The effect of demographic characteristics, Country of birth and country of medical training on the peer evaluations of internal medicine resident physicians

Figures & data

Table 1. Demographic and Academic Characteristics of Resident Physicians.

Characteristics	Result
Age (years), mean ± SD	28 ± 5
Gender, No. (% male)	91 (55.0)
Race/Ethnicity, No. (%)
Asian – India	34 (37.4)
Asian – Other	29 (31.9)
Caucasian	14 (15.4)
Hispanic or Latin	11 (12.1)
Middle East	3 (3.3)
USMLE Step 1 score, mean ± SD	237.4 ± 22.6
USMLE Step 2 score, mean ± SD	243.1 ± 21.3
PGY-1 ITE percentile score, mean ± SD	70.5 ± 28.0
PGY-2 ITE percentile score, mean ± SD	69.0 ± 27.6
PGY-3 ITE percentile score, mean ± SD	71.2 ± 26.8
ABIM Evaluation by Program Director – Year 1, No. (%)
Superior	48 (56.5)
Satisfactory	34 (40.0)
Marginal	1 (1.2)
Unsatisfactory	2 (2.4)
ABIM Evaluation by Program Director – Year 2, No. (%)
Superior	41 (56.2)
Satisfactory	32 (43.8)
ABIM Evaluation by Program Director – Year 3, No. (%)
Superior	41 (66.1)
Satisfactory	21 (33.9)

Abbreviation: SD, standard deviation; USMLE, United States Medical Licensing Examination; PGY, postgraduate year; ITE, In-training Examination; ABIM, American Board of Internal Medicine

Table 2. Resident physician birth and medical school location by region, Sub-region, and Country.

Location	Region		Sub-region		Country
	Birth	Med ^a	Birth	Med ^a	Birth	Med ^a
Americas	23(25.3) ^b	26(28.6)
North America			16(17.6)	17(18.7)
USA					16(17.6)	17(18.7)
Central America			1(1.1)	1(1.1)
Mexico					1(1.1)	1(1.1)
South America			2(2.2)	2(2.2)
Colombia					1(1.1)	2(2.2)
Venezuela					1(1.1)
Latin America/Caribbean			4(4.4)	6(6.6)
Puerto Rico					4(4.4)	4(4.4)
Dominica						1(1.1)
Grenada						1(1.1)
Asia	59(64.8)	57(62.64)
Eastern Asia			17(18.7)	16(17.6)
China					17(18.7)	16(17.6)
Southeast Asia			8(8.8)	6(6.6)
Myanmar					5(5.5)	5(5.5)
Thailand					1(1.1)
Indonesia					1(1.1)
Philippines					1(1.1)	1(1.1)
Southern Asia			33(36.3)	33(36.3)
India					13(14.3)	12(13.2)
Pakistan					19(20.9)	20(22.0)
Nepal					1(1.1)	1(1.1)
Western Asia			1(1.1)	2(2.2)
Iraq					1(1.1)
Syria						1(1.1)
Jordan						1(1.1)
Europe	8(8.8)	6(6.6)
Eastern Europe			5(5.5)	5(5.5)
Russia					3(3.3)	2(2.2)
Slovakia					1(1.1)	1(1.1)
Czech Republic					1(1.1)	1(1.1)
Hungary						1(1.1)
Northern Europe			1(1.1)	1(1.1)
UK					1(1.1)	1(1.1)
Southern Europe			1(1.1)
Albania					1(1.1)
Western Europe			1(1.1)
France					1(1.1)
Africa	1(1.1)	2(2.2)
Northern Africa			1(1.1)	2(2.2)
Egypt					1(1.1)	2(2.2)

a denotes Medical School

b denotes N (%). Each column totals 91 and 100%

Table 3. Univariate analysis of demographic characteristics on PES^a.

