title: Factors affecting resident performance: development of a theoretical model and a focused literature review.
abstract: OBJECTIVE
  The clinical performances of physicians have come under scrutiny as greater public attention is paid to the quality of health care. However, determinants of physician performance have not been well elucidated. The authors sought to develop a theoretical model of physician performance, and explored the literature about factors affecting resident performance.
  
  
  METHODS
  Using expert consensus panel, in 2002-03 the authors developed a hypothesis-generating model of resident performance. The developed model had three input factors (individual resident factors, health care infrastructure, and medical education infrastructure), intermediate process measures (knowledge, skills, attitudes, habits), and final health outcomes (affecting patient, community and population). The authors used factors from the model to focus a PubMed search (1967-2002) for all original articles related to the factors of individual resident performance.
  
  
  RESULTS
  The authors found 52 original studies that examined factors of an individual resident's performance. They describe each study's measurement instrument, study design, major findings, and limitations. Studies were categorized into five domains: learning styles/personality, social/financial factors, practice preferences, personal health, and response to job environment. Few studies examined intermediate or final performance outcomes. Most were single-institution, cross-sectional, and survey-based studies.
  
  
  CONCLUSIONS
  Attempting to understand resident performance without understanding factors that influence performance is analogous to examining patient adherence to medication regimens without understanding the individual patient and his or her environment. Based on a systematic review of the literature, the authors found few discrete associations between the factors of individual resident and the resident's actual job performance. Additionally, they identify and discuss major gaps in the educational literature.
authors.affiliation: Department of Medicine, University of California, Davis, School of Medicine, 4150 V. Street, Suite 2400, Sacramento, CA 95817, USA.
authors.forename: Maya
authors.initials: M
authors.lastname: Mitchell
authors.forename: Malathi
authors.initials: M
authors.lastname: Srinivasan
authors.forename: Daniel C
authors.initials: DC
authors.lastname: West
authors.forename: Peter
authors.initials: P
authors.lastname: Franks
authors.forename: Craig
authors.initials: C
authors.lastname: Keenan
authors.forename: Mark
authors.initials: M
authors.lastname: Henderson
authors.forename: Michael
authors.initials: M
authors.lastname: Wilkes
mesh_terms: D000328:Adult; D002140:California; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000592:standards / Q000639:trends; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D008962:Models, Theoretical; D010818:Practice Patterns, Physicians'; D012680:Sensitivity and Specificity; D013647:Task Performance and Analysis