title: Identification of high-risk residents.
abstract: BACKGROUND
  Identification of high-risk residents allows remediation and support for administrative action when necessary. This study characterizes differences in documentation of marginally performing residents in a general surgery residency.
  
  
  METHODS
  High-risk residents were identified by the former program director. Twenty-four of one hundred fifteen residents over a 10-year period had one to four problematic areas: cognitive, synthetic, family/health, and interpersonal skills. Outcomes included finished (18), voluntary withdrawal (1), and involuntary withdrawal (5). A case-control study matching controls to cases by date of entry into the training program was used. Records were reviewed for demographics, preentry qualifications, American Board of Surgery In-Training Exam (ABSITE) scores, letters of complaint or praise, events of counseling, and monthly ratings. The records of 48 residents were reviewed. Ward evaluations were on eight categories with a 5-point Leikert scale (3-unacceptable to 7-outstanding). The evaluation score assigns points only to low ratings. High scores represent progressively poorer performance. A Wilcoxon signed ranks test was used to compare the cases and controls for continuous variables. The McNemar test was used in comparisons of categorical data with binary outcomes. Exact P values are reported.
  
  
  RESULTS
  Objective data were similar for both groups. Study residents tended to score higher on monthly evaluations at Year 2 and by Year 3 this achieved significance (0.026). Study residents were more likely to have negative faculty letters (0.016) and events of counseling by a faculty member (0.017) and the program director (0.005).
  
  
  CONCLUSIONS
  Identification of residents at risk should begin as early as possible during training. A combination of faculty evaluations and evidence of letters of counseling can detect high-risk residents. Programs may use such indicators to support decisions regarding remedial work or administrative action.
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas, 75390-9156, USA.
authors.forename: P C
authors.initials: PC
authors.lastname: Bergen
authors.forename: J H
authors.initials: JH
authors.lastname: Littlefield
authors.forename: G E
authors.initials: GE
authors.lastname: O'Keefe
authors.forename: R V
authors.initials: RV
authors.lastname: Rege
authors.forename: T A
authors.initials: TA
authors.lastname: Anthony
authors.forename: L T
authors.initials: LT
authors.lastname: Kim
authors.forename: R H
authors.initials: RH
authors.lastname: Turnage
mesh_terms: D004282:Documentation; D004521:Educational Measurement; D005180:Faculty, Medical; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000145:classification / Q000592:standards*; D007398:Interpersonal Relations; D007400:Interprofessional Relations; D013337:Students, Medical; D013781:Texas; D014481:United States