Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea.
Yeongeon Student Support Center, Seoul National University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2024 Aug 26;39(33):e239. doi: 10.3346/jkms.2024.39.e239.
Developmental trajectories of clinical skills in training physicians vary among tasks and show interindividual differences. This study examined the predictors of medical internship performance and residency entrance and found subtypes of performance trajectory in training physicians.
This retrospective cohort study involved 888 training physicians who completed a medical internship between 2015 and 2019. After the internship, 627 physicians applied for residency training between 2016 and 2020. Finally, 160 of them completed their first-year residency in internal medicine, surgery, pediatrics, and psychiatry departments between 2016 and 2020. Pearson's correlation coefficients of internship performance and first year-residency performance (n = 160) were calculated. Latent profile analysis identified performance trajectory subtypes according to medical school grade point average (GPA), internship performance, English proficiency, and residency selection procedures. Multivariate logistic regression models of residency acceptance (n = 627) and performance in the top 30%/lower 10% in the first year of residency were also constructed.
Medical internship performance showed a significant positive correlation with the medical school GPA ( = 0.194) and the written score for the medical licensing examination ( = 0.125). Higher scores in the interview (adjusted odds ratio [aOR], 2.57) and written examination (aOR, 1.45) of residency selection procedures and higher medical internship performance (aOR, 1.19) were associated with a higher chance of residency acceptance. The latent profile analyses identified three training physician subgroups: average performance, consistently high performance (top 30%), and adaptation to changes (lowest 10%). Higher scores in the interview for residency selection (aOR, 1.35) and lower scores for medical internship performance (aOR, 0.79) were associated with a higher chance of performing in the top 30% or lowest 10% in the first year of residency, respectively.
Performance in the interview and medical internship predicted being among the top 30% and lowest 10% of performers in the first year of residency training, respectively. Individualized educational programs to enhance the prospect of trainees becoming high-functioning physicians are needed.
在培训医师的过程中，临床技能的发展轨迹因任务而异，并且存在个体间差异。本研究旨在探讨医学实习表现和住院医师入职的预测因素，并发现培训医师表现轨迹的亚型。
本回顾性队列研究纳入了 888 名在 2015 年至 2019 年期间完成医学实习的培训医师。实习结束后，627 名医师于 2016 年至 2020 年期间申请住院医师培训。最终，其中 160 名医师于 2016 年至 2020 年在内科、外科、儿科和精神科完成了第一年的住院医师培训。计算实习表现和第一年住院医师表现之间的 Pearson 相关系数（n = 160）。根据医学院平均绩点（GPA）、实习表现、英语水平和住院医师选拔程序，采用潜在剖面分析确定表现轨迹亚型。还构建了住院医师接受率（n = 627）和第一年住院医师中前 30%/后 10%表现的多变量逻辑回归模型。
医学实习表现与医学院 GPA（r = 0.194）和医学执照考试的书面成绩（r = 0.125）呈显著正相关。住院医师选拔程序面试（调整优势比 [aOR]，2.57）和书面考试（aOR，1.45）得分较高，以及医学实习表现较高（aOR，1.19）与住院医师接受率较高相关。潜在剖面分析确定了培训医师的三个亚组：平均表现、持续高表现（前 30%）和适应变化（最低 10%）。住院医师选拔程序面试得分较高（aOR，1.35）和医学实习表现得分较低（aOR，0.79）与第一年住院医师培训中表现在前 30%或后 10%的可能性较高相关。
面试和医学实习成绩分别预测了第一年住院医师培训中前 30%和后 10%的表现。需要制定个性化的教育计划，以提高学员成为高功能医师的前景。
