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Wong L, Sacoransky E, Hopman W, Islam O, Chung AD, Kwan BYM. Radiologist preferences for faculty development initiatives to improve resident feedback in the era of competency-based medical education. MEDICAL EDUCATION ONLINE 2024; 29:2357412. [PMID: 38810150 PMCID: PMC11138222 DOI: 10.1080/10872981.2024.2357412] [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: 01/10/2024] [Accepted: 05/15/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION Since 2022, all Canadian post-graduate medical programs have transitioned to a Competence by Design (CBD) model within a Competency-Based Medical Education (CBME) framework. The CBME model emphasized more frequent, formative assessment of residents to evaluate their progress towards predefined competencies in comparison to traditional medical education models. Faculty members therefore have increased responsibility for providing assessments to residents on a more regular basis, which has associated challenges. Our study explores faculty assessment behaviours within the CBD framework and assesses their openness to opportunities aimed at improving the quality of written feedback. Specifically, we explore faculty's receptiveness to routine metric performance reports that offer comprehensive feedback on their assessment patterns. METHODS Online surveys were distributed to all 28 radiology faculty at Queen's University. Data were collected on demographics, feedback practices, motivations for improving the teacher-learner feedback exchange, and openness to metric performance reports and quality improvement measures. Following descriptive statistics, unpaired t-tests and one-way analysis of variance were conducted to compare groups based on experience and subspecialty. RESULTS The response rate was 89% (25/28 faculty). 56% of faculty were likely to complete evaluations after working with a resident. Regarding the degree to which faculty felt written feedback is important, 62% found it at least moderately important. A majority (67%) believed that performance reports could influence their evaluation approach, with volume of written feedback being the most likely to change. Faculty expressed interest in feedback-focused development opportunities (67%), favouring Grand Rounds and workshops. CONCLUSION Assessment of preceptor perceptions reveals that faculty recognize the importance of offering high-quality written feedback to learners. Faculty openness to quality improvement interventions for curricular reform relies on having sufficient time, knowledge, and skills for effective assessments. This suggests that integrating routine performance metrics into faculty assessments could serve as a catalyst for enhancing future feedback quality.
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Affiliation(s)
- Laura Wong
- Department of Diagnostic Radiology, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Ethan Sacoransky
- School of Medicine, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Wilma Hopman
- Kingston General Hospital Research Institute, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Omar Islam
- Department of Diagnostic Radiology, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Andrew D. Chung
- Department of Diagnostic Radiology, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Benjamin Y. M. Kwan
- Department of Diagnostic Radiology, Kingston Health Sciences Centre, Kingston, ON, Canada
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Card A, Daniels G, Bluth P, Chiel L, Herman B, O'Connor M, Plevinsky J, Boyer D. Competency-based medical education (CBME) in graduate medical education: Perspectives from learners, faculty, and program leaders. Curr Probl Pediatr Adolesc Health Care 2024; 54:101677. [PMID: 39214744 DOI: 10.1016/j.cppeds.2024.101677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Affiliation(s)
- Alexandria Card
- Department of Pediatrics, Pediatrics Residency, University of North Carolina at Chapel Hill, USA
| | - Gabriel Daniels
- Department of Medicine, Hospice and Palliative Medicine Fellowship, University of Alabama at Birmingham, USA
| | - Paul Bluth
- Department of Pediatrics, Pediatric Residency, University of Utah, USA
| | - Laura Chiel
- Division of Pulmonary Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Bruce Herman
- Department of Pediatrics, Pediatric Residency, University of Utah, USA
| | - Meghan O'Connor
- Department of Pediatrics, Pediatric Residency, University of Utah, USA
| | - Jill Plevinsky
- Assistant Professor of Clinical Psychiatry, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Debra Boyer
- Professor of Pediatrics, Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.
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Ott MC, Dengler L, Hibbert K, Ott M. Fixing disconnects: Exploring the emergence of principled adaptations in a competency-based curriculum. MEDICAL EDUCATION 2024. [PMID: 39105665 DOI: 10.1111/medu.15475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 05/27/2024] [Accepted: 06/28/2024] [Indexed: 08/07/2024]
Abstract
PURPOSE Competency-based medical education (CBME) promises to improve medical education through curricular reforms to support learner development. This intention may be at risk in the case of a Canadian approach to CBME called Competence by Design (CBD), since there have been negative impacts on residents. According to Joseph Schwab, teachers, learners and milieu must be included in the process of curriculum-making to prevent misalignments between intended values and practice. This study considered what can be learned from the process of designing, enacting and adapting CBD to better support learners. METHODS This qualitative study explored the making of CBD through the perspectives of implementation leads (N = 18) at national, institutional and programme levels. A sociomaterial orientation to agency in curriculum-making guided the inductive approach to interviewing and analysis in phase one. A deductive analysis in phase two applied Schwab's theory to further understand sources of misalignments and the purpose of adaptive responses. RESULTS Misalignments occurred when the needs of teachers, learners and milieu were initially underestimated in the process of curriculum-making, disconnecting assessment practices from experiences of teaching, learning and entrustment. While technical and structural issues posed significant constraints on agency, some implementation leads were able to make changes to the curriculum or context to fix the disconnects. We identified six purposes for principled adaptations to align with CBME values of responsive teaching, individualised learning and meaningful entrustment. CONCLUSION Collectively, the adaptations we characterise demonstrate constructive alignment, a foundational principle of CBME in which assessment and teaching work together to support learning. This study proposes a model for making context-shaped, values-based adaptations to CBME to achieve its promise.
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Affiliation(s)
- Mary C Ott
- Faculty of Education, York University, Toronto, Canada
- Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Lori Dengler
- Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | | | - Michael Ott
- Department of Oncology and professor, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Canada
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Alston J, Gandell D, Kangasjarvi E, Brydges R. Ready, Set, Goal: A Mixed Methods Study of a Goal-Setting Intervention on 2 Competency-Based Geriatric Medicine Rotations. J Grad Med Educ 2024; 16:453-460. [PMID: 39148878 PMCID: PMC11324169 DOI: 10.4300/jgme-d-24-00069.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/05/2024] [Accepted: 06/03/2024] [Indexed: 08/17/2024] Open
Abstract
Background More research is required to understand the effects of implementing structured goal-setting on trainee engagement in competency-based clinical learning environments. Objective To explore how residents experienced a rotation-specific goal-setting intervention on geriatric medicine rotations at 2 hospitals. Methods All rotating residents were expected to complete the intervention, consisting of a SMART-based (Specific, Measurable, Achievable, Relevant, and Time-Bound) goal-setting form and feedback sessions with teaching faculty. From November 2019 to June 2021, we recruited a convenience sample of rotating residents. Study participants completed pre- and postrotation 35-item Dutch Residency Educational Climate Test (D-RECT) questionnaires to compare scores from their rotation before the geriatric rotation and a postrotation semistructured interview, which we transcribed and analyzed using principles of constant comparison and reflexive thematic analysis. Results We interviewed 12 of 58 (20.7%) residents participating in the goal-setting intervention, 11 of whom completed both D-RECT questionnaires. Participants' D-RECT scores favored the geriatric medicine rotation versus the immediately preceding clinical rotation (M=4.29±0.37; M=3.84±0.44, P=.002). Analyses of interview transcripts yielded 3 themes on how participants perceived the intervention influenced their learning experience: (1) structured forms and processes mediate, inform, and constrain goal selection; (2) interactions with faculty, patients, and system factors influenced goal enactment; and (3) unstructured assessments led to uncertainty around goal achievement. Challenges included time restrictions and unpredictable clinical opportunities. Conclusions Goal-setting appeared to help many residents direct their learning efforts and engage in collaborative processes with teaching faculty. We identified challenges limiting residents' engagement with the goal-setting intervention, which may inform the practical implementation of goal-setting in other competency-based curricula.
