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Schumacher DJ, Michelson C, Winn AS, Turner DA, Martini A, Kinnear B. A realist synthesis of prospective entrustment decision making by entrustment or clinical competency committees. MEDICAL EDUCATION 2024; 58:812-824. [PMID: 38088227 DOI: 10.1111/medu.15296] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/03/2023] [Accepted: 11/21/2023] [Indexed: 06/04/2024]
Abstract
INTRODUCTION The real-world mechanisms underlying prospective entrustment decision making (PEDM) by entrustment or clinical competency committees (E/CCCs) are poorly understood. To advance understanding in this area, the authors conducted a realist synthesis of the published literature to address the following research question: In E/CCC efforts to make defensible prospective entrustment decisions (PEDs), what works, for whom, under what circumstances and why? METHODS Realist work seeks to understand the contexts (C), mechanisms (M) and outcomes (O) that explain how and why things work (or do not). In the authors' study, contexts included individual E/CCC members, E/CCC structures and processes, and training programmes. The outcome (i.e. desired outcome) was a PED. Mechanisms were a substantial focus of the analysis and informed the core findings. To define a final corpus of 52 included papers, the authors searched four databases, screened all results from those searches and performed a full-text review of a subset of screened papers. Data extraction focused on developing context-mechanism-outcome configurations from the papers, which were used to create a theory for how PEDM leads to PEDs. RESULTS PEDM is often driven by default (non-deliberate) decision making rather than a deliberate process of deciding whether a trainee should be entrusted or not. When defaulting, some E/CCCs find red flags that sometimes lead to being more deliberate with decision making. E/CCCs that seek to be deliberate describe PEDM that can be effortful (when data are insufficient or incongruent) or effortless (when data are robust and tell a congruent story about a trainee). Both information about trainee trustworthiness and the sufficiency of data about trainee performance influence PEDM. Several moderators influence what is considered to be sufficient data, how trustworthiness data are viewed and how PEDM is carried out. These include perceived consequences and associated risks, E/CCC member trust propensity, E/CCC member personal knowledge of and experience with trainees and E/CCC structures and processes. DISCUSSION PEDM is rarely deliberate but should be. Data about trainee trustworthiness are foundational to making PEDs. Bias, equity and fairness are nearly absent from the papers in this synthesis, and future efforts must seek to advance understanding and practice regarding the roles of bias, equity and fairness in PEDM.
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Affiliation(s)
- Daniel J Schumacher
- Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Catherine Michelson
- Ann and Robert H. Lurie Children's Hospital of Chicago/Northwestern University, Chicago, Illinois, USA
| | - Ariel S Winn
- Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - David A Turner
- American Board of Pediatrics, Chapel Hill, North Carolina, USA
| | - Abigail Martini
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Benjamin Kinnear
- Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Marty AP, Linsenmeyer M, George B, Young JQ, Breckwoldt J, Ten Cate O. Mobile technologies to support workplace-based assessment for entrustment decisions: Guidelines for programs and educators: AMEE Guide No. 154. MEDICAL TEACHER 2023; 45:1203-1213. [PMID: 36706225 DOI: 10.1080/0142159x.2023.2168527] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
With the rise of competency-based medical education and workplace-based assessment (WBA) since the turn of the century, much has been written about methods of assessment. Direct observation and other sources of information have become standard in many clinical programs. Entrustable professional activities (EPAs) have also become a central focus of assessment in the clinical workplace. Paper and pencil (one of the earliest mobile technologies!) to document observations have become almost obsolete with the advent of digital technology. Typically, clinical supervisors are asked to document assessment ratings using forms on computers. However, accessing these forms can be cumbersome and is not easily integrated into existing clinical workflows. With a call for more frequent documentation, this practice is hardly sustainable, and mobile technology is quickly becoming indispensable. Documentation of learner performance at the point of care merges WBA with patient care and WBA increasingly uses smartphone applications for this purpose.This AMEE Guide was developed to support institutions and programs who wish to use mobile technology to implement EPA-based assessment and, more generally, any type of workplace-based assessment. It covers backgrounds of WBA, EPAs and entrustment decision-making, provides guidance for choosing or developing mobile technology, discusses challenges and describes best practices.
