Assessing clinical competence in physical medicine & rehabilitation residency programs.
OBJECTIVE
Evaluation of resident clinical competence is a complex task. A multimodal approach is necessary to capture all of the dimensions of competence. Recent guidelines from the Accreditation Council for Graduate Medical Education delineate six general competencies that physicians should posses. Application of these guidelines presents challenges to residency program directors in defining educational experiences and evaluation methods.


METHODS
We surveyed 81 physical medicine and rehabilitation program directors regarding assessment tools used in their programs. Seventy-five percent responded. The most frequently used assessment tools included: In-training self-assessment examinations, faculty evaluations, direct observation, and conference participation. Program directors assigned the highest values to direct observation, faculty evaluations, self-assessment examinations, and oral examinations.


RESULTS
Of the general competencies, more than 90% of program directors believed they did an adequate job rating dimensions of patient care, medical knowledge, professionalism, and communication skills. Approximately one-third, however, thought they did a less than fair job rating practice-based learning and improvement and systems-based practice. The majority of programs reported that they were able to identify a resident with difficulties during the first year of training, 44% within the first 6 months. Program directors reported that their residents spend a significant amount of their time with nurses and therapists during their inpatient rotations; however, this was not reflected in their evaluation practices, in which only one-fourth of programs reported the use of nurses and therapists in evaluating residents.


CONCLUSIONS
Survey results indicate that physical medicine and rehabilitation program directors apply a variety of assessment tools in evaluating resident clinical competence. Although perceptions about the relative value of these tools vary, most programs report a high value to direct observation of residents by faculty. Of the six general competencies, program directors struggle the most with their evaluation of practice-based learning and improvement and systems-based practice.
Pasquina
Paul F
PF
Physical Medicine and Rehabilitation Training, Walter Reed Army Medical Center, Washington, DC 20307, USA.
Kelly
Sean
S
Hawkins
Richard E
RE
D002983:Clinical Competence / Q000592:standards*; D004521:Educational Measurement; D017408:Guidelines as Topic; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D010810:Physical and Rehabilitation Medicine / Q000193:education*; D011795:Surveys and Questionnaires; D014481:United States