Validity evidence for the Anesthesia Clinical Encounter Assessment (ACEA) tool to support competency-based medical education

The influence of resident and faculty gender on assessments in anesthesia competency-based medical education

PURPOSE

Competency-based medical education (CBME) relies on frequent workplace-based assessments of trainees, providing opportunities for conscious and implicit biases to reflect in these assessments. We aimed to examine the influence of resident and faculty gender on performance ratings of residents within a CBME system.

METHODS

This retrospective cohort study took place from August 2017 to January 2021 using resident assessment data from two workplace-based assessments: the Anesthesia Clinical Encounter Assessment (ACEA) and Entrustable Professional Activities (EPAs). Self-reported gender data were also extracted. The primary outcome-gender-based differences in entrustment ratings of residents on the ACEA and EPAs-was evaluated using mixed-effects logistic regression, with differences reported through odds ratios and confidence intervals (α = 0.01). Gender-based differences in the receipt of free-text comments on the ACEA and EPAs were also explored.

RESULTS

In total, 14,376 ACEA and 4,467 EPA assessments were analyzed. There were no significant differences in entrustment ratings on either assessment tool between men and women residents. Regardless of whether assessments were completed by men or women faculty, entrustment rates between men and women residents were not significantly different for any postgraduate year level. Additionally, men and women residents received strengths-related and actions-related comments on both assessments at comparable frequencies, irrespective of faculty gender.

CONCLUSION

We found no gender-based differences in entrustment ratings for both the ACEA and EPAs, which suggests an absence of resident gender bias within this CBME system. Given considerable heterogeneity in rater leniency, future work would be strengthened by using rater leniency-adjusted scores rather than raw scores.

Competency-Based Medical Education: Are Canadian Pediatric Anesthesiologists Ready?

Background

With the introduction of Competency-Based Medical Education (CBME), the Canadian Pediatric Anesthesia Society (CPAS) surveyed its members to assess their awareness of and prior experience with CBME concepts and evaluation tools, and identify methods for faculty development of CBME teaching strategies for pediatric anesthesia residents and fellows.

Methods

An online survey was sent to CPAS members. Outcomes included respondents’ previous exposure to CBME and the educational support they had received in anticipation of the curriculum. Questions used multi-item Likert scales and a general feedback question. 

Results

The response rate was 39% (60/155). Eighty-eight percent of respondents spent ≥50% of their time practicing pediatric anesthesia; 78% and 45% spent at least a quarter of their time teaching residents and fellows respectively. Eighty-three percent were familiar with CBME concepts, and 58% were familiar with Milestones, Competencies, and Entrustable Professional Activities (EPAs). However, 64% had not received any formal training and 52% had not used any CBME evaluation tools. Learning preferences included small group discussions (72%), lectures with questions and answers (Q&A) (62%), seminars (50%), and workshops (50%).

Conclusions

Despite widespread awareness of CBME concepts, there is a need to educate Canadian pediatric anesthesiologists regarding CBME evaluation tools. Faculty development support will increase the utilization of these tools in teaching practice.