Harvard Medical School, Boston, Massachusetts, USA.
Anesthesiology. 2011 Oct;115(4):862-78. doi: 10.1097/ALN.0b013e318229a27d.
Valid and reliable (dependable) assessment of resident clinical skills is essential for learning, promotion, and remediation. Competency is defined as what a physician can do, whereas performance is what a physician does in everyday practice. There is an ongoing need for valid and reliable measures of resident clinical performance.
Anesthesia residents were evaluated confidentially on a weekly basis by faculty members who supervised them. The electronic evaluation form had five sections, including a rating section for absolute and relative-to-peers performance under each of the six Accreditation Council for Graduate Medical Education core competencies, clinical competency committee questions, rater confidence in having the resident perform cases of increasing difficulty, and comment sections. Residents and their faculty mentors were provided with the resident's formative comments on a biweekly basis.
From July 2008 to June 2010, 140 faculty members returned 14,469 evaluations on 108 residents. Faculty scores were pervasively positively biased and affected by idiosyncratic score range usage. These effects were eliminated by normalizing each performance score to the unique scoring characteristics of each faculty member (Z-scores). Individual Z-scores had low amounts of performance information, but signal averaging allowed determination of reliable performance scores. Average Z-scores were stable over time, related to external measures of medical knowledge, identified residents referred to the clinical competency committee, and increased when performance improved because of an intervention.
This study demonstrates a reliable and valid clinical performance assessment system for residents at all levels of training.
对住院医师临床技能的有效和可靠（可信赖的）评估对于学习、晋升和补救至关重要。能力是指医生能做什么，而表现是指医生在日常实践中所做的。因此，需要有持续有效的方法来衡量住院医师的临床表现。
住院医师的临床表现每周由监督他们的教员进行机密评估。电子评估表有五个部分，包括在六个研究生医学教育认证委员会核心能力下对绝对和相对同行表现的评分部分、临床能力委员会问题、评估者对住院医师执行越来越困难病例的信心、评论部分。住院医师及其导师每两周提供一次对住院医师的形成性意见。
从 2008 年 7 月到 2010 年 6 月，140 名教员对 108 名住院医师进行了 14469 次评估。教员的评分普遍存在正向偏差，并受到独特评分范围使用的影响。通过将每个绩效评分标准化为每个教员的独特评分特征（Z 评分），可以消除这些影响。单个 Z 评分的绩效信息较少，但信号平均允许确定可靠的绩效评分。平均 Z 评分随时间稳定，与外部医学知识衡量标准相关，确定了提交给临床能力委员会的住院医师，并在干预后因绩效提高而增加。
本研究展示了一种可靠且有效的住院医师各级培训临床绩效评估系统。