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Affiliation(s)
- Jillian Alston
- Jillian Alston, MD, MScCH, FRCPC, is Assistant Professor, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, and Staff Physician, Division of Geriatric Medicine, Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Dov Gandell
- Dov Gandell, MDCM, FRCPC, is Assistant Professor, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, and Staff Physician, Division of Geriatric Medicine, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Emilia Kangasjarvi
- Emilia Kangasjarvi, MSSc, is Research Coordinator, Applied Education Research Operatives, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada; and
| | - Ryan Brydges
- Ryan Brydges, PhD, has a Professorship in Technology-Enabled Education, St. Michael’s Hospital, Unity Health Toronto, and is Associate Professor, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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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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Raikhel AV, Starks H, Berger G, Redinger J. Through the Looking Glass: Comparing Hospitalists' and Internal Medicine Residents' Perceptions of Feedback. Cureus 2024; 16:e63459. [PMID: 39077307 PMCID: PMC11285250 DOI: 10.7759/cureus.63459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2024] [Indexed: 07/31/2024] Open
Abstract
INTRODUCTION Feedback is critical for resident growth and is most effective when the relationship between residents and attendings is collaborative, with shared expectations for the purpose, timing, and manner of communication for feedback. Within internal medicine, there is limited work exploring the resident and hospitalist perspectives on whether key elements are included in feedback sessions. METHODS We surveyed internal medicine residents and supervising hospitalists at a large urban training program about their perspectives on four components of effective feedback: specificity,timeliness, respectful communication, and actionability. RESULTS We received surveys from 130/184 internal medicine residents and 74/129 hospitalists (71% and 57% response rate, respectively). Residents and hospitalists differed in their perspectives about specificity and timeliness: 54% (70/129) of residents reported they did not receive specific feedback while 90% (65/72) of hospitalists reported they delivered specific feedback (p<0.01), and 33% (43/129) of residents compared with 82% (59/72) of hospitalists perceived feedback as timely (p<0.01). Internal medicine residents and hospitalists reported concordant rates of feedback sessions consisting of a two-way conversation (84%, 109/129; 89%, 64/72, respectively, p=0.82) and that communication was delivered in a respectful manner (95%, 122/129; 97%, 70/72, respectively, p=0.57). CONCLUSIONS We observed discordance between internal medicine residents and supervising hospitalist perspectives on the inclusion of two critical components of feedback: specificity and timing. The hospitalist cohort reported delivering more components of effective feedback than the resident cohort reported receiving. The etiology of this discordance is likely multifactorial and requires further investigation.
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Affiliation(s)
- Andrew V Raikhel
- Department of Hospital Medicine, VA (Veteran's Affairs) Puget Sound Healthcare System, Seattle Division, Seattle, USA
- Department of General Internal Medicine, University of Washington, Seattle, USA
| | - Helene Starks
- Department of Bioethics and Humanities, University of Washington, Seattle, USA
| | - Gabrielle Berger
- Department of General Internal Medicine, University of Washington, Seattle, USA
| | - Jeffrey Redinger
- Department of Medicine, University of Washington School of Medicine, Seattle, USA
- Department of Hospital Medicine, VA (Veteran's Affairs) Puget Sound Healthcare System, Seattle Division, Seattle, USA
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Murry LT, Boyer JG, Catledge K, Gettig JP, Travlos DV, Zarembski D, Kiersma ME. The Intersection of Growth Mindset and Accreditation in Pharmacy Education. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100711. [PMID: 38723896 DOI: 10.1016/j.ajpe.2024.100711] [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: 09/19/2023] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES To describe existing growth mindset literature within pharmacy and health care education, describe how a growth mindset can be beneficial in the accreditation process, and propose potential ways to promote a growth mindset in faculty, preceptors, students, and staff within pharmacy education. FINDINGS To help pharmacy learners develop a growth mindset, existing literature emphasizes the need for a shift toward and aligning assessment with a growth mindset, helping to create self-directed adaptive learners, leading to health care providers who can adjust their practice to tackle expected and unexpected challenges throughout their careers. Strategies to create a culture of growth mindset identified include training faculty and learners on growth mindset and developing new assessments that track a learner's growth. Recommendations for pharmacy educators include encouraging educators to assess their own growth mindset and use a variety of teaching methods and provide feedback on learner effort that encourages the process of learning rather than focusing on individual attributes, traits, and results. SUMMARY Growth mindset intersects with accreditation standards for both professional degree programs and providers of continuing pharmacy education. Continuing professional development process is one way to encourage faculty, staff, and students to develop a growth mindset. While a growth mindset can have many positive impacts on pharmacy accreditation, it is essential to recognize that achieving and maintaining accreditation is a multifaceted process involving numerous factors. A growth mindset can positively influence pharmacy education accreditation by fostering a culture of continuous improvement, innovation, resilience, student-centeredness, data-driven decision-making, collaboration, and effective leadership.
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Affiliation(s)
- Logan T Murry
- Accreditation Council for Pharmacy Education, Chicago, IL, USA
| | - J Gregory Boyer
- Accreditation Council for Pharmacy Education, Chicago, IL, USA
| | | | - Jacob P Gettig
- Accreditation Council for Pharmacy Education, Chicago, IL, USA
| | | | - Dawn Zarembski
- Accreditation Council for Pharmacy Education, Chicago, IL, USA
| | - Mary E Kiersma
- Accreditation Council for Pharmacy Education, Chicago, IL, USA.
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Simon TA, Owais S, Duarte D, Acai A. Chronicling the Transition to Competency-Based Medical Education in a Small Subspeciality Program. J Grad Med Educ 2024; 16:312-317. [PMID: 38882435 PMCID: PMC11173005 DOI: 10.4300/jgme-d-23-00643.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/30/2023] [Accepted: 03/12/2024] [Indexed: 06/18/2024] Open
Abstract
Background As medical education programs transition to competency-based medical education (CBME), experiences transitioning in the context of small subspecialty programs remain unknown, yet they are needed for effective implementation and continual improvements. Objective To examine faculty and resident experiences transitioning to CBME in a small subspeciality program. Methods Using a qualitative descriptive approach and constructivist lens, faculty and residents in McMaster University's geriatric psychiatry subspecialty program were interviewed about their transition experiences between November 2021 and February 2022, after the program's soft launch of CBME in 2020. Interviews were transcribed and data were analyzed using thematic analysis. Reflexive memo writing and investigator and data triangulation strategies were employed to ensure rigor and trustworthiness of the data. Results Ten of the 17 faculty members (59%) and 3 residents (100%) participated. Six themes were developed: (1) Both faculty and residents see themselves as somewhat knowledgeable about CBME, but sources of knowledge vary; (2) More frequent feedback is beneficial; (3) Aspects of CBME that are challenging for residents are beneficial for faculty; (4) Competence committees are perceived positively despite most participants' limited firsthand experience with them; (5) Small program size is both a barrier and facilitator to providing and receiving feedback; and (6) Suggestions for improvement are centered on helping manage faculty and resident workload imposed by CBME. Conclusions Incongruent expectations surrounding entrustable professional activity management were highlighted as an area requiring support. Collegial relationships among faculty and residents made it difficult for faculty to provide constructive feedback but improved residents' perceptions of the feedback.
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Affiliation(s)
- Taryn A Simon
- is a Research Assistant, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Sawayra Owais
- is a MD/PhD Candidate, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Dante Duarte
- is Assistant Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, and Geriatric Psychiatrist, Seniors Mental Health Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; and
| | - Anita Acai
- is Assistant Professor and Education Scientist, Department of Psychiatry and Behavioural Neurosciences and McMaster Education Research, Innovation and Theory (MERIT) Program, McMaster University, and Education Scientist, St. Joseph's Education & Research Centre (SERC), St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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Braund H, Dalgarno N, O’Dell R, Taylor DR. Making assessment a team sport: a qualitative study of facilitated group feedback in internal medicine residency. CANADIAN MEDICAL EDUCATION JOURNAL 2024; 15:14-26. [PMID: 38827914 PMCID: PMC11139793 DOI: 10.36834/cmej.75250] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Purpose Competency-based medical education relies on feedback from workplace-based assessment (WBA) to direct learning. Unfortunately, WBAs often lack rich narrative feedback and show bias towards Medical Expert aspects of care. Building on research examining interactive assessment approaches, the Queen's University Internal Medicine residency program introduced a facilitated, team-based assessment initiative ("Feedback Fridays") in July 2017, aimed at improving holistic assessment of resident performance on the inpatient medicine teaching units. In this study, we aim to explore how Feedback Fridays contributed to formative assessment of Internal Medicine residents within our current model of competency-based training. Method A total of 53 residents participated in facilitated, biweekly group assessment sessions during the 2017 and 2018 academic year. Each session was a 30-minute facilitated assessment discussion done with one inpatient team, which included medical students, residents, and their supervising attending. Feedback from the discussion was collected, summarized, and documented in narrative form in electronic WBA forms by the program's assessment officer for the residents. For research purposes, verbatim transcripts of feedback sessions were analyzed thematically. Results The researchers identified four major themes for feedback: communication, intra- and inter-personal awareness, leadership and teamwork, and learning opportunities. Although feedback related to a broad range of activities, it showed strong emphasis on competencies within the intrinsic CanMEDS roles. Additionally, a clear formative focus in the feedback was another important finding. Conclusions The introduction of facilitated team-based assessment in the Queen's Internal Medicine program filled an important gap in WBA by providing learners with detailed feedback across all CanMEDS roles and by providing constructive recommendations for identified areas for improvement.
