Effect of Performance Deficiencies on Graduation and Board Certification Rates

Abstract

Background-This multi-center, retrospective study was conducted to determine how resident performance deficiencies affect graduation and board certification.Methods-Primary documents pertaining to resident performance were examined over a 10year period at four academic anesthesiology residencies. Residents entering training between 2000 and 2009 were included, with follow-up through February 2016. Residents receiving actions by the programs' Clinical Competency Committee were categorized by the area of deficiency and compared to peers without deficiencies.Results-A total of 865 residents were studied (range: 127-275 per program). Of these, 215 residents received a total of 405 actions from their respective Clinical Competency Committee. Among those who received an action compared to those who did not, the proportion graduating differed (93% versus 99%, respectively, P<0.001), as did the proportion achieving board certification (89% versus 99%, respectively, P<0.001). When a single deficiency in an Essential Attribute (e.g., ethical, honest, respectful behavior; absence of impairment) was identified, the proportion graduating dropped to 55%. When more than three Accreditation Council for Graduate Medical Education core competencies were deficient, the proportion graduating also dropped significantly.Conclusions-Overall graduation and board certification rates were consistently high in residents with no, or isolated, deficiencies. Residents deficient in an Essential Attribute, or multiple competencies, are at high risk of not graduating or achieving board certification. More research is needed on the effectiveness and selective deployment of remediation efforts, particularly for high-risk groups.

Difficulties in Residency: An Examination of Clinical Rotations and Competencies Where Family Medicine Residents Most Often Struggle

“…The remediation rate of 4.3% in our cohort is consistent with literature reported values of 2% to 9%. [1][2][3][4][5][6] Further, the demographics of the residents in this study (Table 1) are comparable to other family medicine residency programs in Canada (see annual reports from the Canadian Post-MD Education Registry, www.caper.ca/ en/post-graduate-medical-education/ annual-census). Finally, family medicine residency training in Canada is accredited by the College of Family Physicians of Canada, and is relatively consistent across Canada in terms of the clinical rotations and experiences that are offered.…”

“…6 The findings of this study are comparable to those in the context of anesthesia residency training programs, where Turner et al described professionalism as the dominating precipitant of resident probation. 5 These findings benefit training programs by giving guidance regarding clinical areas where learners may need extra support. However, it may be more difficult to address professionalism and interpersonal deficiencies.…”

The “Difficult Learner” in anesthesiology: Challenges, pitfalls, and recommendations

“…1 A "difficult trainee" (also often referred to as "problem resident," "problem learner," "resident in difficulty," "troublesome resident") is defined as a learner who demonstrates problem behaviors significant enough to require intervention by program leadership. 2,3 Anesthesiology Program Directors (PDs) in conjunction with their Clinical Competency Committees (CCC) are tasked with assessment of trainee's performance and suitability for graduation and independent practice. 2 Medical educators in anesthesiology are guided by the six Accreditation Council for Graduate Medical Education (ACGME) Core Competencies, specialty and subspecialty-specific ACGME Milestones 4 (Table 1), and the American Board of Anesthesiology (ABA) seven "Essential Attributes."…”

“…2,3 Anesthesiology Program Directors (PDs) in conjunction with their Clinical Competency Committees (CCC) are tasked with assessment of trainee's performance and suitability for graduation and independent practice. 2 Medical educators in anesthesiology are guided by the six Accreditation Council for Graduate Medical Education (ACGME) Core Competencies, specialty and subspecialty-specific ACGME Milestones 4 (Table 1), and the American Board of Anesthesiology (ABA) seven "Essential Attributes." 5 (Table 2).…”

“…2 Deficiencies in multiple ACGME Core Competencies increased the likelihood that a trainee would not progress to graduation and board certification. 2 Professionalism was perhaps the most predictive core competency of future success as unprofessional behavior was associated with subsequent disciplinary action by medical boards. 6 Perhaps even more predictive of failure than the ACGME Core Competencies were the ABA Essential Attributes-residents who lacked in an Essential Attribute were far less likely to obtain ABA certification than those who lacked in other categories (45% vs. 89%).…”