Cutting the Gordian knot: a two-part approach to the evaluation and professional development of residents.

There is chronic dissatisfaction among both faculty and students about the process and effectiveness of resident performance evaluation. The author asserts that the source of this problem is the current practice of merging the two different purposes for evaluation: to monitor residents' meeting of performance standards and to provide guidance for residents' professional development. By attempting to meet both quality-control and guidance obligations using one set of objective data, most residency programs fall short in meeting one of these aims. The common preoccupation with psychometric precision, objectivity, and the statistical processing of forms frequently distracts users from making effective use of evaluation information. The proposed solution is to divide resident evaluation into two simpler, entirely separate and distinct systems--neither of which would look much like the current system. There would be a faculty-controlled, quality-control system focused on screening for minimal performance standards. This would use simple, qualitative measures for early warning and rapid follow-up. The second evaluation system would be a resident-controlled, guidance-oriented system focused on self-assessment, peer and faculty coaching, and reflection. The hypothesized benefits of this approach include an improvement in residents' motivation and performance, an increase in residents' self-direction, and an enhancement of communication between residents and faculty members.