Bc. Warf et al., The relative contributions of interpersonal and specific clinical skills to the perception of global clinical competence, J SURG RES, 86(1), 1999, pp. 17-23
Background. The objective structured clinical examination (OSCE), an establ
ished instrument for evaluating resident competence, was used to test the h
ypothesis that faculty assessment of clinical competence in residents at va
rious levels of training may be influenced more by general skills as a phys
ician and less by competency in the actual skills being specifically tested
. In this study, advantage was taken of the anticipated observation that ge
neral surgery residents did not demonstrate improvement in their ability to
perform a focused neurological assessment over time.
Methods. An OSCE, which was administered to 56 general surgery residents at
all levels of training, included the assessment of a specific clinical neu
rosurgical problem (sciatica). Univariate and multivariate analyses were us
ed to evaluate the relationship between the global faculty judgment of comp
etent or noncompetent and the other performance measures that were applied.
Results. At different levels of training, there was no observed difference
in the specific skills being tested; nevertheless, junior and senior reside
nts were more likely than incoming interns to be judged "competent" and rec
eived better evaluations of how well they introduced themselves to the pati
ent. The competence judgment correlated significantly with all of the other
performance measures, including the skills being tested.
Conclusions. The perception of competence is not solely dependent upon the
particular skills under scrutiny. General competence does not guarantee com
petence in each specific skill set of a medical specialty. (C) 1999 Academi
c Press.