Assessing Residents’ Competency at Baseline: How Much Does the Medical School Matter?

This month’s Journal Club post was written by Kaylee Underkofler, Maine Track ’18, based on the following article: Assessing Residents’ Competency at Baseline: How Much Does the Medical School Matter? by Gollehon, Stansfield, Guppen, Colletti, Haftel, Woolliscroft, and Lypson.

As medical education shifts focus from time-based curricula to competency-based curricula, there is growing interest in how competency is measured and the factors that influence it. Motivated by a concern that new doctors may be entering residency unprepared, or incompetent, Gollehon et al. studied the relationship between interns’ medical schools of origin and their baseline competency as measured by objective structured clinical examinations (OSCE) during residency orientation. The study was performed from 2002-2012 and measured the clinical performance of all 1,795 first year residents at the University of Michigan Health System in that timeframe. Using linear mixed models, the researchers found that 4.19% of variance in overall clinical performance on the OSCE was attributable to medical school of origin. These findings suggest that where an individual attends medical school does influence their baseline competency upon entering residency. More studies are needed to characterize which features of a medical school have the greatest impact on developing competent new physicians.

 

Discussion Questions:

  1. How can medical schools better prepare their students for residency? What features of different medical schools might explain the observed variance in clinical performance?
  2. Should medical students undergo summative evaluation of standardized competencies as a requirement for graduation? How would this be done? Which competencies should be tested?
  3. Do you think the investigators should release the individual medical schools’ performance results? If the results were to be released, would it be acceptable for residency programs to use the data when ranking prospective trainees for the match?

 

References:

  1. Gollehon NS, Stansfield RB, Gruppen LD, Colletti L, Haftel H, Woolliscroft JO, Lypson ML. Assessing residents’ competency at baseline: how much does the medical school matter? J. Grad. Med. Educ. 2017 Oct;9(5):617-621.

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