title: An ounce of prevention: how are we managing the early assessment of residents' clinical skills?: A CERA study.
abstract: OBJECTIVE
  Clinical skills deficits in residents are common but when identified early can result in decreased cost, faculty time, and stress related to remediation. There is currently no accepted best practice for early assessment of incoming residents' clinical skills. This study describes the current state of early PGY-1 clinical skills assessment in US family medicine residencies.
  
  
  METHODS
  Eleven questions were embedded in the nationwide CERA survey to US family medicine residency directors regarding the processes, components, and barriers to early PGY-1 assessment. Responses are described, and bivariate analyses of the relationship between assessment variables and percentage of international medical graduates (IMGs), type of program, and barriers to implementation were performed using chi square testing.
  
  
  RESULTS
  Almost four of five (78.4%) responding programs conduct formal early assessments to establish baseline clinical skills (89.6%), provide PGY-1 residents with a guide to focus their learning goals (71.6%), and less often, in response to resident performance problems (34.3%). Barriers to implementing PGY-1 early assessment programs include cost of faculty time (56.3%), cost of tools (42.1%), and time for the assessment during the PGY-1 resident's schedule (41.0%). Cost of faculty time and time for assessment from the PGY-1 resident's schedule were statistically significant major/insurmountable barriers for community-based, non-university-affiliated programs.
  
  
  CONCLUSIONS
  Early PGY-1 assessments with locally developed tools for direct observation are commonly used in family medicine residency programs. Assessment program development should be targeted toward using existing, validated tools during the PGY-1 resident's patient care schedule.
authors.affiliation: Department of Family Medicine and Community Health, University of Massachusetts, MA, USA. tracy.kedian@umassmed.edu
authors.forename: Tracy
authors.initials: T
authors.lastname: Kedian
authors.forename: Lisa
authors.initials: L
authors.lastname: Gussak
authors.forename: Judith A
authors.initials: JA
authors.lastname: Savageau
authors.forename: Andreas
authors.initials: A
authors.lastname: Cohrssen
authors.forename: Ilene
authors.initials: I
authors.lastname: Abramson
authors.forename: Kelly
authors.initials: K
authors.lastname: Everard
authors.forename: Alison
authors.initials: A
authors.lastname: Dobbie
mesh_terms: D002983:Clinical Competence / Q000592:standards / Q000706:statistics & numerical data*; D004503:Education, Medical, Graduate / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D004521:Educational Measurement / Q000592:standards / Q000706:statistics & numerical data*; D005194:Family Practice / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000592:standards / Q000706:statistics & numerical data