COMPARING MEDICAL-SCHOOL GRADUATES WHO PERFORM POORLY IN RESIDENCY WITH GRADUATES WHO PERFORM WELL

Background. Most medical school graduates perform well as residents. H owever, the authors' annual surveys have shown that a few graduates fr om each class at their school fail to meet residency directors' expect ations. Method. The medical school records of the 20 of the 153 gradua tes from the class of 1983 at the University of California, San Franci sco, School of Medicine who received poor evaluations from their resid ency directors in the first and/or second year of residency were compa red with the records of 20 of their best-received classmates. The poor ly received graduates did not necessarily receive poor numerical ratin gs of their knowledge, skills, or overall performances, but they did r eceive negative or ambivalent responses to the following question: ''K nowing what you now know about this resident, would select him or her again? Please explain.'' The two groups of graduates were matched for sex, racial-ethnic identification, and residency discipline. Results. The groups were quite similar with respect to qualifications for admis sion to medical school, overall academic achievement, and performance on standardized national examinations. There were minor differences in performances on clinical clerkships. Conclusion. As indicated by resi dency directors' ratings and comments, most of the poorly received gra duates' problems during residency appear to have been personal and mot ivational rather than skills- or knowledge-related. With but few excep tions, the medical school records contained little evidence that might have predicted the graduates' poor reception as residents.