Measuring Clinical Preparedness After Residency Training: Development of a New Instrument

Background and Objectives: Research on preparedness for independent clinical practice typically uses surveys of residents and program directors near graduation, which can be affected by several biases. We developed a novel approach to assess new graduates more objectively using physician and staff member assessors 3 months after graduates started their first job. Methods: We conducted a literature review and key informant interviews with physicians from varying practice types and geographic regions in the United States to identify features that indicate a lack of preparedness for independent clinical practice. We then held a Clinical Preparedness Measurement Summit, engaging measurement experts and family medicine education leaders, to build consensus on key indicators of readiness for independent clinical practice and survey development strategies. The 2015 entrustable professional activities for family medicine end-of-residency training provided the framework for assessment of clinical preparedness by physician assessors. Sixteen published variables assessing interpersonal communication skills and processes of care delivery were identified for staff assessors. We assessed frequencies and compared survey findings between physician and staff assessors in 2016 to assist with survey validation. Results: The assessment of frequencies demonstrated a range of responses, supporting the instrument’s ability to distinguish readiness for independent practice of recent graduate hires. No statistical differences occurred between the physician and staff assessors for the same physician they were evaluating, indicating internal consistency. Conclusions: To learn about the possible impact of length of training, we developed a novel approach to assess preparedness for independent clinical practice of family medicine residency graduates.