Effect of Performance Deficiencies on Graduation and Board Certification Rates: A 10-yr Multicenter Study of Anesthesiology Residents.
BACKGROUND
This multicenter, retrospective study was conducted to determine how resident performance deficiencies affect graduation and board certification.


METHODS
Primary documents pertaining to resident performance were examined over a 10-yr period at four academic anesthesiology residencies. Residents entering training between 2000 and 2009 were included, with follow-up through February 2016. Residents receiving actions by the programs' Clinical Competency Committee were categorized by the area of deficiency and compared to peers without deficiencies.


RESULTS
A total of 865 residents were studied (range: 127 to 275 per program). Of these, 215 residents received a total of 405 actions from their respective Clinical Competency Committee. Among those who received an action compared to those who did not, the proportion graduating differed (93 vs. 99%, respectively, P < 0.001), as did the proportion achieving board certification (89 vs. 99%, respectively, P < 0.001). When a single deficiency in an Essential Attribute (e.g., ethical, honest, respectful behavior; absence of impairment) was identified, the proportion graduating dropped to 55%. When more than three Accreditation Council for Graduate Medical Education Core Competencies were deficient, the proportion graduating also dropped significantly.


CONCLUSIONS
Overall graduation and board certification rates were consistently high in residents with no, or isolated, deficiencies. Residents deficient in an Essential Attribute, or multiple competencies, are at high risk of not graduating or achieving board certification. More research is needed on the effectiveness and selective deployment of remediation efforts, particularly for high-risk groups.
From the Departments of Anesthesiology and Perioperative Medicine (J.A.T., Y.M.H., M.A.K., K.J.H.-Q., N.Z.N., J.C.B., R.H.S.), Medicine Statistics Core (T.R.G.), and UCLA Simulation Center (M.D.D.R.), David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts (M.G.F.); Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California (M.C.P.); and Department of Anesthesiology, University of Colorado School of Medicine, Denver, Colorado (J.L.H.).
Judi A
JA
Turner
Michael G
MG
Fitzsimons
Manuel C
MC
Pardo
Joy L
JL
Hawkins
Yue Ming
YM
Huang
Maria D D
MD
Rudolph
Mary A
MA
Keyes
Kimberly J
KJ
Howard-Quijano
Natale Z
NZ
Naim
Jack C
JC
Buckley
Tristan R
TR
Grogan
Randolph H
RH
Steadman
D000068:Accreditation; D000776:Anesthesiology / Q000193:education* / Q000592:standards*; D002568:Certification; D002983:Clinical Competence; D003142:Communication; D004503:Education, Medical, Graduate / Q000592:standards; D004521:Educational Measurement; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D024382:Professional Role; D012189:Retrospective Studies