1
|
Ginsburg S, Stroud L, Brydges R, Melvin L, Hatala R. Dual purposes by design: exploring alignment between residents' and academic advisors' documents in a longitudinal program. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024:10.1007/s10459-024-10318-2. [PMID: 38438699 DOI: 10.1007/s10459-024-10318-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/04/2024] [Indexed: 03/06/2024]
Abstract
Longitudinal academic advising (AA) and coaching programs are increasingly implemented in competency based medical education (CBME) to help residents reflect and act on the voluminous assessment data they receive. Documents created by residents for purposes of reflection are often used for a second, summative purpose-to help competence committees make decisions-which may be problematic. Using inductive, thematic analysis we analyzed written comments generated by 21 resident-AA dyads in one large internal medicine program who met over a 2 year period to determine what residents write when asked to reflect, how this aligns with what the AAs report, and what changes occur over time (total 109 resident self-reflections and 105 AA reports). Residents commented more on their developing autonomy, progress and improvement than AAs, who commented far more on performance measures. Over time, residents' writing shifted away from intrinsic roles, patient care and improvement towards what AAs focused on, including getting EPAs (entrustable professional activities), studying and exams. For EPAs, the emphasis was on getting sufficient numbers rather than reflecting on what residents were learning. Our findings challenge the practice of dual-purposing documents, by questioning the blurring of formative and summative intent, the structure of forms and their multiple conflicting purposes, and assumptions about the advising relationship over time. Our study suggests a need to re-evaluate how reflective documents are used in CBME programs. Further research should explore whether and how documentation can best be used to support resident growth and development.
Collapse
Affiliation(s)
- Shiphra Ginsburg
- Department of Medicine, Mount Sinai Hospital, Toronto, ON, Canada.
- Wilson Centre for Research in Education, University Health Network, Toronto, ON, Canada.
| | - Lynfa Stroud
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ryan Brydges
- Wilson Centre for Research in Education, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Lindsay Melvin
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Rose Hatala
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
| |
Collapse
|
2
|
Sawatsky AP, Rea JR, Hafdahl LT, Vaa Stelling BE, Huber JM, Wingo MT, Leasure EL. From Apprenticeship to Assembly Line: Recovering Relationships in Medical Education. J Grad Med Educ 2023; 15:627-631. [PMID: 38045942 PMCID: PMC10686647 DOI: 10.4300/jgme-d-23-00468.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Affiliation(s)
- Adam P. Sawatsky
- All authors are with Mayo Clinic, Rochester, Minnesota, USA
- Adam P. Sawatsky, MD, MS, is Associate Professor of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Joanna R. Rea
- All authors are with Mayo Clinic, Rochester, Minnesota, USA
- Joanna R. Rea, MD, is Assistant Professor of Medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Luke T. Hafdahl
- All authors are with Mayo Clinic, Rochester, Minnesota, USA
- Luke T. Hafdahl, MD, is Assistant Professor of Medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Brianna E. Vaa Stelling
- All authors are with Mayo Clinic, Rochester, Minnesota, USA
- Brianna E. Vaa Stelling, MD, is Assistant Professor of Medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jill M. Huber
- All authors are with Mayo Clinic, Rochester, Minnesota, USA
- Jill M. Huber, MD, is Assistant Professor of Medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Majken T. Wingo
- All authors are with Mayo Clinic, Rochester, Minnesota, USA
- Majken T. Wingo, MD, is Assistant Professor of Medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA; and
| | - Emily L. Leasure
- All authors are with Mayo Clinic, Rochester, Minnesota, USA
- Emily L. Leasure, MD, is Assistant Professor of Medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
3
|
Pearce J, Chiavaroli N, Tavares W. On the use and abuse of metaphors in assessment. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1333-1345. [PMID: 36729196 DOI: 10.1007/s10459-022-10203-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 12/29/2022] [Indexed: 06/18/2023]
Abstract
This paper is motivated by a desire to advance assessment in the health professions through encouraging the judicious and productive use of metaphors. Through five specific examples (pixels, driving lesson/test, jury deliberations, signal processing, and assessment as a toolbox), we interrogate how metaphors are being used in assessment to consider what value they add to understanding and implementation of assessment practices. By unpacking these metaphors in action, we probe each metaphor's rationale and function, the gains each metaphor makes, and explore the unintended meanings they may carry. In summarizing common uses of metaphors, we elucidate how there may be both advantages and/or disadvantages. Metaphors can play important roles in simplifying, complexifying, communicating, translating, encouraging reflection, and convincing. They may be powerfully rhetorical, leading to intended consequences, actions, and other pragmatic outcomes. Although metaphors can be extremely helpful, they do not constitute thorough critique, justified evidence or argumentation. We argue that although metaphors have utility, they must be carefully considered if they are to serve assessment needs in intended ways. We should pay attention to how metaphors may be misinterpreted, what they ignore or unintentionally signal, and perhaps mitigate against this with anticipated corrections or nuanced qualifications. Failure to do so may lead to implementing practices that miss underlying and relevant complexities for assessment science and practice. Using metaphors requires careful attention with respect to their role, contributions, benefits and limitations. We highlight the value that comes from critiquing metaphors, and demonstrate the care required to ensure their continued utility.
