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Evaluating obstetrical residency programs using patient outcomes.

David A Asch1, Sean Nicholson, Sindhu Srinivas

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Obstetrics and gynecology residency programs can be ranked by patient complication rates. This quality of care metric is stable and independent of physician licensing exam scores.

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Area of Science:

  • Medical Education
  • Obstetrics & Gynecology
  • Patient Safety

Background:

  • Hospital and physician performance are assessed by patient outcomes.
  • Residency programs traditionally use nonclinical measures for comparison.

Purpose of the Study:

  • To determine if obstetrics and gynecology residency programs can be evaluated based on the quality of care provided by their alumni.
  • Investigating the link between residency training and patient outcomes in obstetrics.

Main Methods:

  • Retrospective analysis of 4,906,169 obstetrical discharges in Florida and New York (1992-2007).
  • Examined 4,124 obstetricians from 107 US residency programs.
  • Utilized nine measures of maternal complications for vaginal and cesarean deliveries.

Main Results:

  • Significant variation in maternal complication rates was associated with obstetricians' residency programs.
  • Graduates from lower-ranked programs had a 3.3% higher complication rate compared to top-ranked programs.
  • Program rankings remained consistent across different complication measures and were not influenced by licensing exam scores.

Conclusions:

  • Obstetrics and gynecology residency programs can be effectively ranked using maternal complication rates of their graduates' patients.
  • These rankings provide a stable and objective measure of program quality.
  • Quality of care metrics are independent of resident licensing examination performance.