Critical performance analysis of rotating resident doctors in Iraq

The present study was undertaken to evaluate the competence of rotating residents in handling clinical problems, falling under the purview of the major clinical disciplines, which they come across during their routine work. Three hundred and one rotating residents (55% of the total) who graduated in June 1981 from the four universities of Iraq, namely, Mustansiryia, Basrah, Mosul and Baghdad, and were currently undergoing their residency posting in the various hospitals of Iraq were selected for the study. Two approaches were used to assess the level of competence: first, on the basis of the resident's responses to fifty simulated patient-management problems and, secondly, their critical performance in patient care adjudged by their respective supervisors. A minimum passing level (MPL) was fixed for patient management problems (PMP). The score for the consultant's observations could range from -70 to +100 to represent the very poor and the very good performance. Only 2% of the residents were found to have reached the minimum pass level of competence taking their overall performance in the various disciplines. No significant variation in performance was observed in relation to the university of graduation. None of the residents could reach the MPL in the case of obstetrics and gynaecology. In the case of medicine and medical emergency the findings were almost similar. The residents put up a much better performance in orthopaedics and paediatrics (45.0% and 27.5% respectively). According to the supervisors' assessment nearly two-thirds of the residents secured at least 50% of the maximum score. The study underscores the need to redefine our educational objectives specifically, with aim of developing competences at a defined level in the learner befitting the needs of the health system through a competency-based curriculum.