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Identifying Gaps in the Performance of Pediatric Trainees Who Receive Marginal/Unsatisfactory Ratings
Su-Ting T Li1, Daniel J Tancredi, Alan Schwartz
1S.T. Li is associate professor, vice chair of education, and pediatric program director, Department of Pediatrics, University of California, Davis, Sacramento, California. D.J. Tancredi is associate professor, Department of Pediatrics and Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California. A. Schwartz is Michael Reese Endowed Professor of Medical Education, associate head, and director of research, Department of Medical Education, and research professor, Department of Pediatrics, University of Illinois College of Medicine, Chicago, Illinois. A. Guillot is professor, Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont. A. Burke is professor and pediatric program director, Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, Ohio. R.F. Trimm is professor, vice chair, and pediatric program director, Department of Pediatrics, University of South Alabama, Mobile, Alabama. S. Guralnick is associate professor, director of graduate medical education, and designated institutional officer, Office of Academic Affairs, Winthrop University Hospital, Mineola, New York. J.D. Mahan is professor, vice chair, and pediatric and pediatric nephrology fellowship program director, Department of Pediatrics, Nationwide Children's Hospital/Ohio State University, Columbus, Ohio. K.A. Gifford is assistant professor and pediatric program director, Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
Pediatric residents with unsatisfactory performance showed specific skill gaps, particularly in organization and care transfer for first-year trainees. Senior residents struggled with trustworthiness, ethics, and feedback incorporation, requiring tailored improvement plans.
Area of Science:
- Medical Education
- Pediatric Residency Training
- Competency-Based Assessment
Background:
- Assessing resident performance is crucial for ensuring patient safety and effective medical training.
- Identifying specific subcompetency deficits in pediatric residents is essential for targeted educational interventions.
- Existing evaluations may not adequately differentiate performance levels or pinpoint specific areas of weakness.
Purpose of the Study:
- To identify subcompetencies where marginal/unsatisfactory pediatric residents exhibit the greatest deficits compared to satisfactory peers.
- To determine which subcompetencies best discriminate between marginal/unsatisfactory and satisfactory pediatric residents across different training levels.
Main Methods:
- A multi-institutional cohort study analyzed milestone evaluations for 1,704 pediatric residents (postgraduate years 1-3) from 2013-2014.
- Compared milestone levels between marginal/unsatisfactory and satisfactory residents, adjusting for program clustering.
- Calculated C-statistics to assess the discriminatory power of subcompetencies, using a Bonferroni-corrected significance threshold of .0007963.
Main Results:
- First-year residents (PGY1) with unsatisfactory performance showed significant deficits and high discrimination in organizing/prioritizing care and transfer of care.
- Second-year residents (PGY2) had the largest performance gap in trustworthiness.
- Third-year residents (PGY3) demonstrated the greatest differences in ethical behavior, incorporating feedback, and professionalization.
Conclusions:
- Subcompetency deficits vary significantly among pediatric residents with marginal/unsatisfactory performance across different training years.
- First-year residents may exhibit global deficits, while senior residents' deficiencies are more specific.
- Individualized counseling and targeted performance improvement plans are necessary for residents struggling with specific subcompetencies.
