Judging residents' performance: a qualitative study using grounded theory

Although program directors judge residents' performance for summative decisions, little is known about how they do this. This study examined what information program directors use and how they value this information in making a judgment of residents' performance and what residents think of this process.

Sixteen semi-structured interviews were held with residents and program directors from different hospitals in the Netherlands in 2015-2016. Participants were recruited from internal medicine, surgery and radiology. Transcripts were analysed using grounded theory methodology. Concepts and themes were identified by iterative constant comparison.

When approaching semi-annual meetings with residents, program directors report primarily gathering information from the following: assessment tools, faculty members and from their own experience with residents. They put more value on faculty's comments during meetings and in the corridors than on feedback provided in the assessment tools. They are influenced by their own beliefs about learning and education in valuing feedback. Residents are aware that faculty members discuss their performance in meetings, but they believe the assessment tools provide the most important proof to demonstrate their clinical competency.

Residents think that feedback in the assessment tools is the most important proof to demonstrate their performance, whereas program directors scarcely use this feedback to form a judgment about residents' performance. They rely heavily on remarks of faculty in meetings instead. Therefore, residents' performance may be better judged in group meetings that are organised to enhance optimal information sharing and decision making about residents' performance.