Assessing Resident Surgical Competency in Urology Using a Global Rating Scale

ObjectiveTraining programs must ensure residents are competent to practice independently. For surgical fields, this is generally done by the faculty who graduate the residents, but there has been no accepted methodology for this process.DesignAs part of a generalized survey, attending physicians performing an operation were asked to assess resident competency to perform the operation independently in an average patient, using a single global question. Residents, in a blinded manner, were asked to answer the same question.SettingUrology Residency Program, Albany Medical College, Albany, NY.ParticipantsParticipants included 12 resident physicians and 10 attending physicians.ResultsThere is a large variation in attending physician assessment of resident surgical competency, and the assessment varies by attending physician and by resident. Generally, attending physicians rated residents lower than the residents rated themselves. The discrepancy was largest for residents early in training and lessened as resident experience increased. Assessments also tended to converge toward the attending physician assessment as competency increased. Assessments had less variability when involving a single, high-volume procedure for a single resident.ConclusionsAssessing resident surgical competency with a standardized global question is feasible, but complex. Attending physicians and residents differ significantly in their assessment of resident competence. The trend of residents׳ perceptions approaching attending physician estimates as training and competence increases supports the current concept that program directors should use attending physician assessments as the primary measure.