360-degree evaluations of plastic surgery resident accreditation council for graduate medical education competencies: Experience using a short form

Background: The Accreditation Council for Graduate Medical Education has asked training programs to develop methods to evaluate resident performance, using competencies essential for outcomes. Methods: A two-page form was completed by 12 surgeons and 28 nurses and clinical staff directly involved in plastic surgery patient care (n = 40), evaluating University of Kentucky plastic surgery residents at each level of training (n = 6). There were eight groups of health care professionals among the 40. Six Accreditation Council for Graduate Medical Education competencies were rated, with technical/operative skills added as a subset of patient care. Hierarchical cluster analysis was used to determine similarity of rating profiles of the rating groups; Kruskal-Wallis analysis of variance delineated the way in which the participants used the competencies to make their selections by asking them whether they would choose the resident for future surgical care. Results: Rating profiles revealed two clusters of raters. In one cluster were nurses assigned to an ambulatory surgery center, faculty, residents, and an intern (the surgeons' cluster; n = 15); in the second cluster were other nurses and clinical staff (nurses' cluster; n = 25). The nurses' cluster was found to rate residents more positively, and the surgeons' cluster more often cited areas for improvement. Specific competencies deemed important to each group were identified. Conclusions: Resident performance is rated differently by health care professionals, in two distinct groups. Based on this clustered arrangement, the resident is able quarterly to enjoy two, independent, formative assessments, potentially over 6 years of integrated training.