Yao Amy, Massenburg Benjamin B, Silver Lester, Taub Peter J
Division of Plastic and Reconstructive Surgery, Icahn School of Medicine, New York, New York.
Division of Plastic and Reconstructive Surgery, Icahn School of Medicine, New York, New York.
J Surg Educ. 2017 Sep-Oct;74(5):773-779. doi: 10.1016/j.jsurg.2017.02.001. Epub 2017 Mar 2.
Graduate medical education has recently undergone a major archetypal shift toward competency-based evaluations of residents' performance. The implementation of the Milestones program by the Accreditation Council for Graduate Medical Education (ACGME) is a core component of the shift, designed to ensure uniformity in measuring residency knowledge using a series of specialty-specific achievements. This study evaluates the correlation between residents' self-evaluations and program directors' assessments of their performance.
The study population comprised 12 plastic surgery residents, ranging from postgraduate year 1 to postgraduate year 6, enrolled in an integrated residency program at a single institution.
Overall, average attending scores were lower than average resident scores at all levels except postgraduate year 6. Correlation between resident and attending evaluations ranged from 0.417 to 0.957, with the correlation of average scores of Patient Care (0.854) and Medical Knowledge (0.816) Milestones significantly higher than those of professional skillsets (0.581). "Patient care, facial esthetics" was the Milestone with the lowest average scores from both groups. Residents scored themselves notably higher than their attendings' evaluations in Practice-based Learning and Improvement categories (+0.958) and notably lower in Medical Knowledge categories such as "Cosmetic Surgery, Trunk and Lower Extremities" (-0.375) and "Non-trauma hand" (-0.208). The total possible number of participants in this study was 12. The actual number of participants was 12 (100%).
The remarkable range of correlations suggests that expectations for performance standards may vary widely between residents and program directors. Understanding gaps between expectations and performance is vital to inform current and future residents as the restructuring of the accreditation process continues.
研究生医学教育最近经历了一次重大的原型转变，转向基于能力的住院医师表现评估。研究生医学教育认证委员会（ACGME）实施的里程碑计划是这一转变的核心组成部分，旨在通过一系列特定专业成就确保住院医师知识评估的一致性。本研究评估住院医师自我评价与项目主任对其表现评估之间的相关性。
研究人群包括12名整形外科住院医师，从研究生一年级到研究生六年级，他们参加了单一机构的综合住院医师培训项目。
总体而言，除研究生六年级外，各级主治医师的平均得分均低于住院医师的平均得分。住院医师与主治医师评估之间的相关性在0.417至0.957之间，患者护理（0.854）和医学知识（0.816）里程碑平均得分的相关性显著高于专业技能集（0.581）。“患者护理，面部美学”是两组平均得分最低的里程碑。在基于实践的学习与改进类别中，住院医师给自己的评分明显高于主治医师的评估（+0.958），而在“整形手术，躯干和下肢”（-0.375）和“非创伤性手部”（-0.208）等医学知识类别中，住院医师给自己的评分明显低于主治医师的评估。本研究的总可能参与者人数为12人。实际参与者人数为12人（100%）。
显著的相关性范围表明，住院医师和项目主任对表现标准的期望可能存在很大差异。随着认证过程的持续重组，了解期望与表现之间的差距对于指导当前和未来的住院医师至关重要。