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Affiliation(s)
- Heather Braund
- Office of Professional Development and Educational Scholarship, Ontario, Canada
- Faculty of Education, Queen’s University, Ontario, Canada
| | - Nancy Dalgarno
- Office of Professional Development and Educational Scholarship, Ontario, Canada
- Department of Biomedical and Molecular Sciences, Faculty of Health Sciences, Queen’s University, Ontario, Canada
| | - Rachel O’Dell
- Department of Internal Medicine, Faculty of Health Sciences, Queen’s University, Ontario, Canada
| | - David R Taylor
- Academy for Teachers and Educators, Department of Medicine, Queen’s University, Ontario, Canada
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Cox R, Arthur J, Burtson K. Feedback perceptions of first year medical residents: An intervention-based survey study. PLoS One 2024; 19:e0300205. [PMID: 38598479 PMCID: PMC11006118 DOI: 10.1371/journal.pone.0300205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/22/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Feedback in residency is a necessity for progression toward clinical competency and is included in The Accreditation Council for Graduate Medical Education (ACGME) milestones as an essential component for accreditation. PURPOSE Our study elucidates perceptions of feedback of first-year residents and aims to identify how these perceptions change after education on building expertise through deliberate practice. METHODS First-year internal medicine and neurology residents of a mid-sized university-affiliated residency program answered a five-question 5-point unipolar response scale questionnaire regarding feedback perceptions before and after attending a workshop about building expertise through effective feedback during residency orientation. Related-Samples Wilcoxon Signed Rank Test was applied for comparing pre- versus post-questionnaire data. RESULTS Of 31 first-year residents, 29 completed the pre-questionnaire for a completion rate of 93.5%, while 24 of 31 completed the post-questionnaire for a completion rate of 77.4%. Of the five questions, three improved when comparing pre and post responses to, including the questions on confidence in the ability to procure feedback (p = <0.001), the effort put into procuring feedback (p = 0.001), and frequency of seeking feedback (p = 0.002). Interest in receiving feedback and the importance of feedback remained unchanged after workshop attendance. CONCLUSION Residents should be educated on building expertise through deliberate practice and how to obtain high-quality feedback, given the emphasis and essentiality of feedback within the milestone assessment system and the core competencies of ACGME. In our study, education on these topics led to significant improvement in resident perceptions of confidence in the ability to procure feedback, effort put into procuring feedback, and frequency at which feedback would be sought.
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Affiliation(s)
- Rachel Cox
- Department of Internal Medicine, Wright Patterson AFB and Wright State University, Wright-Patterson AFB, Ohio, United States of America
| | - John Arthur
- Department of Internal Medicine, Wright Patterson AFB and Wright State University, Wright-Patterson AFB, Ohio, United States of America
| | - Kathryn Burtson
- Department of Internal Medicine, Wright Patterson AFB and Wright State University, Wright-Patterson AFB, Ohio, United States of America
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Dhami N, Hamza DM, Daniels VJ. Motivations for Entrustable Professional Activity Assessment: Gaps Between Curriculum Theory and Resident Reality. J Grad Med Educ 2024; 16:166-174. [PMID: 38993299 PMCID: PMC11234313 DOI: 10.4300/jgme-d-23-00470.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/23/2023] [Accepted: 01/27/2024] [Indexed: 07/13/2024] Open
Abstract
Background Previous research demonstrates mixed reactions from residents toward competency-based medical education (CBME), and entrustable professional activities (EPAs) specifically. However, understanding what motivates residents to obtain EPAs may be vital to the longevity of CBME, given the emphasis on assessment for learning under this paradigm. Objective This study explored resident perspectives across 3 domains: motivation for obtaining EPAs, perceived importance of EPAs, and overall thoughts on CBME curriculum. Methods This was a sequential exploratory mixed-methods study involving 2 phases of data collection. Phase 1 was semi-structured interviews with residents enrolled in CBME at one Canadian institution from November 2019 to July 2020. Analyses included thematic and manifest content analysis. Phase 2 was an electronic close-ended survey to capture residents' primary motivation for requesting EPAs and importance of EPAs for learning. Survey data were analyzed descriptively. Results Of 120 eligible residents, 25 (21%) and 107 (89%) participated in the interview and survey, respectively. Program requirement was the dominant motivation for obtaining EPAs. There was variability in perceived importance of EPAs on learning. Increased resident workload, gaming the system to maximize EPA scores, and lack of shared ownership from preceptors were cited as critiques of the curriculum. Survey responses corroborated interview findings. Conclusions Although many residents recognize the value of EPAs, the majority are not intrinsically motivated to seek out assessment under the current CBME framework.
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Affiliation(s)
- Neil Dhami
- is a PGY-4 Resident, General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Deena M Hamza
- is an Innovation Scientist, Health Professions Education Scientist, Director, Research & Evaluation, Postgraduate Medical Education, Adjunct Assistant Professor, Department of Medicine, Edmonton, Alberta, Canada, and Vice-Chair, Canadian Association for Medical Education Foundation, Ottawa, Ontario, Canada; and
| | - Vijay J Daniels
- is Professor, Division of General Internal Medicine, Associate Chair of Education and Faculty Development, Department of Medicine, and Assistant Dean of Assessment, MD Program, University of Alberta, Edmonton, Alberta, Canada
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Talmi L, Nabecker S, Piquette D, Mema B. Pediatric Critical Care Fellow Perception of Learning through Virtual Reality Bronchoscopy. ATS Sch 2024; 5:174-183. [PMID: 38585579 PMCID: PMC10995860 DOI: 10.34197/ats-scholar.2023-0097in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/28/2023] [Indexed: 04/09/2024] Open
Abstract
Background Virtual reality (VR) simulators have revolutionized training in bronchoscopy, offering unrestricted availability in a low-stakes learning environment and frequent assessments represented by automatic scoring. The VR assessments can be used to monitor and support learners' progression. How trainees perceive these assessments needs to be clarified. Objective The objective of this study was to examine what assessments learners select to document and receive feedback on and what influences their decisions. Methods We used a sequential explanatory mixed methods strategy. All participants were pediatric critical care medicine trainees requiring competency in bronchoscopy skills. During independent simulation practice, we collected the number of learning-focused practice attempts (scores not recorded), assessment-focused practice (scores recorded and reviewed by the instructor for feedback), and the amount of time each attempt lasted. After simulation training, we conducted interviews to explore learners' perceptions of assessment. Results There was no significant difference in the number of attempts for each practice type. The average time per learning-focused attempt was almost three times longer than the assessment-focused attempt (mean [standard deviation] 16 ± 1 min vs. 6 ± 3 min, respectively; P < 0.05). Learners perceived documentation of their scores as high stakes and only recorded their better scores. Learners felt safer experimenting if their assessments were not recorded. Conclusion During independent practice, learners took advantage of automatic assessments generated by the VR simulator to monitor their progression. However, the recording of scores from the simulation program to document learners' trajectory to a set goal was perceived as high stakes, discouraging learners from seeking supervisor feedback.
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Affiliation(s)
- Liron Talmi
- Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sabine Nabecker
- Department of Anesthesiology and Pain Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Dominique Piquette
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; and
- Department of Critical Care Medicine, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Briseida Mema
- Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; and
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Sahi N, Humphrey-Murto S, Brennan EE, O'Brien M, Hall AK. Current use of simulation for EPA assessment in emergency medicine. CAN J EMERG MED 2024; 26:179-187. [PMID: 38374281 DOI: 10.1007/s43678-024-00649-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/12/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE Approximately five years ago, the Royal College emergency medicine programs in Canada implemented a competency-based paradigm and introduced the use of Entrustable Professional Activities (EPAs) for assessment of units of professional activity to assess trainees. Many competency-based medical education (CBME) based curricula, involve assessing for entrustment through observations of EPAs. While EPAs are frequently assessed in clinical settings, simulation is also used. This study aimed to characterize the use of simulation for EPA assessment. METHODS A study interview guide was jointly developed by all study authors and followed best practices for survey development. A national interview was conducted with program directors or assistant program directors across all the Royal College emergency medicine programs across Canada. Interviews were conducted over Microsoft Teams, interviews were recorded and transcribed, using Microsoft Teams transcribing service. Sample transcripts were analyzed for theme development. Themes were then reviewed by co-authors to ensure they were representative of the participants' views. RESULTS A 64.7% response rate was achieved. Simulation has been widely adopted by EM training programs. All interviewees demonstrated support for the use of simulation for EPA assessment for many reasons, however, PDs acknowledged limitations and thematic analysis revealed certain themes and tensions for using simulation for EPA assessment. Thematic analysis revealed six major themes: widespread support for the use of simulation for EPA assessment, concerns regarding the potential for EPA assessment to become a "tick- box" exercise, logistical barriers limiting the use of simulation for EPA assessment, varied perceptions about the authenticity of using simulation for EPA assessment, the potential for simulation for EPA assessment to compromise learner psychological safety, and suggestions for the optimization of use of simulation for EPA assessment. CONCLUSIONS Our findings offer insight for other programs and specialties on how simulation for EPA assessment can best be utilized. Programs should use these findings when considering using simulation for EPA assessment.
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Affiliation(s)
- Nidhi Sahi
- Department of Innovation in Medical Education (DIME), University of Ottawa, Ottawa, ON, Canada.
| | - Susan Humphrey-Murto
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Tier 2 Research Chair in Medical Education and Fellowship Director, Medical Education Research, University of Ottawa, Ottawa, ON, Canada
| | - Erin E Brennan
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - Michael O'Brien
- Emergency Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada
| | - Andrew K Hall
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
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Hall AK, Oswald A, Frank JR, Dalseg T, Cheung WJ, Cooke L, Gorman L, Brzezina S, Selvaratnam S, Wagner N, Hamstra SJ, Van Melle E. Evaluating Competence by Design as a Large System Change Initiative: Readiness, Fidelity, and Outcomes. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:95-107. [PMID: 38343556 PMCID: PMC10854467 DOI: 10.5334/pme.962] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/17/2023] [Indexed: 02/15/2024]
Abstract
Program evaluation is an essential, but often neglected, activity in any transformational educational change. Competence by Design was a large-scale change initiative to implement a competency-based time-variable educational system in Canadian postgraduate medical education. A program evaluation strategy was an integral part of the build and implementation plan for CBD from the beginning, providing insights into implementation progress, challenges, unexpected outcomes, and impact. The Competence by Design program evaluation strategy was built upon a logic model and three pillars of evaluation: readiness to implement, fidelity and integrity of implementation, and outcomes of implementation. The program evaluation strategy harvested from both internally driven studies and those performed by partners and invested others. A dashboard for the program evaluation strategy was created to transparently display a real-time view of Competence by Design implementation and facilitate continuous adaptation and improvement. The findings of the program evaluation for Competence by Design drove changes to all aspects of the Competence by Design implementation, aided engagement of partners, supported change management, and deepened our understanding of the journey required for transformational educational change in a complex national postgraduate medical education system. The program evaluation strategy for Competence by Design provides a framework for program evaluation for any large-scale change in health professions education.
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Affiliation(s)
- Andrew K. Hall
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Anna Oswald
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jason R. Frank
- Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Tim Dalseg
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Warren J. Cheung
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lara Cooke
- Neurology, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lisa Gorman
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Stacey Brzezina
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | | | - Natalie Wagner
- Queen’s Health Sciences Office of Professional Development and Educational Scholarship, Queen’s University, Kingston, ON, Canada
| | - Stanley J. Hamstra
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Department of Milestones Research and Evaluation, Accreditation Council for Graduate Medical Education, Chicago, IL, USA
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elaine Van Melle
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Family Medicine, Queen’s University, Kingston, ON, Canada
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Oswald A, Dubois D, Snell L, Anderson R, Karpinski J, Hall AK, Frank JR, Cheung WJ. Implementing Competence Committees on a National Scale: Design and Lessons Learned. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:56-67. [PMID: 38343555 PMCID: PMC10854462 DOI: 10.5334/pme.961] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/03/2023] [Indexed: 02/15/2024]
Abstract
Competence committees (CCs) are a recent innovation to improve assessment decision-making in health professions education. CCs enable a group of trained, dedicated educators to review a portfolio of observations about a learner's progress toward competence and make systematic assessment decisions. CCs are aligned with competency based medical education (CBME) and programmatic assessment. While there is an emerging literature on CCs, little has been published on their system-wide implementation. National-scale implementation of CCs is complex, owing to the culture change that underlies this shift in assessment paradigm and the logistics and skills needed to enable it. We present the Royal College of Physicians and Surgeons of Canada's experience implementing a national CC model, the challenges the Royal College faced, and some strategies to address them. With large scale CC implementation, managing the tension between standardization and flexibility is a fundamental issue that needs to be anticipated and addressed, with careful consideration of individual program needs, resources, and engagement of invested groups. If implementation is to take place in a wide variety of contexts, an approach that uses multiple engagement and communication strategies to allow for local adaptations is needed. Large-scale implementation of CCs, like any transformative initiative, does not occur at a single point but is an evolutionary process requiring both upfront resources and ongoing support. As such, it is important to consider embedding a plan for program evaluation at the outset. We hope these shared lessons will be of value to other educators who are considering a large-scale CBME CC implementation.
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Affiliation(s)
- Anna Oswald
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Competency Based Medical Education, University of Alberta, Edmonton, AB, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- 8-130 Clinical Sciences building, 11350-83 Avenue, Edmonton, AB, Canada
| | - Daniel Dubois
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Linda Snell
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Institute of Health Sciences Education and Department of Medicine, McGill University, Montreal, QC, Canada
| | - Robert Anderson
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | - Jolanta Karpinski
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Andrew K. Hall
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Dept. of Emergency Medicine, University of Ottawa, Canada
| | - Jason R. Frank
- Centre for Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Canada
| | - Warren J. Cheung
- Dept. of Emergency Medicine, University of Ottawa, Canada
- Royal College of Physicians and Surgeons of Canada, 1053 Carling Avenue, Rm F660, Ottawa, Canada
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Cheung WJ, Bhanji F, Gofton W, Hall AK, Karpinski J, Richardson D, Frank JR, Dudek N. Design and Implementation of a National Program of Assessment Model - Integrating Entrustable Professional Activity Assessments in Canadian Specialist Postgraduate Medical Education. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:44-55. [PMID: 38343554 PMCID: PMC10854461 DOI: 10.5334/pme.956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/04/2023] [Indexed: 02/15/2024]
Abstract
Traditional approaches to assessment in health professions education systems, which have generally focused on the summative function of assessment through the development and episodic use of individual high-stakes examinations, may no longer be appropriate in an era of competency based medical education. Contemporary assessment programs should not only ensure collection of high-quality performance data to support robust decision-making on learners' achievement and competence development but also facilitate the provision of meaningful feedback to learners to support reflective practice and performance improvement. Programmatic assessment is a specific approach to designing assessment systems through the intentional selection and combination of a variety of assessment methods and activities embedded within an educational framework to simultaneously optimize the decision-making and learning function of assessment. It is a core component of competency based medical education and is aligned with the goals of promoting assessment for learning and coaching learners to achieve predefined levels of competence. In Canada, postgraduate specialist medical education has undergone a transformative change to a competency based model centred around entrustable professional activities (EPAs). In this paper, we describe and reflect on the large scale, national implementation of a program of assessment model designed to guide learning and ensure that robust data is collected to support defensible decisions about EPA achievement and progress through training. Reflecting on the design and implications of this assessment system may help others who want to incorporate a competency based approach in their own country.
