Written Tests: The formats and types of testing (i.e., essay, multiple choice), vary greatly and each has its strengths. Most programs use some form of written testing in evaluating the knowledge and comprehension of specific subjects, reading assignments, rotations, and lectures. Additionally, national tests (e.g., inservice examinations) allow for relative comparisons among residency groups.
Oral Tests: Many programs use oral testing or interviews to assess the knowledge, comprehension, and judgment of residents in many areas of clinical patient management. Oral tests may use standardized presentations and allow relative comparisons between residents within a program.
Attendance Records: Attendance records are used to ensure adequate attendance at didactic and other programs.
Log Books: Log books are used to accumulate statistics on procedures, the number and types of patients seen, acuity levels and other objective data to ensure adequate clinical experience.
Quality Assurance Programs (Q.A.): This information may be used to provide statistical and subjective data concerning performance, quality of care, complaints, productivity, utilization review, appropriate documentation, and appropriate use of ancillary tests. Several programs use the data to determine the ability of residents to provide appropriate documentation. QA programs frequently identify problems from ineffective communication. Information from the management of complaints and assessment of patient satisfaction can be provided to assess minimal levels of expected performance. Some QA programs also provide statistical information and productivity. Problems with patient management and disposition may be identified via the QA process, as well as the length of time taken to make dispositions. This information is best used to access the resident's ability to meet a minimum expected level of performance or identify potential problems.
Departmental/Statistical: Patient numbers, acuity levels, admissions, diagnoses, procedures, etc., may be derived from departmental data for particular physicians. Billing information may provide this data and has been used to monitor productivity and performance. Programs may establish productivity goals for each PGY level. Additionally, they may look at outliers both too high and too low as a means to determine if there are any problems with the care provided.
Evaluations of Lectures and Presentations Given by Residents: Evaluation of presentations provide direct feedback to presenters from their audience. Establishing standardized methods to evaluate presentations helps provide meaningful and constructive feedback.
Rotation Evaluations: Clinical evaluation of performance on rotations is best provided by the physicians directly supervising the resident. Establishing specific areas to evaluate, using standardized forms, and defining expectations for evaluators for resident performance allows for more reliable and useful evaluations.
Supervision: Direct supervision, observation and feedback are the most commonly used evaluation techniques. This includes the direct immediate feedback provided by supervising attendings as residents provide patient care. Establishing expected levels of performance for specific resident levels and assuring the skills of supervisors to effectively evaluate and constructively communicate maximizes this type of feedback. Additionally, some programs have scheduled evaluations of specific cases (either real or simulated) at specified times in the training program.
Laboratory and Procedures Skills: Testing can assess technical skill levels through direct observation. Skills demonstrations may be used during the course of patient care.
Case Simulations: These may be used in verbal and written forms, as well as in patient simulations to evaluate patient assessment and management skills.
Resident Self-Evaluation: This technique has been used in conjunction with resident interviews to focus on compliance with expectations and subjective elements of individual performance.
Videotape Evaluations: Videotapes have been used to allow self-evaluation and for critical evaluation of performance (i.e., trauma resuscitation tapes).
M&M Case Presentations: These allow for peer evaluation and feedback.
Job Evaluations: Some programs ask the clinical supervisors of their graduates to provide an evaluation of the graduate's clinical and administrative skills. These programs use this information to strengthen areas of weakness.
Interactive Computer Programs: These have been used by some programs to assess knowledge and skill levels.
Achievement of Certifications (ACLS, ATLS, PALS, Base Station Course): These courses use the specific evaluation methods developed for each course.
Formal Written Resident Evaluations: The program director is required to provide direct feedback to the resident on performance at least biannually. Frequently, these are based on written evaluations by faculty and a compilation of other information on the resident's performance.
Resident Evaluations: Residents are frequently asked to evaluate rotations, lectures and faculty. Some programs have asked residents to evaluate their training after they have been in their first clinical job for one year.