Evaluating the performance of inpatient attending physicians: a new instrument for today's teaching hospitals.
OBJECTIVE
Instruments available to evaluate attending physicians fail to address their diverse roles and responsibilities in current inpatient practice. We developed a new instrument to evaluate attending physicians on medical inpatient services and tested its reliability and validity.


METHODS
Analysis of 731 evaluations of 99 attending physicians over a 1-year period.


METHODS
Internal medicine residency program at a university-affiliated public teaching hospital.


METHODS
All medical residents (N= 145) and internal medicine attending physicians (N= 99) on inpatient ward rotations for the study period.


METHODS
A 32-item questionnaire assessed attending physician performance in 9 domains: evidence-based medicine, bedside teaching, clinical reasoning, patient-based teaching, teaching sessions, patient care, rounding, professionalism, and feedback. A summary score was calculated by averaging scores on all items.


RESULTS
Eighty-five percent of eligible evaluations were completed and analyzed. Internal consistency among items in the summary score was 0.95 (Cronbach's alpha). Interrater reliability, using an average of 8 evaluations, was 0.87. The instrument discriminated among attending physicians with statistically significant differences on mean summary score and all 9 domain-specific mean scores (all comparisons, P <.001). The summary score predicted winners of faculty teaching awards (odds ratio [OR], 17; 95% confidence interval [CI], 8 to 36) and was strongly correlated with residents' desire to work with the attending again (r =.79; 95% CI, 0.74 to 0.83). The single item that best predicted the summary score was how frequently the physician made explicit his or her clinical reasoning in making medical decisions (r(2)=.90).


CONCLUSIONS
The new instrument provides a reliable and valid method to evaluate the performance of inpatient teaching attending physicians.
Smith
Christopher A
CA
Department of Medicine, Cook County, Chicago, IL 60612, USA. christopher_smith@rush.edu
Varkey
Anita B
AB
Evans
Arthur T
AT
Reilly
Brendan M
BM
D002983:Clinical Competence; D005240:Feasibility Studies; D006779:Hospitals, Public; D006784:Hospitals, Teaching; D006801:Humans; D007388:Internal Medicine / Q000193:education / Q000592:standards*; D007396:Internship and Residency / Q000592:standards*; D008485:Medical Audit; D008505:Medical Staff, Hospital / Q000592:standards*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires