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Key Points Question Is competency-based assessment associated with changes in rates of identification of and support for residents in difficulty compared with traditional assessment? Findings In this cohort study of 458 Canadian medical residents, there were significant reductions in the proportions of residents receiving flagged assessments on multiple rotations, reductions in proportions of residents defined as being in difficulty, and increases in documented evidence identifying that gaps were discussed with the resident following introduction of a competency-based assessment program. Meaning Competency-based assessment may contribute to better identification of and support for residents in difficulty.

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Background and Objectives: Residents in difficulty are costly to programs in both time and resources, and encountering difficulty can be emotionally harmful to residents. Approximately 10% of residents will encounter difficulty at some point in training. While there have been several studies looking at common factors among residents who encounter difficulty, some of the findings are inconsistent. The objective of this study was to determine whether there are common factors among the residents who encounter difficulty during training in a large Canadian family medicine residency program. Methods: Secondary data analysis was performed on archived resident files from a Canadian family medicine residency program. Residents who commenced an urban family medicine residency program between the years of 2006 and 2014 were included in the study. Results: Five hundred nine family medicine residents were included in data analysis. Residents older than 30 years were 2.33 times (95% CI: 1.27-4.26) more likely to encounter difficulty than residents aged 30 years or younger. Nontransfer residents were 8.85 times (95% CI: 1.17-66.67) more likely to encounter difficulty than transfer residents. The effects of sex, training site, international medical graduate status, and rotation order on the likelihood of encountering difficulty were nonsignificant. Conclusions: Older and nontransfer residents may be facing unique circumstances and may benefit from additional support from the program.

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