“A difference to be a difference must make a difference.”
Gertrude Stein1
With the Institute of Medicine’s recommendation for clinical outcomes-based Medicare graduate medical education funding, a pay-for-performance initiative awaits. The article by Bansal et al,2 titled “Using Patient Outcomes to Evaluate General Surgery Residency Program Performance,” is certainly timely. The authors concluded, “This study demonstrates the feasibility of ranking general surgery residency programs using the outcomes of patients treated by the programs’ graduates. … However, as the rankings differed by the individual measures tested, careful consideration will need to be put into the choice of metrics used in any residency program assessment system.”2