Centralized assessment in graduate medical education: cents and sensibilities.

RATIONALE: The start of residency represents an "educational handoff." Accreditation and credentialing organizations have called for better assessments of learner and patient outcomes and improved patient safety and quality of care. INTERVENTION: We describe the development of centralized assessments of baseline, core residency competencies at 2 institutions, and summarize principles and lessons learned for other institutions interested in developing similar interventions.
RESULTS: At one institution, 70% of 1 083 new residents assessed via the Objective Standardized Clinical Examination stated they learned a new skill; 80% believe it was a useful way to spend orientation; 78% felt better prepared for aspects of internship; and 80% would recommend it for next year's interns. High levels of satisfaction are expressed by participants at the other institution, especially with the immediate provision of feedback after each station. At this institution, average new resident performance in the communication skills domain approached 90%, but patient care domain scores showed wide variability. The lowest scores were related to performing the psychomotor skills of aseptic technique. DISCUSSION: From a patient safety perspective, results suggest a need to improve the preparation of new residents, along with careful supervision of their early clinical work. The presence of skill deficits likely adds to the highly stressful transition into residency. Teaching institutions may use centralized assessment to enhance education and patient safety and to promote accountability to accrediting bodies, residents, and patients. The approach may identify gaps in the undergraduate curriculum. The addition of hand hygiene and aseptic technique teaching and assessment modules are currently being piloted at each of the institutions.