From a “Generalist” Medical Graduate to a “Specialty” Resident: Can an Entry-level Assessment Facilitate the Transition? Assessing the Preparedness Level of New Surgical Trainees

Abstract

Introduction: Concerns have been raised in the literature about how well the undergraduate curriculum prepares medical students for residency. An assessment was designed and administered to entering postgraduate residents in surgery to test their preparedness vis-a-vis the competence level expected of them at the beginning of their training. This paper explores the role and place of such an assessment in the medical education continuum. Materials and Methods: Faculty members from the Department of Surgery at Bharati Vidyapeeth University Medical College (BVUMC), Pune, India and experts from the Department of Medical Education, University of Michigan Medical School, Ann Arbor designed and administered an assessment based on the multiple-choice question examination (MCQE) and objective structured clinical examination (OSCE) in June 2005 to 24 examinees from 3 different training levels at BVUMC. Results: All subsections of the MCQE showed significant correlation except the breast and endocrine section. The test showed an overall reliability of 0.8 (Cronbach’s alpha). The scores and level of difficulty of the OSCE were inversely related. There was a significant difference in performance between the 3 groups and these differences were more pronounced for more complex tasks, specifically the procedural skills station, where the intern performance was particularly poor. Clinical skills reliability was 0.85. The communication skills score correlated well with the clinical skills score and also showed good reliability. Four out of the 5 new residents had below-satisfactory levels of competence for this level. Conclusion: This pilot study reveals definite educational gaps in both knowledge and skills among the residents studied. Such an intervention can be very informative, providing immense educational benefit to the learner, faculty and programme, and has an important place in the continuum of medical training. Key words: Competence, Education, Postgraduate, Surgery