In Reply We thank the Editor for the opportunity to respond to the letter from Leeds et al about our article.1 From their letter, we were able to deduce 3 major concerns.
The performance outcome used in our study is one of the most comprehensive resident performance criteria in the published literature and triangulates data representing all of the Accreditation Council for Graduate Medical Education competencies from multiple stakeholders and sources. Of note, the “most heavily weighted” factor, monthly faculty evaluations, contributed little more than one-third of the total performance criterion and thus was not the main driver of any outcome. The rest was pulled from administrative logs (18%), procedural case activity (17%), in-training examination scores (14%), research output (8%), and medical student evaluations (6%) (Table 11).