Chandler Nicole, Henderson Gavin, Park Brittany, Byerley Julie, Brown Wallace D, Steiner Michael J
J Grad Med Educ. 2010 Sep;2(3):430-4. doi: 10.4300/JGME-D-10-00013.1.
Faculty have traditionally evaluated resident physician professionalism and interpersonal skills without input from patients, family members, nurses, or the residents themselves. The objective of our study was to use "360-degree evaluations," as suggested by the Accreditation Council for Graduate Medical Education (ACGME), to determine if nonfaculty ratings of resident professionalism and interpersonal skills differ from faculty ratings.
Pediatrics residents were enrolled in a hospital-based resident continuity clinic during a 5-week period. Patient/families (P/Fs), faculty (MD [doctor of medicine]), nurses (RNs [registered nurses]), and residents themselves (self) completed evaluator-specific evaluations after each clinic session by using a validated 10-item questionnaire with a 5-point Likert scale. The average Likert score was tallied for each questionnaire. Mean Likert scale scores for each type of rater were compared by using analysis of variance, text with pair-wise comparisons when appropriate. Agreement between rater types was measured by using the Pearson correlation.
A total of 823 evaluations were completed for 66 residents (total eligible residents, 69; 95% participation). All evaluators scored residents highly (mean Likert score range, 4.4 to 4.9). However, MDs and RNs scored residents higher than did P/Fs (mean scores: MD, 4.77, SD [standard deviation], 0.32; RN, 4.85, SD, 0.30; P/F, 4.53, SD, 0.96; P < .0001). MD and RN scores also were higher than residents' self-evaluation scores, but there was no difference between self-scores and P/F scores (average resident self-score, 4.44, SD, 0.43; P < .0001 compared to MD and RN; P = .19 compared to P/F). Correlation coefficients between all combinations of raters ranged from -0.21 to 0.21 and none were statistically significant.
Our study found high ratings for resident professionalism and interpersonal skills. However, different members of the health care team rated residents differently, and ratings are not correlated. Our results provide evidence for the potential value of 360-degree evaluations.
传统上，教员在评估住院医师的职业素养和人际沟通技巧时，并未参考患者、家属、护士或住院医师本人的意见。我们研究的目的是按照毕业后医学教育认证委员会（ACGME）的建议，采用“360度评估”，以确定非教员对住院医师职业素养和人际沟通技巧的评分是否与教员评分存在差异。
在为期5周的时间里，儿科住院医师参与了一家医院的住院医师连续性门诊。患者/家属（P/F）、教员（医学博士[MD]）、护士（注册护士[RN]）以及住院医师本人（自我）在每次门诊结束后，通过使用一份经过验证的、包含10个项目且采用5级李克特量表的问卷，完成针对评估者的特定评估。统计每份问卷的平均李克特得分。通过方差分析比较各类评估者的平均李克特量表得分，在适当情况下进行两两比较。使用皮尔逊相关性来衡量评估者类型之间的一致性。
共为66名住院医师完成了823份评估（ eligible residents总数为69名；参与率95%）。所有评估者对住院医师的评分都很高（平均李克特得分范围为4.4至4.9）。然而，医学博士和注册护士对住院医师的评分高于患者/家属（平均得分：医学博士，4.77，标准差[SD]，0.32；注册护士，4.85，标准差，0.30；患者/家属，4.53，标准差，0.96；P <.0001）。医学博士和注册护士的评分也高于住院医师的自我评价得分，但自我评价得分与患者/家属得分之间没有差异（住院医师平均自我评分为4.44，标准差，0.43；与医学博士和注册护士相比，P <.0001；与患者/家属相比，P = 0.19）。评估者所有组合之间的相关系数范围为-0.21至0.21，均无统计学意义。
我们的研究发现对住院医师职业素养和人际沟通技巧的评分较高。然而，医疗团队的不同成员对住院医师的评分不同，且评分不相关。我们的结果为360度评估的潜在价值提供了证据。
