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Acad Med. 2017 Jun 20. doi: 10.1097/ACM.0000000000001775. [Epub ahead of print]

Identifying Gaps in the Performance of Pediatric Trainees Who Receive Marginal/Unsatisfactory Ratings.

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S.T. Li is associate professor, vice chair of education, and pediatric program director, Department of Pediatrics, University of California, Davis, Sacramento, California. D.J. Tancredi is associate professor, Department of Pediatrics and Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California. A. Schwartz is Michael Reese Endowed Professor of Medical Education, associate head, and director of research, Department of Medical Education, and research professor, Department of Pediatrics, University of Illinois College of Medicine, Chicago, Illinois. A. Guillot is professor, Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont. A. Burke is professor and pediatric program director, Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, Ohio. R.F. Trimm is professor, vice chair, and pediatric program director, Department of Pediatrics, University of South Alabama, Mobile, Alabama. S. Guralnick is associate professor, director of graduate medical education, and designated institutional officer, Office of Academic Affairs, Winthrop University Hospital, Mineola, New York. J.D. Mahan is professor, vice chair, and pediatric and pediatric nephrology fellowship program director, Department of Pediatrics, Nationwide Children's Hospital/Ohio State University, Columbus, Ohio. K.A. Gifford is assistant professor and pediatric program director, Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.



To perform a derivation study to determine in which subcompetencies marginal/unsatisfactory pediatric residents had the greatest deficits compared with their satisfactorily performing peers and which subcompetencies best discriminated between marginal/unsatisfactory and satisfactorily performing residents.


Multi-institutional cohort study of all 21 milestones (rated on four or five levels) reported to the Accreditation Council for Graduate Medical Education, and global marginal/unsatisfactory versus satisfactory performance reported to the American Board of Pediatrics. Data were gathered in 2013-2014. For each level of training (postgraduate year [PGY] 1, 2, and 3), mean differences between milestone levels of residents with marginal/unsatisfactory and satisfactory performance adjusted for clustering by program and C-statistics (area under receiver operating characteristic curve) were calculated. A Bonferroni-corrected significance threshold of .0007963 was used to account for multiple comparisons.


Milestone and overall performance evaluations for 1,704 pediatric residents in 41 programs were obtained. For PGY1s, two subcompetencies had almost a one-point difference in milestone levels between marginal/unsatisfactory and satisfactory trainees and outstanding discrimination (≥ 0.90): organize/prioritize (0.93; C-statistic: 0.91) and transfer of care (0.97; C-statistic: 0.90). The largest difference between marginal/unsatisfactory and satisfactory PGY2s was trustworthiness (0.78). The largest differences in marginal/unsatisfactory and satisfactory PGY3s were ethical behavior (1.17), incorporating feedback (1.03), and professionalization (0.96). For PGY2s and PGY3s, no subcompetencies had outstanding discrimination.


Marginal/unsatisfactory pediatric residents had different subcompetency gaps at different training levels. While PGY1s may have global deficits, senior residents may have different performance deficiencies requiring individualized counseling and targeted performance improvement plans.

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