Evaluating the performance of inpatient attending physicians

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Abstract

OBJECTIVE

Instruments available to evaluate attending physicians fail to address their diverse roles and responsibilities in current inpatient practice. We developed a new instrument to evaluate attending physicians on medical inpatient services and tested its reliability and validity.

DESIGN

Analysis of 731 evaluations of 99 attending physicians over a 1-year period.

SETTING

Internal medicine residency program at a university-affiliated public teaching hospital.

PARTICIPANTS

All medical residents (N=145) and internal medicine attending physicians (N=99) on inpatient ward rotations for the study period.

MEASUREMENTS

A 32-item questionnaire assessed attending physician performance in 9 domains: evidence-based medicine, bedside teaching, clinical reasoning, patient-based teaching, teaching sessions, patient care, rounding, professionalism, and feedback. A summary score was calculated by averaging scores on all items.

RESULTS

Eighty-five percent of eligible evaluations were completed and analyzed. Internal consistency among items in the summary score was 0.95 (Cronbach's α). Interrater reliability, using an average of 8 evaluations, was 0.87. The instrument discriminated among attending physicians with statistically significant differences on mean summary score and all 9 domain-specific mean scores (all comparisons,P<.001). The summary score predicted winners of faculty teaching awards (odds ratio [OR], 17; 95% confidence interval [CI], 8 to 36) and was strongly correlated with residents' desire to work with the attending again (r=.79; 95% CI, 0.74 to 0.83). The single item that best predicted the summary score was how frequently the physician made explicit his or her clinical reasoning in making medical decisions (r2=.90).

CONCLUSION

The new instrument provides a reliable and valid method to evaluate the performance of inpatient teaching attending physicians.

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