Resident clinical competence in cardiac anesthesia: a case performance-based evaluation study

The purpose of this study was to estimate the minimum number of cases that anesthesiology residents need to complete in order to master the clinical skills required in cardiac anesthesia. In addition, the extent to which the resident's general anesthesia experience and in-training examination scores influence clinical performance was also studied. The data presented were based on observation of 99 actual cases, which were managed by 16 residents. A performance-based evaluation approach was developed, encompassing nine clinical performance skills considered essential to effective and safe cardiac anesthesia management. It was determined that there was consistent improvement in every clinical skill with the number of cardiac cases managed, except for preanesthetic assessment. The minimum number of cardiac cases that residents needed to manage before achieving a satisfactory level of skill ranged from about 10 cases for preoperative assessment to 20 to 30 cases for hemodynamic and coagulation management. It is concluded that residents needed different lengths of time to develop different skills, and it is logical to look at each basic skill independently in the evaluation of resident progress. Based on the findings of this study, it is suggested that a case performance-based evaluation approach might provide a more objective and accurate means for assessing resident progress in cardiac anesthesia.