Assessing Residents' Competency at Baseline: How Much Does the Medical School Matter?

Background Although there is some consensus about the competencies needed to enter residency, the actual skills of graduating medical students may not meet expectations. In addition, little is known about the association between undergraduate medical education and clinical performance at entry into and during residency. Objective We explored the association between medical school of origin and clinical performance using a multi-station objective structured clinical examination for incoming residents at the University of Michigan Health System. Methods Prior to assuming clinical duties, all first-year residents at the University of Michigan Health System participate in the Postgraduate Orientation Assessment (POA). This assesses competencies needed during the first months of residency. Performance data for 1795 residents were collected between 2002 and 2012. We estimated POA variance by medical school using linear mixed models. Results Medical school predicted the following amounts of variance in performance—data gathering scores: 1.67% (95% confidence interval [CI] 0.36–2.93); assessment scores: 4.93% (95% CI 1.84–6.00); teamwork scores: 0.80% (95% CI 0.00–1.82); communication scores: 2.37% (95% CI 0.66–3.83); and overall POA scores: 4.19% (95% CI 1.59–5.35). Conclusions The results show that residents' medical school of origin is weakly associated with clinical competency, highlighting a potential source of variability in undergraduate medical education. The practical significance of these findings needs further evaluation.