Collapse
Affiliation(s)
- Jacob Pearce
- Tertiary Education, Australian Council for Educational Research, Camberwell, Australia.
| | - Neville Chiavaroli
- Tertiary Education, Australian Council for Educational Research, Camberwell, Australia
| | - Walter Tavares
- Department of Health and Society and Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, ON., Canada
| |
Collapse
|
4
|
Carmelli G, Fullmer R, Goodrich M, Grawey T, Pearce E, Santen SA, Schnapp BH. Creating master adaptive learners during emergency medicine clerkships. AEM EDUCATION AND TRAINING 2022; 6:e10829. [PMID: 36562025 PMCID: PMC9763970 DOI: 10.1002/aet2.10829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/11/2022] [Accepted: 10/28/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Guy Carmelli
- Department of Emergency MedicineUniversity of MassachusettsWorcesterMassachusettsUSA
| | - Rodney Fullmer
- Department of Emergency MedicineSwedish Hospital Part of NorthShoreChicagoIllinoisUSA
| | - Margaret Goodrich
- Department of Emergency MedicineUniversity of Missouri School of MedicineMissouriColumbiaUSA
| | - Tom Grawey
- Department of Emergency MedicineMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Elspeth Pearce
- Department of Emergency MedicineThe University of Kansas Health SystemKansas CityMissouriUSA
| | - Sally A. Santen
- Department of Emergency MedicineSchool of Medicine, Virginia Commonwealth University and University of CincinnatiVirginiaRichmondUSA
| | - Benjamin H. Schnapp
- Department of Emergency MedicineUniversity of Wisconsin School of Medicine and Public HealthWisconsinMadisonUSA
| |
Collapse
|
5
|
Daly M, Lucas G, Wilkinson TJ. Learning, judgement and workforce tensions impact failure to fail in a medical postgraduate setting: A supervisor perspective. MEDICAL TEACHER 2022; 44:1092-1099. [PMID: 35430929 DOI: 10.1080/0142159x.2022.2058385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Medical training organisations have a duty to prepare medical graduates for future safe, competent practice. Decisions about underperformance are high stakes at the postgraduate level and failure to fail can occur. We aimed to explore this concept from a systems and supervisor perspective. METHOD Supervisors of specialist physician trainees were invited to provide written feedback on failure to fail as part of a broader anonymous supervisor survey. They were provided with a trigger statement and responded in free-text format. A deductive content analysis was undertaken through the lenses of supervisor and institution. RESULTS Of 663 supervisors who responded to the broader survey, 373 (56%) provided feedback on the failure to fail trigger statement. Analyses indicated an interplay between trainee and supervisor characteristics, and broader system elements. System elements that contributed to failure to fail trainees included lack of longitudinal monitoring and quality of assessment information. Supervisor characteristics included confident, conflicted and avoidant behaviours towards underperforming trainees. CONCLUSIONS Individual and system challenges that contributed to failure to fail were identified in this study, and we propose a three-way tension among learning, judgement and workforce. Three potential mitigation strategies have been identified to reduce failure to fail, namely a stage-based approach to remediation, faculty development in supervisory skills and improved assessment-for-learning processes.
