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Mind the Gap: Rethinking Procedural Skill Assessment in Medical Residency
Pete Meliagros1, Adam Garber1, Matthew Ambrosio2
1From the Department of Internal Medicine, Division of Hospital Medicine, Virginia Commonwealth University Health, Richmond.
Southern Medical Journal
|August 4, 2026
Summary
This study found that combining procedural checklists and global rating scales (GRSs) with self-evaluation improves resident procedural skill assessment. This approach helps bridge the gap between perceived and actual competency.
Area of Science:
- Medical Education
- Clinical Skills Assessment
- Procedural Competency
Background:
- Evaluating resident proficiency in bedside procedures is crucial for patient safety.
- Existing assessment tools may not fully capture actual procedural skill, leading to a 'competency gap'.
- Self-assessment is a potential tool to enhance procedural skill evaluation.
Purpose of the Study:
- To assess the effectiveness of different tools in evaluating resident bedside procedure proficiency.
- To explore the value of self-assessment in closing the gap between perceived and actual procedural skills.
Main Methods:
- A retrospective, observational study analyzed resident performance on two bedside procedures.
- Evaluated residents using evidence-based global rating scales (GRSs) and procedural checklists.
- Compared supervisor assessments with resident self-assessments to identify discrepancies.
Main Results:
- Most residents completed procedural checklist items (94% and 79%).
- Fewer residents achieved a high GRS score (≥4) and completed all checklist items (79% and 48%).
- Residents were more likely to complete checklist items than achieve a high GRS score (P < 0.001).
Conclusions:
- Comprehensive performance checklists and GRSs offer a more precise evaluation.
- Integrating self-evaluation coaching and feedback enhances procedural performance assessment.
- A combined approach provides a more accurate measure of resident competency.
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