Predictors of clinical performance among internal medicine residents

Objective: To determine whether personal characteristics influence residents’ psychological states during training and to evaluate the relative importance of personal characteristics and psychological states in predicting clinical performance. Design: Cohort study utilizing prospective, serial surveys of emotions (anxiety, depression, competence) and attitudes (satisfaction with the decision to become a physician) among two classes of internal medicine residents during all years of their training. Subjects completed a socio-demographic survey at the conclusion of training, and faculty-assigned clinical ranks and examination scores were used to rate their clinical performances. Main results: Personal characteristics bad a stronger relationship to psychological states during the first training year than in subsequent years. The highest association was found for depression, for which 25% of the variation was accounted for by personal characteristics. The combination of personal characteristics and psychological states explained 48% of the variation in clinical ranks and 38% of the variation in American Board of Internal Medicine certifying examination scores. Conclusion: There are recognizable relationships among the personal characteristics of residents, their psychologic states during training, and their clinical performances. There results should be helpful to program directors and faculty in identifying potentially weak residents and avoiding pitfalls when working with troubled residents.