Collapse
Affiliation(s)
- Michele Daly
- Member Learning and Development, Royal Australasian College of Physicians, Sydney, Australia
| | - Gillian Lucas
- Education Policy, Research and Evaluation, Royal Australasian College of Physicians, Sydney, Australia
| | - Tim J Wilkinson
- FRACP, Royal Australasian College of Physicians, Sydney, Australia
| |
Collapse
|
6
|
Phinney LB, Fluet A, O'Brien BC, Seligman L, Hauer KE. Beyond Checking Boxes: Exploring Tensions With Use of a Workplace-Based Assessment Tool for Formative Assessment in Clerkships. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1511-1520. [PMID: 35703235 DOI: 10.1097/acm.0000000000004774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE To understand the role of a workplace-based assessment (WBA) tool in facilitating feedback for medical students, this study explored changes and tensions in a clerkship feedback activity system through the lens of cultural historical activity theory (CHAT) over 2 years of tool implementation. METHOD This qualitative study uses CHAT to explore WBA use in core clerkships by identifying feedback activity system elements (e.g., community, tools, rules, objects) and tensions among these elements. University of California, San Francisco core clerkship students were invited to participate in semistructured interviews eliciting experience with a WBA tool intended to enhance direct observation and feedback in year 1 (2019) and year 2 (2020) of implementation. In year 1, the WBA tool required supervisor completion in the school's evaluation system on a computer. In year 2, both students and supervisors had WBA completion abilities and could access the form via a smartphone separate from the school's evaluation system. RESULTS Thirty-five students participated in interviews. The authors identified tensions that shifted with time and tool iterations. Year 1 students described tensions related to cumbersome tool design, fear of burdening supervisors, confusion over WBA purpose, WBA as checking boxes, and WBA usefulness depending on clerkship context and culture. Students perceived dissatisfaction with the year 1 tool version among peers and supervisors. The year 2 mobile-based tool and student completion capabilities helped to reduce many of the tensions noted in year 1. Students expressed wider WBA acceptance among peers and supervisors in year 2 and reported understanding WBA to be for low-stakes feedback, thereby supporting formative assessment for learning. CONCLUSIONS Using CHAT to explore changes in a feedback activity system with WBA tool iterations revealed elements important to WBA implementation, including designing technology for tool efficiency and affording students autonomy to document feedback with WBAs.
Collapse
Affiliation(s)
- Lauren B Phinney
- L.B. Phinney is a first-year internal medicine resident, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Angelina Fluet
- A. Fluet is a fourth-year medical student, University of California, San Francisco School of Medicine, San Francisco, California
| | - Bridget C O'Brien
- B.C. O'Brien is professor of medicine and education scientist, Department of Medicine and Center for Faculty Educators, University of California, San Francisco School of Medicine, San Francisco, California
| | - Lee Seligman
- L. Seligman is a second-year internal medicine resident, Department of Medicine, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York
| | - Karen E Hauer
- K.E. Hauer is associate dean for competency assessment and professional standards and professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| |
Collapse
|
7
|
Tornwall J, Rusnak S. Frameworks and Technology for Triangulation of Feedback to Support Learning. Nurs Clin North Am 2022; 57:575-588. [DOI: 10.1016/j.cnur.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
8
|
Hatala R, Tavares W. Workplace-based licensing assessments: an idea worth considering? CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:115-116. [PMID: 36091735 PMCID: PMC9441125 DOI: 10.36834/cmej.73837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Rose Hatala
- Department of Medicine, University of British Columbia, British Columbia, Canada
| | - Walter Tavares
- The Wilson Centre and Temerty Faculty of Medicine, University Health Network, University of Toronto, Ontario, Canada
| |
Collapse
|
9
|
Penner JC, Hauer KE, Julian KA, Sheu L. How preceptors develop trust in continuity clinic residents and how trust influences supervision: A qualitative study. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:73-79. [PMID: 34914028 PMCID: PMC8941004 DOI: 10.1007/s40037-021-00694-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 09/25/2021] [Accepted: 09/29/2021] [Indexed: 05/21/2023]
Abstract
INTRODUCTION To advance in their clinical roles, residents must earn supervisors' trust. Research on supervisor trust in the inpatient setting has identified learner, supervisor, relationship, context, and task factors that influence trust. However, trust in the continuity clinic setting, where resident roles, relationships, and context differ, is not well understood. We aimed to explore how preceptors in the continuity clinic setting develop trust in internal medicine residents and how trust influences supervision. METHODS In this qualitative study, we conducted semi-structured interviews with faculty preceptors from two continuity clinic sites in an internal medicine residency program at an urban academic medical center in the United States from August 2018-June 2020. We analyzed transcripts using thematic analysis with sensitizing concepts related to the theoretical framework of the five factors of trust. RESULTS Sixteen preceptors participated. We identified four key drivers of trust and supervision in the continuity clinic setting: 1) longitudinal resident-preceptor-patient relationships, 2) direct observations of continuity clinic skills, 3) resident attitude towards their primary care physician role, and 4) challenging context and task factors influencing supervision. Preceptors shared challenges to determining trust stemming from incomplete knowledge about patients and limited opportunities to directly observe and supervise between-visit care. DISCUSSION The continuity clinic setting offers unique supports and challenges to trust development and trust-supervision alignment. Maximizing resident-preceptor-patient continuity, promoting direct observation, and improving preceptor supervision of residents' provision of between-visit care may improve resident continuity clinic learning and patient care.
