Assessing residents' competencies at baseline: identifying the gaps.
OBJECTIVE
Entering residents have variable medical school experiences and differing knowledge and skill levels. To structure curricula, enhance patient safety, and begin to meet accreditation requirements, baseline assessment of individual resident's knowledge and skills is needed. To this end, in 2001 the University of Michigan Health System created the Postgraduate Orientation Assessment (POA), an eight-station, objective structured clinical examination for incoming residents.


METHODS
The POA, administered at orientation, included items addressing critical laboratory values, cross-cultural communication, evidence-based medicine, radio-graphic image interpretation, informed consent, pain assessment and management, aseptic technique, and system compliance such as fire safety. The POA assessed many of the skills needed by interns in their initial months of training when supervision by senior physicians might not be present.


RESULTS
In 2002, 132 interns from 14 different specialties and 59 different schools participated in the POA. The mean score was 74.8% (SD = 5.8). When scores were controlled for U.S. Medical Licensing Examination scores, there were no significant differences in performance across specialties. There were differences between University of Michigan Medical School graduates and those from other institutions (p <.001). Eighty-one percent of the residents would recommend the POA.


CONCLUSIONS
The POA provides a feasible format to measure initial knowledge and skills and identify learning needs. Orientation is an effective time to identify important gaps in learning between medical school and residency. This is the first step in a continuing evaluation of the Accreditation Council for Graduate Medical Education's general competencies.
Lypson
Monica L
ML
VA Ann Arbor Healthcare System and the Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, 48109-0429, USA. Mlypson@umich.edu
Frohna
John G
JG
Gruppen
Larry D
LD
Woolliscroft
James O
JO
D000068:Accreditation; D000328:Adult; D002983:Clinical Competence; D018864:Cultural Diversity; D004503:Education, Medical, Graduate / Q000592:standards / Q000639:trends; D004521:Educational Measurement / Q000592:standards*; D019317:Evidence-Based Medicine / Q000193:education; D005260:Female; D006801:Humans; D007258:Informed Consent; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D008511:Medicine; D011336:Probability; D012577:Schools, Medical / Q000592:standards / Q000639:trends; D012680:Sensitivity and Specificity; D013038:Specialization; D014481:United States