Identification of high-risk residents

Background. Identification of high-risk residents allows remediation and su pport for administrative action when necessary. This study characterizes di fferences in documentation of marginally performing residents in a general surgery residency. Methods. High-risk residents were identified by the former program director . Twenty-four of one hundred fifteen residents over a 10-year period had on e to four problematic areas: cognitive, synthetic, family/health, and inter personal skills. Outcomes included finished (18), voluntary withdrawal (1), and involuntary withdrawal (5), A case-control study matching controls to cases by date of entry into the training program was used, Records were rev iewed for demographics, preentry qualifications, American Board of Surgery In-Training Exam (ABSITE) scores, letters of complaint or praise, events of counseling, and monthly ratings. The records of 48 residents were reviewed . Ward evaluations were on eight categories with a 5-point Leikert scale (3 -unacceptable to 7-outstanding). The evaluation score assigns points only t o low ratings. High scores represent progressively poorer performance. A Wi lcoxon signed ranks test was used to compare the cases and controls for con tinuous variables. The McNemar test was used in comparisons of categorical data with binary outcomes. Exact P values are reported. Results. Objective data were similar for both groups. Study residents tende d to score higher on monthly evaluations at Year 2 and by Year 3 this achie ved significance (0.026). Study residents were more likely to have negative faculty letters (0.016) and events of counseling by a faculty member (0.01 7) and the program director (0.005). Conclusions. Identification of residents at risk should begin as early as p ossible during training. A combination of faculty evaluations and evidence of letters of counseling can detect high-risk residents. Programs may use s uch indicators to support decisions regarding remedial work or administrati ve action. (C) 2000 Academic Press.