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Affiliation(s)
- Warren J. Cheung
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, CA
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada, 1053 Carling Avenue, Rm F660, Ottawa, ON K1Y 4E9, CA
| | - Farhan Bhanji
- Department of Pediatrics (Critical Care), Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, CA
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, CA
| | - Wade Gofton
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, CA
- Department of Surgery, Division of Orthopaedic Surgery, University of Ottawa, Ottawa, ON, CA
| | - Andrew K. Hall
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, CA
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, CA
| | - Jolanta Karpinski
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, CA
- Department of Medicine, University of Ottawa, Ottawa, ON, CA
| | - Denyse Richardson
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, CA
- Department of Physical Medicine and Rehabilitation, Queen’s University, Kingston, ON, CA
| | - Jason R. Frank
- Department of Emergency Medicine, Director, Centre for Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, ON, CA
| | - Nancy Dudek
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, CA
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Ottawa, Ottawa, ON, CA
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Miller F, Wood S, Livingston P. The lived experience of Competence by Design: Canadian resident physicians' perspectives. Can J Anaesth 2024; 71:254-263. [PMID: 38133715 DOI: 10.1007/s12630-023-02678-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/12/2023] [Accepted: 07/21/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE Canadian specialist residency programs are in the process of transitioning to a hybrid time and competence model, Competence by Design (CBD), developed by the Royal College of Physicians and Surgeons Canada. Although there is extensive literature around competency-based medical education (CBME), few studies have evaluated the experience of residents after CBME implementation. The purpose of this study was to obtain a rich perspective on the lived experience of residents. METHODS We designed a qualitative study with inductive thematic analysis of semistructured interview data. The study population was residents in CBD postgraduate training programs in anesthesiology, internal medicine, or surgery (including all surgical subspecialties) at Dalhousie University (Halifax, NS, Canada). RESULTS Residents identified the following benefits of their programs and CBD: supportive peers and clinical supervisors, a roadmap for residency, formalized feedback opportunities, and program evolution. Resident-identified drawbacks of CBD included: a lack of transparency around CBD, CBD not as advertised, a lack of buy-in, increased administrative burden, difficulties obtaining evidence for entrustable professional activities (EPAs); the onus for CBD on residents, inconsistent feedback, cumbersome technology, and significant psychological burden. Resident-suggested improvements were reducing the number of EPAs, streamlining EPA requirements, increasing transparency and communication with competence committees, providing incentives and continuous education for clinical supervisors, improving on existing electronic interfaces, and developing technology better suited to the needs of CBD. CONCLUSION This study highlights that the significant administrative and psychological burden of CBD detracts from clinical learning and enthusiasm for residency. Future research could explore whether overcoming the identified challenges will improve residents' experiences.
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Affiliation(s)
- Franziska Miller
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada.
| | - Sarah Wood
- School of Medicine, University of Dundee, Dundee, Scotland, UK
| | - Patricia Livingston
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
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18
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Braund H, Patel V, Dalgarno N, Mann S. Exploring residents' perceptions of competency-based medical education across Canada: A national survey study. MEDEDPUBLISH 2024; 14:2. [PMID: 38487752 PMCID: PMC10933567 DOI: 10.12688/mep.19247.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 03/17/2024] Open
Abstract
Background: As competency-based medical education (CBME) is implemented across Canada, little is known about residents' perceptions of this model. This study examined how Canadian residents understand CBME and their lived experiences with implementation. Methods: We administered a survey in 2018 with Likert-type and open-ended questions to 375 residents across Canada, of whom 270 were from traditional programs ("pre-CBME") and 105 were in a CBME program. We used the Mann-Whitney test to examine differences across samples, and analyzed qualitative data thematically. Results: Three themes were identified across both groups: program outcome concerns, changes, and emotional responses. In relation to program concerns, both groups were concerned about the administrative burden, challenges with the assessment process, and feedback quality. Only pre-CBME residents were concerned about faculty engagement and buy-in. In terms of changes, both groups discussed a more formalized assessment process with mixed reactions. Residents in the pre-CBME sample reported greater concerns for faculty time constraints, assessment completion, and quality of learning experiences, whilst those in CBME programs reported being more proactive in their learning and greater selfreflection. Residents expressed strong emotional narrative responses including greater stress and frustration in a CBME environment. Conclusion: Findings demonstrate that residents have mixed feelings and experiences regarding CBME. Their positive experiences align with the aim of developing more self-directed learners. However, the concerns suggest the need to address specific shortcomings to increase buy-in, while the emotional responses associated with CBME may require a cultural shift within residency programs to guard against burnout.
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Affiliation(s)
- Heather Braund
- Professional Development & Educational Scholarship, Queen's University, Kingston, Ontario, K7L 1B9,, Canada
| | - Vivesh Patel
- Faculty of Health Sciences, Queen's University, Kingston, Ontario, K7L 2Y1, Canada
| | - Nancy Dalgarno
- Professional Development & Educational Scholarship, Queen's University, Kingston, Ontario, K7L 1B9,, Canada
| | - Steve Mann
- Department of Surgery, Queen's University, Kingston, Ontario, K7L 2V7, Canada
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Fisk D, Clendenning B, St John P, Francois J. Multi-stakeholder validation of entrustable professional activities for a family medicine care of the elderly residency program: A focus group study. GERONTOLOGY & GERIATRICS EDUCATION 2024; 45:12-25. [PMID: 36326195 DOI: 10.1080/02701960.2022.2130913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Entrustable Professional Activities (EPAs) have become widely used within Competency-Based Medical Education (CBME) for the training and evaluation of residents. Little is known about the effectiveness of incorporating multiple stakeholder groups in the validation of EPAs. Here, we seek to validate an EPA framework developed for the University of Manitoba Care of the Elderly Enhanced Skills program using online focus groups consisting of five stakeholder groups. Participants were recruited to take part in one of five online focus groups, one for each stakeholder group (physician faculty, residents, non-physician healthcare professionals, administrators/managers, and patients). Each group met one time for 90 minutes over ZOOM®. The themes arising from stakeholder feedback suggest that successful EPAs must neither be too specific nor too expansive in scope, clearly delineate appropriate means of evaluation, and indicate specific clinical settings in which each EPA should be evaluated. Cross-cutting themes included requiring trainees to collaborate with other professionals when it would optimize patient care, and preparing trainees to advocate for their patients' health (Advocacy). The present study demonstrates that multi-stakeholder analysis yields diverse feedback that can help make EPAs more clear, easier to use in evaluation, and more socially accountable.
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Affiliation(s)
- Derek Fisk
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ben Clendenning
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Philip St John
- Max Rady College of Medicine, Department of Internal Medicine, Section of Geriatric Medicine, Winnipeg, Manitoba, Canada
- University of Manitoba Centre on Aging, Winnipeg, Manitoba, Canada
| | - Jose Francois
- University of Manitoba Centre on Aging, Winnipeg, Manitoba, Canada
- Department of Family Medicine, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
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20
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Pusic MV, Ellaway RH. Researching models of innovation and adoption in health professions education. MEDICAL EDUCATION 2024; 58:164-170. [PMID: 37495269 DOI: 10.1111/medu.15161] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/30/2023] [Accepted: 06/15/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Despite the constant presence of change and innovation in health professions education (HPE), there has been relatively little theoretical modelling of such change, the experiences of change, the ideology associated with change or the unexpected consequences of change. In this paper, the authors explore theoretical approaches to the adoption of innovations in HPE as a way of mapping a broader theoretical landscape of change. METHOD The authors, HPE researchers with an interest in technology adoption and systemic change, present a narrative review of the literature based on a series of thought experiments regarding how communities and individuals respond to the introduction of new ideas or methods. This research investigates the stages of innovation adoption, from the emergence and hype around new ideas to the concrete experiences of early adopters. RESULTS When an innovation first emerges, there is often little concrete information available to inform potential adopters, leaving it susceptible to hype, both positive and negative. This can be described using the Gartner Hype Cycle model, albeit with important caveats. Once the adoption of an innovation gets underway, early adopter user experiences can inform those that follow. This can be described using Rogers' diffusion of innovation model, again with caveats. Notably, neither model goes beyond the point of single point-in-time, yes/no, individual adoption. Other approaches, such as learning curve theory, are needed to track uptake and maintenance by individuals over time. SIGNIFICANCE This expanded theoretical base, while still somewhat instrumentalist, combined with complementary theoretical perspectives can afford opportunities to better explore reasons for variance, volunteerism and resistance to change. In summary, change is complicated and nuanced, and better models and theories are needed to understand and work meaningfully with change in HPE. To that end, the authors seek to encourage richer and more thoughtful research and scholarly thinking about change and a more nuanced approach to the pursuit of change in HPE as a whole.
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Affiliation(s)
- Martin Victor Pusic
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- American Board of Medical Specialties, Chicago, Illinois, USA
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21
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Van Ostaeyen S, De Langhe L, De Clercq O, Embo M, Schellens T, Valcke M. Automating the Identification of Feedback Quality Criteria and the CanMEDS Roles in Written Feedback Comments Using Natural Language Processing. PERSPECTIVES ON MEDICAL EDUCATION 2023; 12:540-549. [PMID: 38144670 PMCID: PMC10742245 DOI: 10.5334/pme.1056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 10/03/2023] [Indexed: 12/26/2023]
Abstract
Introduction Manually analysing the quality of large amounts of written feedback comments is time-consuming and demands extensive resources and human effort. Therefore, this study aimed to explore whether a state-of-the-art large language model (LLM) could be fine-tuned to identify the presence of four literature-derived feedback quality criteria (performance, judgment, elaboration and improvement) and the seven CanMEDS roles (Medical Expert, Communicator, Collaborator, Leader, Health Advocate, Scholar and Professional) in written feedback comments. Methods A set of 2,349 labelled feedback comments of five healthcare educational programs in Flanders (Belgium) (specialistic medicine, general practice, midwifery, speech therapy and occupational therapy) was split into 12,452 sentences to create two datasets for the machine learning analysis. The Dutch BERT models BERTje and RobBERT were used to train four multiclass-multilabel classification models: two to identify the four feedback quality criteria and two to identify the seven CanMEDS roles. Results The classification models trained with BERTje and RobBERT to predict the presence of the four feedback quality criteria attained macro average F1-scores of 0.73 and 0.76, respectively. The F1-score of the model predicting the presence of the CanMEDS roles trained with BERTje was 0.71 and 0.72 with RobBERT. Discussion The results showed that a state-of-the-art LLM is able to identify the presence of the four feedback quality criteria and the CanMEDS roles in written feedback comments. This implies that the quality analysis of written feedback comments can be automated using an LLM, leading to savings of time and resources.
