Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Wilmer Biostatistics Center, Johns Hopkins School of Public Health, Baltimore, Maryland.
J Surg Educ. 2019 Jul-Aug;76(4):1076-1087. doi: 10.1016/j.jsurg.2018.12.004. Epub 2019 Mar 5.
Accurate self-assessment is an important aspect of practice-based learning and improvement and a critical skill for resident growth. The Accreditation Council for Graduate Medical Education mandates semiannual milestones assessments by a clinical competency committee (CCC) for all ophthalmology residents. There are six core competencies: patient care (PC), medical knowledge, systems-based practice, practice-based learning and improvement, professionalism, and interpersonal communication skills. These competencies are assessed by the milestones rubric, which has detailed behavioral anchors and are also used for trainee self-assessments. This study compares resident self-assessed (SA) and faculty CCC milestones scores.
Residents completed milestones self-assessments prior to receiving individual score reports from the CCC. Correlation coefficients were calculated comparing the SA and CCC scores. In addition, statistical models were used to determine predictors of disparities and differences between the SA and CCC scores.
Wilmer Eye Institute, Johns Hopkins Hospital.
Twenty-one residents in the Wilmer Ophthalmology Residency program from July 2014 to June 2016.
Fifty-seven self-assessments were available for the analysis. For each resident's first assessment, SA and CCC scores were strongly correlated (r ≥ 0.6 and p < 0.05) for four milestones, and not correlated for the remaining 20 milestones. In multivariable models, the SA and CCC scores are less disparate for medical knowledge and systems-based practice competencies compared to practice-based learning and improvement. Higher year of training, PC and professionalism competencies were predictive of statistically significant resident overestimation of scores relative to the CCC. In addition, higher CCC scores predicted statistically significant lower SA-CCC disparities and differences. SA-CCC differences did not lower to a significant extent with repeated assessments or modification to the end-of-rotation evaluation forms.
Self-assessments by ophthalmology residents are not well-correlated with faculty assessments, emphasizing the need for improved and frequent timely feedback. Residents have the greatest difficulty self-assessing their professionalism and PC competency. In general, senior residents and underperforming residents have more inaccurate self-assessments.
准确的自我评估是实践学习和改进的重要方面，也是住院医师成长的关键技能。研究生医学教育认证委员会要求所有眼科住院医师每半年由临床能力委员会（CCC）进行一次里程碑式评估。有六项核心能力：患者护理（PC）、医学知识、以系统为基础的实践、基于实践的学习和改进、专业精神和人际沟通技巧。这些能力是通过里程碑式评分表进行评估的，该评分表有详细的行为锚点，也用于学员的自我评估。本研究比较了住院医师自我评估（SA）和教员 CCC 里程碑式评分。
住院医师在收到 CCC 的个人评分报告之前完成里程碑式自我评估。计算 SA 和 CCC 评分之间的相关系数。此外，还使用统计模型来确定差异的预测因素以及 SA 和 CCC 评分之间的差异。
威尔默眼科研究所，约翰霍普金斯医院。
2014 年 7 月至 2016 年 6 月威尔默眼科住院医师项目的 21 名住院医师。
可用于分析的自我评估有 57 项。对于每位住院医师的第一次评估，SA 和 CCC 评分在四个里程碑上高度相关（r≥0.6，p<0.05），而在其余 20 个里程碑上不相关。在多变量模型中，与基于实践的学习和改进相比，医疗知识和以系统为基础的实践能力的 SA 和 CCC 评分差异较小。较高的培训年限、PC 和专业精神能力与相对于 CCC 的住院医师评分过高有关。此外，较高的 CCC 评分预测了统计学上显著的 SA-CCC 差异和差异降低。随着重复评估或对轮班结束评估表的修改，SA-CCC 差异并没有显著降低。
眼科住院医师的自我评估与教员评估相关性不强，强调需要改进和频繁及时的反馈。住院医师在自我评估他们的专业精神和 PC 能力方面最困难。一般来说，资深住院医师和表现不佳的住院医师的自我评估更不准确。
