评估住院医师的能力：关于临床能力委员会在绩效评估中作用的定性研究
Reviewing residents' competence: a qualitative study of the role of clinical competency committees in performance assessment.
作者信息
Hauer Karen E, Chesluk Benjamin, Iobst William, Holmboe Eric, Baron Robert B, Boscardin Christy K, Cate Olle Ten, O'Sullivan Patricia S
机构信息
K.E. Hauer is professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. B. Chesluk is clinical research associate, Evaluation, Research, and Development, American Board of Internal Medicine, Philadelphia, Pennsylvania. W. Iobst is vice president for academic and clinical affairs and vice dean, Commonwealth Medical College, Scranton, Pennsylvania. E. Holmboe is senior vice president, Accreditation Council for Graduate Medical Education, Chicago, Illinois, and adjunct professor of medicine, Yale School of Medicine, New Haven, Connecticut. R.B. Baron is professor of medicine and associate dean for graduate and continuing medical education, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. C.K. Boscardin is associate professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. O. ten Cate is professor of medical education and director, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands. P.S. O'Sullivan is professor of medicine and director of research and development in medical education, Office of Medical Education, University of California, San Francisco, School of Medicine, San Francisco, California.
出版信息
Acad Med. 2015 Aug;90(8):1084-92. doi: 10.1097/ACM.0000000000000736.
PURPOSE
Clinical competency committees (CCCs) are now required in graduate medical education. This study examined how residency programs understand and operationalize this mandate for resident performance review.
METHOD
In 2013, the investigators conducted semistructured interviews with 34 residency program directors at five public institutions in California, asking about each institution's CCCs and resident performance review processes. They used conventional content analysis to identify major themes from the verbatim interview transcripts.
RESULTS
The purpose of resident performance review at all institutions was oriented toward one of two paradigms: a problem identification model, which predominated; or a developmental model. The problem identification model, which focused on identifying and addressing performance concerns, used performance data such as red-flag alerts and informal information shared with program directors to identify struggling residents.In the developmental model, the timely acquisition and synthesis of data to inform each resident's developmental trajectory was challenging. Participants highly valued CCC members' expertise as educators to corroborate the identification of struggling residents and to enhance credibility of the committee's outcomes. Training in applying the milestones to the CCC's work was minimal.Participants were highly committed to performance review and perceived the current process as adequate for struggling residents but potentially not for others.
CONCLUSIONS
Institutions orient resident performance review toward problem identification; a developmental approach is uncommon. Clarifying the purpose of resident performance review and employing efficient information systems that synthesize performance data and engage residents and faculty in purposeful feedback discussions could enable the meaningful implementation of milestones-based assessment.
目的
研究生医学教育现在要求设立临床能力委员会（CCC）。本研究调查了住院医师培训项目如何理解并落实这一针对住院医师绩效评估的要求。
方法
2013年，研究人员对加利福尼亚州五所公立机构的34位住院医师培训项目主任进行了半结构化访谈，询问各机构的CCC及住院医师绩效评估流程。他们采用传统内容分析法，从访谈逐字记录中识别主要主题。
结果
所有机构的住院医师绩效评估目的都导向两种模式之一：占主导地位的问题识别模式，或发展模式。问题识别模式侧重于识别并解决绩效问题，利用诸如警示信号警报等绩效数据以及与项目主任共享的非正式信息来识别表现不佳的住院医师。在发展模式中，及时获取并综合数据以为每位住院医师的发展轨迹提供信息具有挑战性。参与者高度重视CCC成员作为教育工作者的专业知识，以证实对表现不佳住院医师的识别，并提高委员会结果的可信度。将里程碑应用于CCC工作的培训很少。参与者高度致力于绩效评估，认为当前流程对表现不佳的住院医师足够，但对其他住院医师可能不够。
结论
各机构将住院医师绩效评估导向问题识别；发展模式并不常见。明确住院医师绩效评估的目的，采用有效的信息系统来综合绩效数据，并让住院医师和教职员工参与有目的的反馈讨论，可能有助于有意义地实施基于里程碑的评估。
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