provide an opportunity to instigate a sabermetrics framework to assess whether trainer behavior objectively impacts trainee CogL and surgical performance, with no risk to patient safety. In this randomized trial, vascular surgery residents will be allocated to one of two groups: supportive trainer or critical trainer. All participants will be tasked with completing a standardized, simulated vascular anastomosis using a femoral artery model, during which they will be exposed to one of these trainer behaviors. A sabermetrics framework will be utilized to collate objective data about participant technical performance, non-technical skills and CogL. Full ethical approval has been obtained for this study. Dissemination of the results will be through conferences and publications in peer reviewed journals.

It's not that SIMPL—Identifying deficiencies in general surgery trainees' autonomy and competence performing parathyroidectomy and thyroidectomy

BackgroundAlthough many parathyroid and thyroid operations are performed by nonfellowship-trained general surgeons in the United States, there is growing uncertainty of whether graduating residents can perform these procedures competently. This study investigates trends in competency and autonomy among general surgery residents performing parathyroid and thyroid operations using a national survey-based dataset. MethodsA retrospective analysis of the Society for Improving Medical Professional Learning database was performed. Case data from categorical general surgery residents performing parathyroidectomy or thyroidectomy between 2015 and 2023 were included. Competent performance and meaningful autonomy were dichotomized on the basis of faculty surgeon responses. Agreement between resident and faculty evaluations were assessed. Logistic regression was used to examine resident performance and autonomy using postgraduate year level and case complexity as covariates. ResultsThe study included 907 parathyroidectomies and 1,555 thyroidectomies from 724 residents at 77 residency programs. Competent performance was observed in 34.0% of parathyroidectomies and 38.6% of thyroidectomies. Meaningful autonomy was observed in 31.6% of parathyroidectomies and 32.3% of thyroidectomies. Residents and faculty agreed on performance (50.3%) and autonomy (59.1%) in most cases, however when discordant residents often underestimated their performance (44.7%) or autonomy (25.3%). The likelihood of postgraduate year 5 residents demonstrating competent performance or meaningful autonomy was 65.9% and 51.6%, respectively for parathyroidectomy and 77.2% and 58.4%, respectively for thyroidectomy. ConclusionMany graduating residents do not demonstrate competent performance or meaningful autonomy in parathyroidectomy and thyroidectomy. Further initiatives are needed to improve graduating general surgeons' competence for these operations, given access disparities to high-volume endocrine surgeons.

Safer Pediatric Sedations: Simulation Checklists to Improve Knowledge, Attitudes, and Skills in Emergency Medicine Residents.

Background Pediatric sedation is a low-frequency, high-stakes procedure. This study aimed to train emergency medicine (EM) residents in pediatric procedural sedation through a sedation checklist, enhancing patient safety. Methods EM residents completed a pre-test and a survey on their knowledge and experiences with sedation protocols. Residents were subdivided into four groups: two control groups underwent a pediatric sedation simulation without the aid of a procedural checklist, while two intervention groups were given the procedural checklist to guide their management of the procedure. Following the simulations, a simulation faculty member reviewed sedation management and safety with residents for all groups and answered questions. An improvement analysis was performed via a post-intervention examination among all residents. Results Residents in the intervention group demonstrated an improvement in obtaining more critical actions during the simulation (intervention group critical actions 14, 13 vs non-intervention critical actions 10, 12) and confidence with the procedure (via a Likert scale survey across multiple arenas of pediatric sedation), with only moderately increased scores on the post-test examination (pre-simulation score of 6.28±2.14; post-simulation score of 6.75±1.88). Conclusion The data suggest that a checklist, combined with dedicated training through simulation, improves knowledge, confidence, and skill with regard to pediatric sedations. Further study is required to examine the longitudinal impact of our program on resident performance and patient outcomes.

Requested a Different Doctor: Developing and Evaluating an OSCE Assessing Core Skills in Supporting Trainees Facing Patient Discrimination.

Suboptimal support for colleagues experiencing discrimination can adversely impact clinician well-being and patient care. To describe resident performance and experience during an Objective Structured Clinical Examination (OSCE) case centered on supporting a trainee facing discrimination to inform enhanced, supportive learning environments. Formative, internal medicine OSCE at a simulation center. 148second-year residents across 2018, 2019, 2021, 2022. Residents had 10min to support a Muslim standardized intern (SI) experiencing discrimination from a patient. The SI rated resident performance across Supervision, Relationship Development, and Support domains and provided written feedback. Post-OSCE evaluations elicited resident reflections on case challenges. Proficient residents (≥ 80% average score across domains, n = 85) performed better in all items, except in not acting defensive and collaborating with SI to develop follow-up plan, compared to non-proficient residents (n = 65). The SI described effective approaches to feeling supported, including using empathetic statements, stating personal stance on discrimination, exhibiting supportive body language, and verbalizing support. Stating knowledge of situation upfront was an area of improvement. Residents found engaging the distressed SI difficult. Use of an explicit discrimination OSCE case can help identify effective approaches to supporting targets of discriminatory patients to inform future training.

Gender Differences in Clinical Performance Assessment of Internal Medicine Residents: A Longitudinal Analysis of the Influence of Faculty and Trainee Gender.

Competency-based medical education relies on equitable assessment. This study examined the influence of faculty and trainee gender on assessments of internal medicine (IM) resident performance over time. A longitudinal analysis of clinical performance assessments from 7 U.S. IM residency programs (July 2014-June 2019) was conducted. Core competency scores (patient care [PC], medical knowledge [MK], practice-based learning and improvement [PBLI], systems-based practice [SBP], professionalism [PROF], and interpersonal and communication skills [ICS]) were standardized across programs. Cross-classified mixed-effects linear regression evaluated the relationship between gender and standardized competency scores within training programs, while adjusting for multiple variables including IM In Training Examination percentile rank. Data included 9,346 evaluations by 1,011 faculty (552 [55%] men, 459 [45%] women) for 664 residents (358 [54%] men, 306 [46%] women). Initially, women residents' scores were significantly lower than men's in PC (estimated difference [standard error ] -0.097 [0.033], P = .004), MK (-0.145 [0.034], P < .001), and PBLI -0.090 [0.040], P = .022). PC, MK, PBLI, and SBP scores increased more over time for women residents than men (PC: 0.050 [0.015], P = .001; MK: 0.052 [0.015], P = .001; PBLI: 0.036 [0.018], P = .048; SBP: 0.036 [0.016], P = .027). PROF and ICS scores were comparable across gender. There was a significant interaction between faculty gender and postgraduate year (PGY) across all competencies but none between resident gender, faculty gender, and PGY, indicating that men and women faculty rated residents differently over time but were consistent in how they rated men and women residents. Gender-based assessment differences were variable across competencies and time. Women residents had lower scores initially but greater gains in "hard skill" (MK, PC, and PBLI) than in "soft skill" (ICS and PROF) competencies, suggesting assessment inequities. Efforts to ensure equitable assessment are needed.