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Affiliation(s)
| | - Loic De Langhe
- Language and Translation Technology Team at Ghent University, Belgium
| | - Orphée De Clercq
- Language and Translation Technology Team at Ghent University, Belgium
| | - Mieke Embo
- Department of Educational Sciences at Ghent University and in the Expertise Network Health and Care at the Artevelde University of Applied Sciences, Belgium
| | - Tammy Schellens
- Department of Educational Sciences at Ghent University, Belgium
| | - Martin Valcke
- Department of Educational Sciences at Ghent University, Belgium
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Szulewski A, Braund H, Dagnone DJ, McEwen L, Dalgarno N, Schultz KW, Hall AK. The Assessment Burden in Competency-Based Medical Education: How Programs Are Adapting. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:1261-1267. [PMID: 37343164 DOI: 10.1097/acm.0000000000005305] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Residents and faculty have described a burden of assessment related to the implementation of competency-based medical education (CBME), which may undermine its benefits. Although this concerning signal has been identified, little has been done to identify adaptations to address this problem. Grounded in an analysis of an early Canadian pan-institutional CBME adopter's experience, this article describes postgraduate programs' adaptations related to the challenges of assessment in CBME. From June 2019-September 2022, 8 residency programs underwent a standardized Rapid Evaluation guided by the Core Components Framework (CCF). Sixty interviews and 18 focus groups were held with invested partners. Transcripts were analyzed abductively using CCF, and ideal implementation was compared with enacted implementation. These findings were then shared back with program leaders, adaptations were subsequently developed, and technical reports were generated for each program. Researchers reviewed the technical reports to identify themes related to the burden of assessment with a subsequent focus on identifying adaptations across programs. Three themes were identified: (1) disparate mental models of assessment processes in CBME, (2) challenges in workplace-based assessment processes, and (3) challenges in performance review and decision making. Theme 1 included entrustment interpretation and lack of shared mindset for performance standards. Adaptations included revising entrustment scales, faculty development, and formalizing resident membership. Theme 2 involved direct observation, timeliness of assessment completion, and feedback quality. Adaptations included alternative assessment strategies beyond entrustable professional activity forms and proactive assessment planning. Theme 3 related to resident data monitoring and competence committee decision making. Adaptations included adding resident representatives to the competence committee and assessment platform enhancements. These adaptations represent responses to the concerning signal of significant burden of assessment within CBME being experienced broadly. The authors hope other programs may learn from their institution's experience and navigate the CBME-related assessment burden their invested partners may be facing.
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Affiliation(s)
- Adam Szulewski
- A. Szulewski is associate professor, Departments of Emergency Medicine and Psychology, and educational scholarship lead, Postgraduate Medical Education, Queen's University, Kingston, Ontario, Canada; ORCID: https://orcid.org/0000-0002-3076-6221
| | - Heather Braund
- H. Braund is associate director of scholarship and simulation education, Office of Professional Development and Educational Scholarship, and assistant (adjunct) professor, Department of Biomedical and Molecular Sciences and School of Medicine, Queen's University, Kingston, Ontario, Canada; ORCID: https://orcid.org/0000-0002-9749-7193
| | - Damon J Dagnone
- D.J. Dagnone is associate professor, Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada; ORCID: https://orcid.org/0000-0001-6963-7948
| | - Laura McEwen
- L. McEwen is director of assessment and evaluation of postgraduate medical education and assistant professor, Department of Pediatrics, Postgraduate Medical Education, Queen's University, Kingston, Ontario, Canada; ORCID: https://orcid.org/0000-0003-2457-5311
| | - Nancy Dalgarno
- N. Dalgarno is director of education scholarship, Office of Professional Development and Educational Scholarship, and assistant professor (adjunct), Department of Biomedical and Molecular Sciences and Master of Health Professions Education, Queen's University, Kingston, Ontario, Canada; ORCID: https://orcid.org/0000-0001-7932-9949
| | - Karen W Schultz
- K.W. Schultz is professor, Department of Family Medicine, and associate dean of postgraduate medical education, Queen's University, Kingston, Ontario, Canada; ORCID: https://orcid.org/0000-0003-0208-3981
| | - Andrew K Hall
- A.K. Hall is associate professor and vice chair of education, Department of Emergency Medicine, University of Ottawa, and clinician educator, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada; ORCID: https://orcid.org/0000-0003-1227-5397
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Gore KM, Schiebout J, Peksa GD, Hock S, Patwari R, Gottlieb M. The integrative feedback tool: assessing a novel feedback tool among emergency medicine residents. Clin Exp Emerg Med 2023; 10:306-314. [PMID: 36796780 PMCID: PMC10579731 DOI: 10.15441/ceem.22.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/19/2023] [Accepted: 02/07/2023] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVE Feedback is critical to the growth of learners. However, feedback quality can be variable in practice. Most feedback tools are generic, with few targeting emergency medicine. We created a feedback tool designed for emergency medicine residents, and this study aimed to evaluate the effectiveness of this tool. METHODS This was a single-center, prospective cohort study comparing feedback quality before and after introducing a novel feedback tool. Residents and faculty completed a survey after each shift assessing feedback quality, feedback time, and the number of feedback episodes. Feedback quality was assessed using a composite score from seven questions, which were each scored 1 to 5 points (minimum total score, 7 points; maximum, 35 points). Preintervention and postintervention data were analyzed using a mixed-effects model that took into account the correlation of random effects between study participants. RESULTS Residents completed 182 surveys and faculty members completed 158 surveys. The use of the tool was associated with improved consistency in the summative score of effective feedback attributes as assessed by residents (P=0.040) but not by faculty (P=0.259). However, most of the individual scores for attributes of good feedback did not reach statistical significance. With the tool, residents perceived that faculty spent more time providing feedback (P=0.040) and that the delivery of feedback was more ongoing throughout the shift (P=0.020). Faculty felt that the tool allowed for more ongoing feedback (P=0.002), with no perceived increase in the time spent delivering feedback (P=0.833). CONCLUSION The use of a dedicated tool may help educators provide more meaningful and frequent feedback without impacting the perceived required time needed to provide feedback.
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Affiliation(s)
- Katarzyna M. Gore
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Jessen Schiebout
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Gary D. Peksa
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Sara Hock
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Rahul Patwari
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
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Loosveld LM, Driessen EW, Theys M, Van Gerven PWM, Vanassche E. Combining Support and Assessment in Health Professions Education: Mentors' and Mentees' Experiences in a Programmatic Assessment Context. PERSPECTIVES ON MEDICAL EDUCATION 2023; 12:271-281. [PMID: 37426357 PMCID: PMC10327863 DOI: 10.5334/pme.1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/23/2023] [Indexed: 07/11/2023]
Abstract
Introduction Mentors in programmatic assessment support mentees with low-stakes feedback, which often also serves as input for high-stakes decision making. That process potentially causes tensions in the mentor-mentee relationship. This study explored how undergraduate mentors and mentees in health professions education experience combining developmental support and assessment, and what this means for their relationship. Methods The authors chose a pragmatic qualitative research approach and conducted semi-structured vignette-based interviews with 24 mentors and 11 mentees that included learners from medicine and the biomedical sciences. Data were analyzed thematically. Results How participants combined developmental support and assessment varied. In some mentor-mentee relationships it worked well, in others it caused tensions. Tensions were also created by unintended consequences of design decisions at the program level. Dimensions impacted by experienced tensions were: relationship quality, dependence, trust, and nature and focus of mentoring conversations. Mentors and mentees mentioned applying various strategies to alleviate tensions: transparency and expectation management, distinguishing between developmental support and assessment, and justifying assessment responsibility. Discussion Combining the responsibility for developmental support and assessment within an individual worked well in some mentor-mentee relationships, but caused tensions in others. On the program level, clear decisions should be made regarding the design of programmatic assessment: what is the program of assessment and how are responsibilities divided between all involved? If tensions arise, mentors and mentees can try to alleviate these, but continuous mutual calibration of expectations between mentors and mentees remains of key importance.