Characteristic	Frequency N (%)	PES mean (± SD)	PES Median	P-Value ^b
Age Difference				0.902
≤5 years	1,785 (61.09)	2.79 (0.34)	3.00
≥5 years	1,137 (38.91)	2.79 (0.33)	3.00
Ethnicity/Race				0.039
Same	1,549 (53.19)	2.83 (3.30)	3.00
Different	1,363 (46.81)	2.76 (0.37)	3.00
Gender				0.487
Same	1,506 (51.54)	2.79 (0.34)	3.00
Different	1,416 (48.46)	2.79 (0.34)	3.00
Birth Country				0.001
Same Country	43.5 (14.94)	2.80 (0.34)	3.00
Same Sub-Region Only	192 (6.59)	2.88 (0.24)	2.96
Same Region Only	843 (28.95)	2.79 (0.32)	3.00
All Different	1,442 (49.52)	2.78 (0.36)	3.00
Medical School Country				<0.001
Same Country	439 (15.08)	2.83 (0.31)	3.00
Same Sub-Region Only	171 (5.87)	2.88 (0.24)	3.00
Same Region Only	787 (27.03)	2.80 (0.32)	3.00
All Different	1,515 (52.03)	2.77 (0.36)	3.00

^a = Peer Evaluation Score

^b = Kruskal Wallis Test

Table 4. Multivariable analysis of demographic and academic characteristics of residents on Peer Evaluation Score (PES).

Characteristic	Estimate	Standard Error	T Value	P Value
ABIM Evaluation by Program Director	0.400	0.0366	10.92	<0.0001
USMLE Score	−0.0001	0.0003	−0.38	0.7019
PGY 1 Age Above 26	−0.0046	0.0014	−3.30	0.0010
Age Difference > 5	0.0315	0.0142	2.22	0.0265
Gender Difference	0.0004	0.0122	0.03	0.9738
Medical School Country
Same Country vs. Diff Region	0.0718	0.0180	3.98	<0.001
Same Sub-region vs. Diff Region	0.0767	0.0270	2.84	0.0045
Same Region vs. Diff Region	0.0283	0.0148	1.91	0.0563

Table A1. Resident Peer Evaluation.

Resident Photo	Subject Name		Evaluator
	Subject Employer
	Evaluation Dates		Evaluator Name
	Subject Rotation		Evaluator Employer
Please be as complete and honest as possible in assigning values to each component
Try to identify areas that should be improved and give suggestions of how improvement could be achieve
Comments expected regarding any ‘Improvement Needed’ areas and encouraged for ‘Exceptional Performance’ areas
		Room for Improvement 1	Meets Standards 2	Exceptional Performance 3	Not Applicable
Patient Care & Professionalism
(1) Shows compassion in patient care
(2) Communicates effectively with patients’ family
(3) Culturally sensitive when delivering care
(4) Maintains patient confidentiality
(5) He/she arrives to work on time and is well prepared for daily rounds
(6) Follows up on patient issues after rounds on tests/serial exams/consultants’ input
Interpersonal and Communication Skills
(7) Communicates effectively with the rounding team and is a team player
(8) Coordinates care effectively for patients with other health professionals, physicians and health care resource centers
Medical Knowledge
(9) Case presentations are appropriate, clear and concise
(10) Considers appropriate DDX
(11) Selects and assesses diagnostic tests appropriately
(12) Manages patients with complex medical problems well
(13) Consults in an appropriate manner
Practice-Based Learning
(14) Use of Internet as source of information
(15) Applies pertinent evidence-based medicine to clinical care
Systems-Based Practice
(16) Maintains quality written progress notes
(17) Accepts constructive criticism
(18) Understands cost effective care and costs to patients
Senior Resident as Teacher (Use this section only if peer is supervising)
(19) Was a good role model of a caring doctor
(20) Encouraged teamwork
(21) Demonstrated a broad working fund of knowledge
(22) Modeled self-directed learning
(23) Raised critical teaching points on rounds
(24) Encouraged team members to pursue their own learning issues
(25) Encouraged critical appraisal of the literature/evidenced based learning
(26) Participated actively in teaching/review of current literature
(27) Demonstrated good judgement in patient management
Overall Comments: