Discrepancies Between Preceptor and Resident Performance Assessment: Using an Electronic Formative Assessment Tool to Improve Residents’ Self-Assessment Skills

PROBLEM: Accurate self-assessment is a critical skill for residents to develop to become safe, adaptive clinicians upon graduation. Physicians need to be able to identify and fill in knowledge and skill gaps to deal with the rapid expansion of medical knowledge and unpredicted novel emerging medical issues. Residency training to date has not consistently focused on building these overarching skills, nor have the burgeoning assessment data that competency-based medical education (CBME) affords been used beyond their initial intent to inform summative assessment decisions. Both are important missed opportunities. APPROACH: The Queen's University Family Medicine Program adopted CBME in 2010. In 2011, it added the capacity for residents to electronically self-assess their daily performance, with preceptors reviewing and modifying as needed before submitting. In 2018, it designed software to report discordance between residents' self-assessment and preceptors' assessment of performance. OUTCOMES: From 2011-2019, 56,585 field notes were submitted, 11,429 by residents, with 28% of those (3,200/11,429) showing discordance between residents' and preceptors' performance assessments. When discordant, residents assessed their performance as less competent (undercalled) than their preceptor did 73% of the time (2,336/3,200 field notes). For the 864 field notes (27% of 3,200 discordant notes) where residents rated their performance higher than their preceptor did (overcalled, for 162/1,120 [14%] residents), 6 residents overcalled performance to a dangerous extent (2 or 3 levels of supervision higher than what their supervisors assessed them at) and 26 repeatedly (greater than 5 times) overcalled their level of performance by 1 supervisory level. NEXT STEPS: Inaccurate self-assessment (both overcalling and undercalling performance) has negative consequences. Awareness is a first step in addressing this. Discrepancy reports will be used during regular academic reviews with residents to discuss the nature, degree, and frequency of discrepancies, with the intent of fostering improved self-assessment of performance.