Collapse
Affiliation(s)
- John C Penner
- Department of Medicine, School of Medicine, University of California, San Francisco, USA.
| | - Karen E Hauer
- Department of Medicine, School of Medicine, University of California, San Francisco, USA
| | - Katherine A Julian
- Department of Medicine, School of Medicine, University of California, San Francisco, USA
| | - Leslie Sheu
- Department of Medicine, School of Medicine, University of California, San Francisco, USA
| |
Collapse
|
10
|
Schumacher DJ, Teunissen PW, Kinnear B, Driessen EW. Assessing trainee performance: ensuring learner control, supporting development, and maximizing assessment moments. Eur J Pediatr 2022; 181:435-439. [PMID: 34286373 DOI: 10.1007/s00431-021-04182-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/28/2022]
Abstract
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.
Collapse
Affiliation(s)
- Daniel J Schumacher
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Pim W Teunissen
- School of Health Professions Education (SHE), Faculty of Health Medicine and Life Sciences and Gynecologist, Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Benjamin Kinnear
- Internal Medicine and Pediatrics, Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Erik W Driessen
- School of Health Professions Education (SHE), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
11
|
Steenbruggen RA, Maas MJM, Hoogeboom TJ, Brand PLP, van der Wees PJ. The application of the tracer method with peer observation and formative feedback for professional development in clinical practice: a scoping review. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:15-21. [PMID: 34762266 PMCID: PMC8733089 DOI: 10.1007/s40037-021-00693-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The tracer method, commonly used for quality assessment, can also be used as a tool for peer observation and formative feedback on professional development. This scoping review describes how, by whom, and with what effect the tracer method is applied as a formative professional development instrument between healthcare professionals of equal status and aims to identify the types of scientific evidence for this use of the tracer method. METHODS The authors searched four electronic databases for eligible articles, which were screened and assessed for eligibility by two independent researchers. From eligible studies, data were extracted to summarize, collate, and make a narrative account of the findings. RESULTS The electronic search yielded 1757 unique studies, eight of which were included as valid and relevant to our aim: five qualitative, two mixed methods, and one quantitative study. Seven studies took place in hospitals and one in general practice. The tracer method was used mainly as a form of peer observation and formative feedback. Most studies evaluated the tracer method's feasibility and its impact on professional development. All but one study reported positive effects: participants described the tracer method generally as being valuable and worth continuing. DISCUSSION Although the body of evidence is small and largely limited to the hospital setting, using the tracer method for peer observation and formative feedback between healthcare professionals of equal status appears sufficiently useful to merit further rigorous evaluation and implementation in continuous professional development in healthcare.
Collapse
Affiliation(s)
- Rudi A Steenbruggen
- School of Health, Physiotherapy, Saxion University of Applied Sciences, Enschede, The Netherlands.