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Affiliation(s)
- Lianne M. Loosveld
- Department of Educational Development & Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, 6229 ER Maastricht, the Netherlands
| | - Erik W. Driessen
- Department of Educational Development & Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, 6229 ER Maastricht, the Netherlands
| | - Mattias Theys
- Department of Educational Development & Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, 6229 ER Maastricht, the Netherlands
| | - Pascal W. M. Van Gerven
- Department of Educational Development & Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, 6229 ER Maastricht, the Netherlands
| | - Eline Vanassche
- Faculty of Psychology and Educational Sciences, KU Leuven Kulak, Etienne Sabbelaan 51, P.O. Box 7654, 8500 Kortrijk, Belgium
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Berger S, Stalmeijer RE, Marty AP, Berendonk C. Exploring the Impact of Entrustable Professional Activities on Feedback Culture: A Qualitative Study of Anesthesiology Residents and Attendings. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:836-843. [PMID: 36812061 DOI: 10.1097/acm.0000000000005188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE Entrustable professional activities (EPAs) were introduced as a potential way to optimize workplace-based assessments. Yet, recent studies suggest that EPAs have not yet overcome all of the challenges to implementing meaningful feedback. The aim of this study was to explore the extent to which the introduction of EPAs via mobile app impacts feedback culture as experienced by anesthesiology residents and attending physicians. METHOD Using a constructivist grounded theory approach, the authors interviewed a purposive and theoretical sample of residents (n = 11) and attendings (n = 11) at the Institute of Anaesthesiology, University Hospital of Zurich, where EPAs had recently been implemented. Interviews took place between February and December 2021. Data collection and analysis were conducted iteratively. The authors used open, axial, and selective coding to gain knowledge and understanding on the interplay of EPAs and feedback culture. RESULTS Participants reflected on a number of changes in their day-to-day experience of feedback culture with the implementation of EPAs. Three main mechanisms were instrumental in this process: lowering the feedback threshold, change in feedback focus, and gamification. Participants felt a lower threshold to feedback seeking and giving and that the frequency of feedback conversations increased and tended to be more focused on a specific topic and shorter, while feedback content tended to focus more on technical skills and more attention was given to average performances. Residents indicated that the app-based approach fostered a game-like motivation to "climb levels," while attendings did not perceive a game-like experience. CONCLUSIONS EPAs may offer a solution to problems of infrequent occurrence of feedback and invite attention to average performances and technical competencies, but may come at the expense of feedback on nontechnical skills. This study suggests that feedback culture and feedback instruments have a mutually interacting influence on each other.
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Affiliation(s)
- Sabine Berger
- S. Berger is a third-year medical resident, Internal Medicine Training Program, St. Claraspital, Basel, Switzerland
| | - Renee E Stalmeijer
- R.E. Stalmeijer is associate professor, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Adrian P Marty
- A.P. Marty is currently senior attending physician and team lead for education, Institute of Anaesthesiology, Intensive Care and Pain Medicine, Orthopedic University Hospital Balgrist, Zurich, Switzerland. At the time of writing, he was attending physician, Institute of Anaesthesiology, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Christoph Berendonk
- C. Berendonk is senior lecturer in medical education, Institute for Medical Education, University of Bern, Bern, Switzerland
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Gauthier S, Braund H, Dalgarno N, Taylor D. Assessment-Seeking Strategies: Navigating the Decision to Initiate Workplace-Based Assessment. TEACHING AND LEARNING IN MEDICINE 2023:1-10. [PMID: 37384570 DOI: 10.1080/10401334.2023.2229803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 04/13/2023] [Accepted: 06/01/2023] [Indexed: 07/01/2023]
Abstract
Phenomenon: Competency-based medical education (CBME) relies on workplace-based assessment (WBA) to generate formative feedback (assessment for learning-AfL) and make inferences about competence (assessment of learning-AoL). When approaches to CBME rely on residents to initiate WBA, learners experience tension between seeking WBA for learning and for establishing competence. How learners resolve this tension may lead to unintended consequences for both AfL and AoL. We sought to explore the factors that impact both decisions to seek and not to seek WBA and use the findings to build a model of assessment-seeking strategy used by residents. In building this model we consider how the link between WBA and promotion or progression within a program impacts an individual's assessment-seeking strategy. Approach: We conducted 20 semi-structured interviews with internal medicine residents at Queen's University about the factors that influence their decision to seek or avoid WBA. Using grounded theory methodology, we applied a constant comparative analysis to collect data iteratively and identify themes. A conceptual model was developed to describe the interaction of factors impacting the decision to seek and initiate WBA. Findings: Participants identified two main motivations when deciding to seek assessments: the need to fulfill program requirements and the desire to receive feedback for learning. Analysis suggested that these motivations are often at odds with each other. Participants also described several moderating factors that impact the decision to initiate assessments, irrespective of the primary underlying motivation. These included resident performance, assessor factors, training program expectations, and clinical context. A conceptual framework was developed to describe the factors that lead to strategic assessment-seeking behaviors. Insights: Faced with the dual purpose of WBA in CBME, resident behavior in initiating assessment is guided by specific assessment-seeking strategies. Strategies reflect individual underlying motivations, influenced by four moderating factors. These findings have broad implications for programmatic assessment in a CBME context including validity considerations for assessment data used in summative decision-making including readiness for unsupervised practice.
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Affiliation(s)
- Stephen Gauthier
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Heather Braund
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Nancy Dalgarno
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - David Taylor
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
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Lip A, Watling CJ, Ginsburg S. What does "Timely" Mean to Residents? Challenging Feedback Assumptions in Postgraduate Education. PERSPECTIVES ON MEDICAL EDUCATION 2023; 12:218-227. [PMID: 37334109 PMCID: PMC10275343 DOI: 10.5334/pme.1052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/29/2023] [Indexed: 06/20/2023]
Abstract
Introduction Current orthodoxy states that feedback should be timely and face-to-face, yet the optimal timing and mode of delivery for feedback is unclear. We explored what "optimal timing" means from residents' points of view as feedback providers and receivers, to ultimately inform strategies to optimize feedback in training. Methods As near-peers who have dual roles in both providing and receiving feedback, 16 subspecialty (PGY4 and 5) internal medicine residents were interviewed about their perceptions of the optimal timing and format of feedback. Using constructivist grounded theory, interviews were conducted and analyzed iteratively. Results Drawing on their experiences as providers and recipients, residents described simultaneously considering and weighing multiple factors when deciding on when and how to provide feedback. These included their own readiness to engage in providing meaningful feedback, the perceived receptiveness of the learner and the apparent urgency of feedback delivery (e.g., if patient safety was at stake). Face-to-face verbal feedback was valued for encouraging dialogue but could be uncomfortable and limited by time constraints. Written feedback could be more honest and concise, and the possibility of asynchronous delivery had potential to overcome issues with timing and discomfort. Discussion Participants' perceptions of the optimal timing of feedback challenge current assumptions about the benefits of "immediate" versus "delayed". The concept of "optimal timing" for feedback was found to be complex and context-dependent, defying a formulaic approach. There may be a role for asynchronous and/or written feedback, which has potential to address unique issues identified issues in near-peer relationships.
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Affiliation(s)
- Alyssa Lip
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, CA
| | - Christopher J. Watling
- Centre for Education Research and Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, CA
| | - Shiphra Ginsburg
- Department of Medicine, Sinai Health System and Faculty of Medicine, University of Toronto, scientist, Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, CA
- Canada Research Chair in Health Professions Education, CA
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Matava CT, Alam F, Kealey A, Bahrey LA, McCreath GA, Walsh CM. The influence of resident and faculty gender on assessments in anesthesia competency-based medical education. Can J Anaesth 2023; 70:978-987. [PMID: 37165126 PMCID: PMC10171726 DOI: 10.1007/s12630-023-02454-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 05/12/2023] Open
Abstract
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.
