Trainee and Program Director Perspectives on Meaningful Patient Attribution and Clinical Outcomes Data

The Accreditation Council for Graduate Medical Education specifies that trainees must receive clinical outcomes and quality benchmark data at specific levels related to institutional patient populations. Program directors (PDs) are challenged to identify meaningful data and provide them in formats acceptable to trainees.

We sought to understand what types of patients, data/metrics, and data delivery systems trainees and PDs prefer for supplying trainees with clinical outcomes data.

Trainees (n = 21) and PDs (n = 12) from multiple specialties participated in focus groups during academic year 2017-2018. They described key themes for providing clinical outcomes data to trainees.

Trainees and PDs differed in how they identified patients for clinical outcomes data for trainees. Trainees were interested in encounters where they felt a sense of responsibility or had autonomy/independent decision-making opportunities, continuity, or learned something new; PDs used broader criteria including all patients cared for by their trainees. Both groups thought trainees should be given trainee-level metrics and consistently highlighted the importance of comparison to peers and/or benchmarks. Both groups found value in "push" and "pull" data systems, although trainees wanted both, while PDs wanted one or the other. Both groups agreed that trainees should review data with specific faculty. Trainees expressed concern about being judged based on their patients' clinical outcomes.

Trainee and PD perspectives on which patients they would like outcomes data for differed, but they overlapped for types of metrics, formats, and review processes for the data.