Beyond the checklist: development and validation of a multidimensional clinical competency assessment tool for bedside procedures

PROBLEM: Medical residents perform bedside procedures that affect patient outcomes. However, no national standard exists to determine when residents can perform procedures without direct supervision. The utility and feasibility of various procedural competency assessment methods remain unclear. APPROACH: A multidimensional clinical competency assessment tool (CAT) was developed to evaluate procedural performance using a checklist, global skills assessment (GSA), and Entrustment Score (ES). Residents had to meet cutoffs for all 3 components to pass. Checklist cutoffs were set using the Angoff method. The CAT assessed internal medicine interns performing large-volume paracentesis (LVP) and central venous catheter insertion (CVC) across 3 hospital systems from July 2022 to June 2023. Inter-rater reliability was assessed using 2 simultaneous assessments. OUTCOMES: The CAT was completed in 29.7% (174) of LVP and CVC procedures performed by postgraduate year-1s. The checklist passing cutoffs were