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Simulation-based Assessment to Reliably Identify Key Resident Performance Attributes
Richard H Blum1, Sharon L Muret-Wagstaff, John R Boulet
1From the Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts (R.H.B.); the Department of Surgery, Emory University School of Medicine, Atlanta, Georgia (S.L.M.-W.); the Foundation for Advancement of International Medical Education and Research, Philadelphia, Pennsylvania (J.R.B.); the Center for Medical Simulation, Charlestown, Massachusetts (J.B.C., R.H.B.); and the Department of Anesthesia, Critical Care and Pain Medicine (J.B.C.), the Department of Surgery and Massachusetts General Hospital Learning Laboratory (E.R.P.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts Center for Medical Simulation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts Newton-Wellesley Hospital, Newton, Massachusetts Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Background:
Obtaining reliable and valid information on resident performance is critical to patient safety and training program improvement. The goals were to characterize important anesthesia resident performance gaps that are not typically evaluated, and to further validate scores from a multiscenario simulation-based assessment.
Methods:
Seven high-fidelity scenarios reflecting core anesthesiology skills were administered to 51 first-year residents (CA-1s) and 16 third-year residents (CA-3s) from three residency programs. Twenty trained attending anesthesiologists rated resident performances using a seven-point behaviorally anchored rating scale for five domains: (1) formulate a clear plan, (2) modify the plan under changing conditions, (3) communicate effectively, (4) identify performance improvement opportunities, and (5) recognize limits. A second rater assessed 10% of encounters. Scores and variances for each domain, each scenario, and the total were compared. Low domain ratings (1, 2) were examined in detail.
Results:
Interrater agreement was 0.76; reliability of the seven-scenario assessment was r = 0.70. CA-3s had a significantly higher average total score (4.9 ± 1.1 vs. 4.6 ± 1.1, P = 0.01, effect size = 0.33). CA-3s significantly outscored CA-1s for five of seven scenarios and domains 1, 2, and 3. CA-1s had a significantly higher proportion of worrisome ratings than CA-3s (chi-square = 24.1, P < 0.01, effect size = 1.50). Ninety-eight percent of residents rated the simulations more educational than an average day in the operating room.
Conclusions:
Sensitivity of the assessment to CA-1 versus CA-3 performance differences for most scenarios and domains supports validity. No differences, by experience level, were detected for two domains associated with reflective practice. Smaller score variances for CA-3s likely reflect a training effect; however, worrisome performance scores for both CA-1s and CA-3s suggest room for improvement.
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