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Marjo J M Maas
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute of Allied Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Thomas J Hoogeboom
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul L P Brand
- Isala Hospital, Zwolle, The Netherlands
- University of Groningen and University Medical Centre, Groningen, The Netherlands
| | - Philip J van der Wees
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
12
|
Abstract
If used thoughtfully and with intent, feedback and coaching will promote learning and growth as well as personal and professional development in our learners. Feedback is an educational tool as well as a social interaction between learner and supervisor, in the context of a respectful and trusting relationship. It challenges the learner's thinking and supports the learner's growth. Coaching is an educational philosophy dedicated to supporting learners' personal and professional development and growth and supporting them to reach their potential. In clinical education, feedback is most effective when it is explicitly distinguished from summative assessment. Importantly, feedback should be about firsthand observed behaviors (which can be direct or indirect) and not about information which comes from a third party. Learners are more receptive to feedback if it comes from a source that they perceive as credible, and with whom they have developed rapport. The coaching relationship between learner and supervisor should also be built on mutual trust and respect. Coaching can be provided in the moment (feedback on everyday clinical activities that leads to performance improvement, even with short interaction with a supervisor) and over time (a longer term relationship with a supervisor in which there is reflection on the learner's development and co-creation of new learning goals). Feedback and coaching are most valuable when the learner and teacher exhibit a growth mindset. At the organizational level, it is important that both the structures and training are in place to ensure a culture of effective feedback and coaching in the clinical workplace.Conclusions: Having a thoughtful and intentional approach to feedback and coaching with learners, as well as applying evidence-based principles, will not only contribute in a significant way to their developmental progression, but will also provide them with the tools they need to have the best chance of achieving competence throughout their training. What is Known: • Feedback and coaching are key to advancing the developmental progression of trainees as they work towards achieving competence. • Feedback is not a one-way delivery of specific information from supervisor to trainee, but rather a social interaction between two individuals in which trust and respect play a key role. • Provision of effective feedback may be hampered by confusing formative (supporting trainee learning and development) and summative (the judgment that is made about a trainee's level of competence) purposes. What is New: • Approaches to both the provision of feedback/coaching and the assessment of competence must be developed in parallel to ensure success in clinical training programs. • Faculty development is essential to provide clinical teachers with the skills to provide effective feedback and coaching. • Coaching's effectiveness relies on nurturing strong trainee-supervisor relationships, ensuring high-quality feedback, nourishing a growth mindset, and encouraging an institutional culture that embraces feedback and coaching.
Collapse
|
13
|
Rietmeijer CBT, Blankenstein AH, Huisman D, van der Horst HE, Kramer AWM, de Vries H, Scheele F, Teunissen PW. What happens under the flag of direct observation, and how that matters: A qualitative study in general practice residency. MEDICAL TEACHER 2021; 43:937-944. [PMID: 33765396 DOI: 10.1080/0142159x.2021.1898572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION In competency-based medical education, direct observation (DO) of residents' skills is scarce, notwithstanding its undisputed importance for credible feedback and assessment. A growing body of research is investigating this discrepancy. Strikingly, in this research, DO as a concrete educational activity tends to remain vague. In this study, we concretised DO of technical skills in postgraduate longitudinal training relationships. METHODS Informed by constructivist grounded theory, we performed a focus group study among general practice residents. We asked residents about their experiences with different manifestations of DO of technical skills. A framework describing different DO patterns with their varied impact on learning and the training relationship was constructed and refined until theoretical sufficiency was reached. RESULTS The dominant DO pattern was ad hoc, one-way DO. Importantly, in this pattern, various unpredictable, and sometimes unwanted, scenarios could occur. Residents hesitated to discuss unwanted scenarios with their supervisors, sometimes instead refraining from future requests for DO or even for help. Planned bi-directional DO sessions, though seldom practiced, contributed much to collaborative learning in a psychologically safe training relationship. DISCUSSION AND CONCLUSION Patterns matter in DO. Residents and supervisors should be made aware of this and educated in maintaining an open dialogue on how to use DO for the benefit of learning and the training relationship.
