Mind the Gap: Rethinking Procedural Skill Assessment in Medical Residency

OBJECTIVES: The purpose of this study was to investigate the efficacy of various assessment tools in accurately evaluating resident proficiency in bedside procedures and to determine the potential value of incorporating self-assessment as a means to bridge the “competency gap” between perceived and actual procedural skill. METHODS: This retrospective, observational study evaluated resident performance of two common bedside procedures using evidence-based global rating scales (GRSs) and procedural checklists. We additionally compared supervisor assessments with resident self-assessments to identify discrepancies. Residents were assessed by a small group of expert faculty on a medicine procedure service at Virginia Commonwealth University from June 2016 to July 2020. RESULTS: Most residents (94% and 79%) performed all of the procedural checklist items. Only 79% and 48% of residents achieved both a GRS score ≥4 and completed all of the items on the checklist for each respective procedure. Residents were significantly more likely to perform all items on the checklist than obtain a GRS score ≥4 (P < 0.001) for both procedures. The mean number of procedures needed for resident and supervisor assessment to agree was 1.34 and 1.28. CONCLUSIONS: The combined use of comprehensive performance checklists and GRSs, coupled with deliberate self-evaluation coaching and timely feedback, provides a more comprehensive and precise evaluation of procedural performance.