Nudging clinical supervisors to provide better in-training assessment reports

How does multisource feedback influence residency training? A qualitative case study

INTRODUCTION

Multisource feedback (MSF), also called 360-degree assessment, is one form of assessment used in postgraduate training. However, there is an ongoing discussion on its value, because the factors that influence the impact of MSF and the main impact of MSF are not fully understood. In this study, we investigated both the influencing factors and the impact of MSF on residency training.

METHODS

We conducted a qualitative case study within the boundaries of the residency training for paediatricians and paediatric surgeons at a University Hospital. We collected data from seven focus group interviews with stakeholders of MSF (residents, raters and supervisors). By performing a reflexive thematic analysis, we extracted the influencing factors and the impact of MSF.

RESULTS

We found seven influencing factors: MSF is facilitated by the announcement of a clear goal of MSF, the training of raters on the MSF instrument, a longitudinal approach of observation, timing not too early and not too late during the rotation, narrative comments as part of the ratings, the residents' self-assessment and a supervisor from the same department. We found three themes on the impact of MSF: MSF supports the professional development of residents, enhances interprofessional teamwork and increases the raters' commitment to the training of residents.

CONCLUSION

This study illuminates the influencing factors and impact of MSF on residency training. We offer novel recommendations on the continuity of observation, the timing during rotations and the role of the supervisor. Moreover, by discussing our results through the lens of identity formation theory, this work advances our conceptual understanding of MSF. We propose identity formation theory as a framework for future research on MSF to leverage the potential of MSF in residency training.

Beyond the ratings: gender effects in written comments from clinical teaching assessments

Assessment of clinical teachers by learners is problematic. Construct-irrelevant factors influence ratings, and women teachers often receive lower ratings than men. However, most studies focus only on numeric scores. Therefore, the authors analyzed written comments on 4032 teacher assessments, representing 282 women and 448 men teachers in one Department of Medicine, to explore for gender differences. NVivo was used to search for 61 evidence- and theoretically-based terms purported to reflect teaching excellence, which were analyzed using 2 × 2 chi-squared tests. The Linguistic Index and Word Count (LIWC) was used to categorize comment data, which were analyzed using linear regressions. The only significant difference in NVivo was that men were more likely than women to have the word "available" in a comment (OR 1.4, p < .05). A subset of LIWC variables showed significant gender differences, but all effects were modest. Men teachers had more positive emotion words written about them, while negative emotion words appeared equally. Significant differences occurred more often between the men and women residents who wrote the comments, rather than those attributed to the gender of the teachers. For example, women residents used more social and gender-related words (β 1.87, p < 0.001) and fewer words related to power or achievement (β -3.78, p < 0.001) than men residents. Profound gender differences were not found in teacher assessment comments in this large, diverse academic department of medicine, which differs from other studies. The authors explore possible reasons including differences in departmental culture and issues related to the methods used.

Assessing trainee performance: ensuring learner control, supporting development, and maximizing assessment moments

In this article, the authors provide practical guidance for frontline supervisors' efforts to assess trainee performance. They focus on three areas. First, they argue the importance of promoting learner control in the assessment process, noting that providing learners agency and control can shift the stakes of assessment from high to low and promote a safe environment that facilitates learning. Second, they posit that assessment should be used to support continued development by promoting a relational partnership between trainees and supervisors. This partnership allows supervisors to reinforce desirable aspects of performance, provide real-time support for deficient areas of performance, and sequence learning with the appropriate amount of scaffolding to push trainees from competence (what they can do alone) to capability (what they are able to do with support). Finally, they advocate the importance of optimizing the use of written comments and direct observation while also recognizing that performance is interdependent in efforts to maximize assessment moments.Conclusion: Using best practices in trainee assessment can help trainees take next steps in their development in a learner-centered partnership with clinical supervisors. What is Known: • Many pediatricians are asked to assess the performance of medical students and residents they work with but few have received formal training in assessment. What is New: • This article presents evidence-based best practices for assessing trainees, including giving trainees agency in the assessment process and focusing on helping trainees take next steps in their development.

Driving lesson or driving test? : A metaphor to help faculty separate feedback from assessment

Although there is consensus in the medical education world that feedback is an important and effective tool to support experiential workplace-based learning, learners tend to avoid the feedback associated with direct observation because they perceive it as a high-stakes evaluation with significant consequences for their future. The perceived dominance of the summative assessment paradigm throughout medical education reduces learners' willingness to seek feedback, and encourages supervisors to mix up feedback with provision of 'objective' grades or pass/fail marks. This eye-opener article argues that the provision and reception of effective feedback by clinical supervisors and their learners is dependent on both parties' awareness of the important distinction between feedback used in coaching towards growth and development (assessment for learning) and reaching a high-stakes judgement on the learner's competence and fitness for practice (assessment of learning). Using driving lessons and the driving test as a metaphor for feedback and assessment helps supervisors and learners to understand this crucial difference and to act upon it. It is the supervisor's responsibility to ensure that supervisor and learner achieve a clear mutual understanding of the purpose of each interaction (i.e. feedback or assessment). To allow supervisors to use the driving lesson-driving test metaphor for this purpose in their interactions with learners, it should be included in faculty development initiatives, along with a discussion of the key importance of separating feedback from assessment, to promote a feedback culture of growth and support programmatic assessment of competence.