Collapse
Affiliation(s)
- Chris B T Rietmeijer
- Department of General Practice, Location VUmc, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Annette H Blankenstein
- Department of General Practice, Location VUmc, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Daniëlle Huisman
- Department of General Practice, Location VUmc, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Henriëtte E van der Horst
- Department of General Practice, Location VUmc, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Anneke W M Kramer
- Department of Public Health and Primary Care, Leiden University, Leiden, The Netherlands
| | - Henk de Vries
- Department of General Practice, Location VUmc, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Fedde Scheele
- School of Medical Sciences, Amsterdam University Medical Center, Location VUmc, Athena Institute for Transdisciplinary Research, VU University, Amsterdam, The Netherlands
| | - Pim W Teunissen
- School of Health Professions Education, Maastricht University, Universiteitssingel 60, Maastricht, The Netherlands
| |
Collapse
|
14
|
Bradley EB, Waselewski EA, Gusic ME. How Do Clerkship Students Use EPA Data? Illuminating Students' Perspectives as Partners in Programs of Assessment. MEDICAL SCIENCE EDUCATOR 2021; 31:1419-1428. [PMID: 34457983 PMCID: PMC8368261 DOI: 10.1007/s40670-021-01327-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The implementation of programs of assessment based on Entrustable Professional Activities (EPAs) offers an opportunity for students to obtain unique data to guide their ongoing learning and development. Although authors have explored factors that contribute to trust-based decisions, learners' use of assessors' decisions about the level of supervision they need has not been fully investigated. METHODS In this study, we conducted semi-structured interviews of clerkship students who participated in the first year of our EPA program to determine how they interpret and use supervision ratings provided in EPA assessments. Content analysis was performed using concept-driven and open coding. RESULTS Nine interviews were completed. Twenty-two codes derived from previous work describing factors involved in trust decisions and 12 novel codes were applied to the interview text. Analyses revealed that students focus on written and verbal feedback from assessors more so than on supervision ratings. Axial coding revealed a temporal organization that categorized how students considered the data from EPA assessments. While factors before, during, and after an assessment affected students' use of information, the relationship between the student and the assessor had impact throughout. CONCLUSIONS Although students reported varying use of the supervision ratings, their perspectives about how assessors and students interact and/or partner before, during, and after assessments provide insights into the importance of an educational alliance in making a program of assessment meaningful and acceptable to learners.
Collapse
Affiliation(s)
- Elizabeth B. Bradley
- Center for Medical Education Research and Scholarly Innovation, Office of Medical Education, University of Virginia School of Medicine, VA Charlottesville, USA
| | - Eric A. Waselewski
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan USA
| | - Maryellen E. Gusic
- Center for Medical Education Research and Scholarly Innovation, Office of Medical Education, University of Virginia School of Medicine, VA Charlottesville, USA
| |
Collapse
|
15
|
Kinnear B, Warm EJ, Caretta-Weyer H, Holmboe ES, Turner DA, van der Vleuten C, Schumacher DJ. Entrustment Unpacked: Aligning Purposes, Stakes, and Processes to Enhance Learner Assessment. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S56-S63. [PMID: 34183603 DOI: 10.1097/acm.0000000000004108] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Educators use entrustment, a common framework in competency-based medical education, in multiple ways, including frontline assessment instruments, learner feedback tools, and group decision making within promotions or competence committees. Within these multiple contexts, entrustment decisions can vary in purpose (i.e., intended use), stakes (i.e., perceived risk or consequences), and process (i.e., how entrustment is rendered). Each of these characteristics can be conceptualized as having 2 distinct poles: (1) purpose has formative and summative, (2) stakes has low and high, and (3) process has ad hoc and structured. For each characteristic, entrustment decisions often do not fall squarely at one pole or the other, but rather lie somewhere along a spectrum. While distinct, these continua can, and sometimes should, influence one another, and can be manipulated to optimally integrate entrustment within a program of assessment. In this article, the authors describe each of these continua and depict how key alignments between them can help optimize value when using entrustment in programmatic assessment within competency-based medical education. As they think through these continua, the authors will begin and end with a case study to demonstrate the practical application as it might occur in the clinical learning environment.
Collapse
Affiliation(s)
- Benjamin Kinnear
- B. Kinnear is associate professor of internal medicine and pediatrics, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0003-0052-4130
| | - Eric J Warm
- E.J. Warm is professor of internal medicine and program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0002-6088-2434
| | - Holly Caretta-Weyer
- H. Caretta-Weyer is assistant professor of emergency medicine, Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California; ORCID: https://orcid.org/0000-0002-9783-5797
| | - Eric S Holmboe
- E.S. Holmboe is chief, research, milestones development and evaluation officer, Accreditation Council for Graduate Medical Education, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-0108-6021
| | - David A Turner
- D.A. Turner is vice president, Competency-Based Medical Education, American Board of Pediatrics, Chapel Hill, North Carolina
| | - Cees van der Vleuten
- C. van der Vleuten is professor of education, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; ORCID: https://orcid.org/0000-0001-6802-3119
| | - Daniel J Schumacher
- D.J. Schumacher is associate professor of pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0001-5507-8452
| |
Collapse
|