Lypson Monica L, Ross Paula T, Hamstra Stanley J, Haftel Hilary M, Gruppen Larry D, Colletti Lisa M
J Grad Med Educ. 2010 Sep;2(3):354-9. doi: 10.4300/JGME-D-10-00050.1.
Some have commented that the limited number of underrepresented minorities (URMs) in United States' residency programs is due to a lack of qualified candidates. At the University of Michigan, an objective structured clinical examination is administered to incoming residents at the beginning of training to determine baseline competence. In this study we wanted to determine if competence differed for underrepresented minorities when compared to non-URM residents.
The postgraduate orientation assessment, a 10-station examination, was developed that focused specifically on the knowledge and skills needed in the first 6 to 18 weeks of training. Stations assessed competence in informed consent, aseptic technique, evidence-based medicine, diagnostic images, critical laboratory values, cross-cultural communication, and Joint Commission requirements such as surgical fire safety, pain assessment, and management. We used various assessment measures including standardized patients, computer-based testing, and multiple-choice questions.
Our study found no significant differences in overall mean scores between URM residents and all other residents for the 5 years during which we administered the examination, except for 2002. This stands in contrast to the consistently worse performances of URM students on USMLE Step 1 and Step 2 Clinical Knowledge. Also, URM residents did not perform better or worse than their non-URM colleagues on standardized patient stations during the course of 5 years during which the examination was administered.
The postgraduate orientation assessment provides residency program directors with a standard format to measure initial clinical skills. When compared to incoming non-URM residents from a variety of medical schools, URM residents perform as well as other trainees. Our results may aid in the recruitment efforts of URM medical students into academic residency programs such as those at the University of Michigan.
一些人认为美国住院医师培训项目中未被充分代表的少数族裔（URM）数量有限是由于缺乏合格的候选人。在密歇根大学，培训开始时会对新入职的住院医师进行客观结构化临床考试以确定其基线能力。在本研究中，我们想确定与非URM住院医师相比，URM的能力是否存在差异。
开发了研究生入职评估，这是一项包含10个站点的考试，特别关注培训最初6至18周所需的知识和技能。各站点评估了知情同意、无菌技术、循证医学、诊断影像、关键实验室值、跨文化交流以及联合委员会要求（如手术消防安全、疼痛评估和管理）方面的能力。我们使用了多种评估方法，包括标准化病人、计算机测试和多项选择题。
我们的研究发现，在我们进行考试的5年中，除了2002年，URM住院医师与所有其他住院医师的总体平均分数没有显著差异。这与URM学生在美国医师执照考试第一步和第二步临床知识考试中一贯较差的表现形成对比。此外，在进行考试的5年期间，URM住院医师在标准化病人站点上的表现并不比他们的非URM同事更好或更差。
研究生入职评估为住院医师培训项目主任提供了一种衡量初始临床技能的标准形式。与来自各种医学院的新入职非URM住院医师相比，URM住院医师的表现与其他受训者相当。我们的结果可能有助于将URM医学生招募到学术住院医师培训项目中，比如密歇根大学的项目。
