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Defining and Adopting Clinical Performance Measures in Graduate Medical Education

Where Are We Now and Where Are We Going?

Smirnova, Alina, MD, PhD; Sebok-Syer, Stefanie S., PhD; Chahine, Saad, PhD; Kalet, Adina L., MD, MPH; Tamblyn, Robyn, PhD; Lombarts, Kiki M.J.M.H., PhD; van der Vleuten, Cees P.M., PhD; Schumacher, Daniel J., MD, MEd

doi: 10.1097/ACM.0000000000002620
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Assessment and evaluation of trainees’ clinical performance measures is needed to ensure safe, high-quality patient care. These measures also aid in the development of reflective, high-performing clinicians and hold graduate medical education (GME) accountable to the public. Although clinical performance measures hold great potential, challenges of defining, extracting, and measuring clinical performance in this way hinder their use for educational and quality improvement purposes. This article provides a way forward by identifying and articulating how clinical performance measures can be used to enhance GME by linking educational objectives with relevant clinical outcomes. The authors explore four key challenges: defining as well as measuring clinical performance measures, using electronic health record and clinical registry data to capture clinical performance, and bridging silos of medical education and health care quality improvement. The authors also propose solutions to showcase the value of clinical performance measures and conclude with a research and implementation agenda. Developing a common taxonomy of uniform specialty-specific clinical performance measures, linking these measures to large-scale GME databases, and applying both quantitative and qualitative methods to create a rich understanding of how GME affects quality of care and patient outcomes is important, the authors argue. The focus of this article is primarily GME, yet similar challenges and solutions will be applicable to other areas of medical and health professions education as well.

A. Smirnova is a PhD researcher, School of Health Professions Education, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands, and Professional Performance Research Group, Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

S.S. Sebok-Syer is instructor, Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California.

S. Chahine is assistant professor and scientist, Centre for Educational Research and Innovation (CERI), Western University, London, Ontario, Canada.

A.L. Kalet is professor of medicine and surgery, director of research on medical education outcomes (ROMEO), Unit of the Division of General Internal Medicine and Clinical Innovation, Department of Medicine, and director of research, Program on Medical Education and Technology, NYU School of Medicine, New York, New York.

R. Tamblyn is professor, Department of Medicine and Department of Epidemiology and Biostatistics, McGill University, medical scientist, McGill University Health Center Research Institute, scientific director, Clinical and Health Informatics Research Group, McGill University, and scientific director, Canadian Institutes of Health Research–Institute of Health Services and Policy Research, Montreal, Quebec, Canada.

K.M.J.M.H. Lombarts is professor and lead investigator, Professional Performance Research Group, Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

C.P.M. van der Vleuten is professor and scientific director, School of Health Professions Education, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.

D.J. Schumacher is associate professor, Division of Emergency Medicine, and pediatric emergency physician, Cincinnati Children’s Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Previous presentations: Oral presentation, Second World Summit on Competency-Based Medical Education; August 24, 2018; Basel, Switzerland.

Correspondence should be addressed to Daniel J. Schumacher, Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center/University of Cincinnati College of Medicine, MLC 2008, 3333 Burnet Ave., Cincinnati, OH 45229; telephone: (513) 803-2639; e-mail: daniel.schumacher@cchmc.org.

© 2019 by the Association of American Medical Colleges