Evaluating the performance of inpatient attending physicians: a new instrument for today's teaching hospitals

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 alpha). 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 (r(2)=.90).

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

FIGURE 1

Boxplots of the 99 attending physicians’ average scores by domain. The gray box represents the distribution of the middle half of physicians’ average scores; the vertical black line transecting the box represents the median value; the whiskers extend to the minimum average score and maximum average score.