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Affiliation(s)
| | - Machelle Linsenmeyer
- West Virginia School of Osteopathic Medicine, Lewisburg, WV, United States of America
| | - Brian George
- Surgery and Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, United States of America
| | - John Q Young
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell &, Zucker Hillside Hospital, NY, United States of America
| | - Jan Breckwoldt
- Institute of Anesthesia at the University Hospital Zurich, Switzerland
| | - Olle Ten Cate
- Utrecht Center for Research and Development of Health Professions Education at UMC Utrecht, The Netherlands
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Singh S, Cheung WJ, Dewhirst S, Wood TJ, Landreville JM. The influence of clinical coaching teams on quality of entrustable professional activity assessments. AEM EDUCATION AND TRAINING 2023; 7:e10879. [PMID: 37361186 PMCID: PMC10290210 DOI: 10.1002/aet2.10879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/18/2023] [Accepted: 03/28/2023] [Indexed: 06/28/2023]
Abstract
Background Coaching is an important component of workplace-based assessment in competency-based medical education. Longitudinal coaching relationships have been proposed to enhance the trainee-supervisor relationship and promote high-quality assessment. Objective The objective of this study was to determine the influence of longitudinal coaching relationships on the quality of entrustable professional activity (EPA) assessments. Methods EPAs (n = 174) completed by emergency medicine (EM) supervisors between July 2020 and June 2021 were extracted and divided into two groups; one group consisted of EPAs completed by supervisors when a longitudinal coaching relationship existed (n = 87) and the other group consisted of EPAs completed by the same supervisors when no coaching relationship existed (n = 87). Three physicians were recruited to rate the EPAs using the Quality of Assessment and Learning (QuAL) score, a previously published measure of EPA quality. An analysis of variance was performed to compare mean QuAL scores between the groups. Linear regression analysis was conducted to examine the relationship between trainee performance (EPA rating) and EPA assessment quality (QuAL score). Results All raters completed the survey. The mean ± SD QuAL score in the coaching relationship group (3.63 ± 0.91) was higher than the no coaching relationship group (3.51 ± 1.10) but the difference was not statistically significant (p = 0.40). Supervisor was a significant predictor of QuAL score (p = 0.012) and supervisor alone accounted for 26% of the variability in QuAL scores (R2 = 0.26). There was no significant relationship between trainee performance and EPA assessment quality. Conclusions The presence of a longitudinal coaching relationship did not influence the quality of EPA assessments.
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Affiliation(s)
| | - Warren J. Cheung
- Department of Emergency MedicineUniversity of OttawaOttawaOntarioCanada
- Royal College of Physicians and Surgeons of CanadaOttawaOntarioCanada
| | | | - Timothy J. Wood
- Department of Innovation in Medical EducationUniversity of OttawaOttawaOntarioCanada
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Leclair R, Ho JSS, Braund H, Kouzmina E, Bruzzese S, Awad S, Mann S, Zevin B. Exploring the Quality of Narrative Feedback Provided to Residents During Ambulatory Patient Care in Medicine and Surgery. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231175734. [PMID: 37216002 PMCID: PMC10192660 DOI: 10.1177/23821205231175734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 04/21/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVES The transition to competency-based medical education (CBME) has increased the volume of residents' assessment data; however, the quality of the narrative feedback is yet to be used as feedback-on-feedback for faculty. Our objectives were (1) to explore and compare the quality and content of narrative feedback provided to residents in medicine and surgery during ambulatory patient care and (2) to use the Deliberately Developmental Organization framework to identify strengths, weaknesses, and opportunities to improve quality of feedback within CBME. METHODS We conducted a mixed convergent methods study with residents from the Departments of Surgery (DoS; n = 7) and Medicine (DoM; n = 9) at Queen's University. We used thematic analysis and the Quality of Assessment for Learning (QuAL) tool to analyze the content and quality of narrative feedback documented in entrustable professional activities (EPAs) assessments for ambulatory care. We also examined the association between the basis of assessment, time to provide feedback, and the quality of narrative feedback. RESULTS Forty-one EPA assessments were included in the analysis. Three major themes arose from thematic analysis: Communication, Diagnostics/Management, and Next Steps. Quality of the narrative feedback varied; 46% had sufficient evidence about residents' performance; 39% provided a suggestion for improvement; and 11% provided a connection between the suggestion and the evidence. There were significant differences between DoM and DoS in quality of feedback scores for evidence (2.1 [1.3] vs. 1.3 [1.1]; p < 0.01) and connection (0.4 [0.5] vs. 0.1 [0.3]; p = 0.04) domains of the QuAL tool. Feedback quality was not associated with the basis of assessment or time taken to provide feedback. CONCLUSION The quality of the narrative feedback provided to residents during ambulatory patient care was variable with the greatest gap in providing connections between suggestions and evidence about residents' performance. There is a need for ongoing faculty development to improve the quality of narrative feedback provided to residents.
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Affiliation(s)
- Rebecca Leclair
- School of Medicine, Queen's University, Kingston, ON, Canada
| | | | - Heather Braund
- Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
- Office of Professional Development and
Educational Scholarship, Queen's University, Kingston, ON, Canada
| | - Ekaterina Kouzmina
- School of Medicine, Queen's University, Kingston, ON, Canada
- Division of General Surgery, Department
of Surgery, Kingston Health Sciences
Center, Kingston, ON, Canada
| | - Samantha Bruzzese
- School of Medicine, Queen's University, Kingston, ON, Canada
- Division of Internal Medicine,
Department of Medicine, Kingston Health Sciences
Center, Kingston, Kingston, ON, Canada
| | - Sara Awad
- School of Medicine, Queen's University, Kingston, ON, Canada
- Division of Endocrinology and
Metabolism, Department of Medicine, Kingston Health Sciences
Center, Kingston ON, Canada
| | - Steve Mann
- School of Medicine, Queen's University, Kingston, ON, Canada
- Division of Orthopaedic Surgery,
Department of Surgery, Kingston Health Sciences
Center, Kingston, ON, Canada
| | - Boris Zevin
- School of Medicine, Queen's University, Kingston, ON, Canada
- Division of General Surgery, Department
of Surgery, Kingston Health Sciences
Center, Kingston, ON, Canada
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