An Analysis of Gaps in Resident Performance Data and Competence Determination in Surgical Training

open_access
Open Access
Author:
Mesler, Sarah
Area of Honors:
Industrial Engineering
Degree:
Bachelor of Science
Document Type:
Thesis
Thesis Supervisors:
Scarlett Miller, Thesis Supervisor
Joseph Dennis Cuiffi, Thesis Honors Advisor
Keywords:
Residency Training
Hospital Systems
Procedural Competence
Surgical Education
Central Venous Catheterization
Clinical Documentation Systems
Patient Safety
Abstract:
Medical training is evolving with technological advancements, but non-interoperable hospital systems and unstandardized resident performance documentation create challenges for medical educators and researchers in evaluating whether skills developed during resident training translate to clinical performance. Specifically, these challenges arise from training and assessment measures that differ by specialty and institution, reporting across multiple systems, and inconsistent and unstandardized documentation. This study aimed to identify resident procedural performance documentation systems and barriers to accurate, consistent data tracking for Central Venous Catheterization (CVC) at a large academic medical center. Thirty-minute semi-structured interviews were conducted with 5 medical residents, 1 fellow, 1 attending physician, and 2 program coordinators at a large academic medical center. Interviews were audio-recorded and transcribed, then analyzed using thematic analysis. Thematic analysis identified key themes of (1) procedural training is front-loaded, unstandardized, and non-evaluative, (2) formal procedural skill reassessment is absent, (3) clinical performance is not defined or documented in a systematic way, and (4) complication tracking is fragmented and informally connected to resident training. Residents’ CVC experience was inconsistently documented across the currently used systems, and clinical performance was rarely documented in a systematic way. Additionally, explorations of CVC training revealed infrequent training reinforcement and very minimal evaluations beyond informal observation of the resident performing on a mannequin. These findings highlight how disconnected and unstandardized documentation practices limit the usability of procedural performance data in resident competency assessments. Together, the disconnect between training, clinical performance, and documentation complicates resident CVC competence determinations and identifications of skill decay. Although this study is specific to a single institution, it highlights general challenges faced in medical education, specifically in accurately evaluating resident clinical performance using existing systems.