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Affiliation(s)
- Clyde T Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Fahad Alam
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Alayne Kealey
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lisa A Bahrey
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, University Health Network-Toronto General Hospital, Toronto, ON, Canada
| | - Graham A McCreath
- SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Catharine M Walsh
- SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Martin L, Blissett S, Johnston B, Tsang M, Gauthier S, Ahmed Z, Sibbald M. How workplace-based assessments guide learning in postgraduate education: A scoping review. MEDICAL EDUCATION 2023; 57:394-405. [PMID: 36286100 DOI: 10.1111/medu.14960] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/16/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Competency-based medical education (CBME) led to the widespread adoption of workplace-based assessment (WBA) with the promise of achieving assessment for learning. Despite this, studies have illustrated tensions between the summative and formative role of WBA which undermine learning goals. Models of workplace-based learning (WBL) provide insight, however, these models excluded WBA. This scoping review synthesizes the primary literature addressing the role of WBA to guide learning in postgraduate medical education, with the goal of identifying gaps to address in future studies. METHODS The search was applied to OVID Medline, Web of Science, ERIC and CINAHL databases, articles up to September 2020 were included. Titles and abstracts were screened by two reviewers, followed by a full text review. Two members independently extracted and analysed quantitative and qualitative data using a descriptive-analytic technique rooted in Billett's four premises of WBL. Themes were synthesized and discussed until consensus. RESULTS All 33 papers focused on the perception of learning through WBA. The majority applied qualitative methodology (70%), and 12 studies (36%) made explicit reference to theory. Aligning with Billett's first premise, results reinforce that learning always occurs in the workplace. WBA helped guide learning goals and enhanced feedback frequency and specificity. Billett's remaining premises provided an important lens to understand how tensions that existed in WBL have been exacerbated with frequent WBA. As individuals engage in both work and WBA, they are slowly transforming the workplace. Culture and context frame individual experiences and the perceived authenticity of WBA. Finally, individuals will have different goals, and learn different things, from the same experience. CONCLUSION Analysing WBA literature through the lens of WBL theory allows us to reframe previously described tensions. We propose that future studies attend to learning theory, and demonstrate alignment with philosophical position, to advance our understanding of assessment-for-learning in the workplace.
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Affiliation(s)
- Leslie Martin
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Blissett
- Department of Medicine, Western University, London, Ontario, Canada
| | - Bronte Johnston
- McMaster Education Research, Innovation, and Theory Program, McMaster University, Hamilton, Ontario, Canada
| | - Michael Tsang
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Stephen Gauthier
- Department of Medicine, Queens University, Kingston, Ontario, Canada
| | - Zeeshan Ahmed
- Department of Medicine, Ottawa University, Ottawa, Ontario, Canada
| | - Matthew Sibbald
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Paterson QS, Alrimawi H, Sample S, Bouwsema M, Anjum O, Vincent M, Cheung WJ, Hall A, Woods R, Martin LJ, Chan T. Examining enablers and barriers to entrustable professional activity acquisition using the theoretical domains framework: A qualitative framework analysis study. AEM EDUCATION AND TRAINING 2023; 7:e10849. [PMID: 36994315 PMCID: PMC10041073 DOI: 10.1002/aet2.10849] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/20/2023] [Accepted: 01/29/2023] [Indexed: 06/19/2023]
Abstract
Background Without a clear understanding of the factors contributing to the effective acquisition of high-quality entrustable professional activity (EPA) assessments, trainees, supervising faculty, and training programs may lack appropriate strategies for successful EPA implementation and utilization. The purpose of this study was to identify barriers and facilitators to acquiring high-quality EPA assessments in Canadian emergency medicine (EM) training programs. Methods We conducted a qualitative framework analysis study utilizing the Theoretical Domains Framework (TDF). Semistructured interviews of EM resident and faculty participants underwent audio recording, deidentification, and line-by-line coding by two authors, being coded to extract themes and subthemes across the domains of the TDF. Results From 14 interviews (eight faculty and six residents) we identified, within the 14 TDF domains, major themes and subthemes for barriers and facilitators to EPA acquisition for both faculty and residents. The two most cited domains (and their frequencies) among residents and faculty were environmental context and resources (56) and behavioral regulation (48). Example strategies to improving EPA acquisition include orienting residents to the competency-based medical education (CBME) paradigm, recalibrating expectations relating to "low ratings" on EPAs, engaging in continuous faculty development to ensure familiarity and fluency with EPAs, and implementing longitudinal coaching programs between residents and faculty to encourage repetitive longitudinal interactions and high-quality specific feedback. Conclusions We identified key strategies to support residents, faculty, programs, and institutions in overcoming barriers and improving EPA assessment processes. This is an important step toward ensuring the successful implementation of CBME and the effective operationalization of EPAs within EM training programs.
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Affiliation(s)
- Quinten S. Paterson
- Department of Emergency MedicineUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Hussein Alrimawi
- Emergency Medicine Division, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Spencer Sample
- Emergency Medicine Division, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Melissa Bouwsema
- Department of Emergency MedicineQueens UniversityKingstonOntarioCanada
| | - Omar Anjum
- Department of Emergency MedicineUniversity of OttawaOttawaOntarioCanada
| | - Maggie Vincent
- Emergency Medicine Division, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Warren J. Cheung
- Department of Emergency MedicineUniversity of OttawaOttawaOntarioCanada
| | - Andrew Hall
- Department of Emergency MedicineQueens UniversityKingstonOntarioCanada
- Department of Emergency MedicineUniversity of OttawaOttawaOntarioCanada
| | - Rob Woods
- Department of Emergency MedicineUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Lynsey J. Martin
- Department of Emergency MedicineUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Teresa Chan
- Emergency Medicine Division, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
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Yilmaz Y, Chan MK, Richardson D, Atkinson A, Bassilious E, Snell L, Chan TM. Defining new roles and competencies for administrative staff and faculty in the age of competency-based medical education. MEDICAL TEACHER 2023; 45:395-403. [PMID: 36471921 DOI: 10.1080/0142159x.2022.2136517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE These authors sought to define the new roles and competencies required of administrative staff and faculty in the age of CBME. METHOD A modified Delphi process was used to define the new CBME roles and competencies needed by faculty and administrative staff. We invited international experts in CBME (volunteers from the ICBME Collaborative email list), as well as faculty members and trainees identified via social media to help us determine the new competencies required of faculty and administrative staff in the CBME era. RESULTS Thirteen new roles were identified. The faculty-specific roles were: National Leader/Facilitator in CBME; Institutional/University lead for CBME; Assessment Process & Systems Designer; Local CBME Leads; CBME-specific Faculty Developers or Trainers; Competence Committee Chair; Competence Committee Faculty Member; Faculty Academic Coach/Advisor or Support Person; Frontline Assessor; Frontline Coach. The staff-specific roles were: Information Technology Lead; CBME Analytics/Data Support; Competence Committee Administrative Assistant. CONCLUSIONS The authors present a new set of faculty and staff roles that are relevant to the CBME context. While some of these new roles may be incorporated into existing roles, it may be prudent to examine how best to ensure that all of them are supported within all CBME contexts in some manner.
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Affiliation(s)
- Yusuf Yilmaz
- McMaster Education Research, Innovation, and Theory (MERIT), and Office of Continuing Professional Development, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Medical Education, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ming-Ka Chan
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Denyse Richardson
- Department of Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Adelle Atkinson
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Ereny Bassilious
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Linda Snell
- Medicine and Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Teresa M Chan
- McMaster Education Research, Innovation, and Theory (MERIT), and Office of Continuing Professional Development, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Divisions of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Canada
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Puri A, Memari M, Sottile EM, Snydman LK, Lee WW, Bonnema RA, Jones D, Nandiwada DR. Changing the Assessment Paradigm: Promoting a Growth Mindset Across the Medical Education Continuum. Am J Med 2023; 136:207-212. [PMID: 36441037 DOI: 10.1016/j.amjmed.2022.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/18/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Aditi Puri
- Department of Internal Medicine, MacNeal Hospital, Loyola University Health System, North Riverside, Ill.
| | - Milad Memari
- Division of General Internal Medicine University of Pittsburgh Medical Center, Pa
| | - Elisa M Sottile
- Division of General Internal Medicine, University of Florida College of Medicine - Jacksonville
| | - Laura K Snydman
- Division of General Internal Medicine, Tufts Medical Center, Boston, Mass
| | - Wei Wei Lee
- Section of General Internal Medicine, University of Chicago Pritzker School of Medicine, Ill
| | - Rachel A Bonnema
- Division of General Internal Medicine, University of Texas Southwestern School of Medicine, Dallas
| | - Danielle Jones
- Division of General Internal Medicine, Emory University of Medicine, Atlanta, Ga
| | - D Rani Nandiwada
- Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
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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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Mooney CJ, Pascoe JM, Blatt AE, Lang VJ, Kelly MS, Braun MK, Burch JE, Stone RT. Predictors of faculty narrative evaluation quality in medical school clerkships. MEDICAL EDUCATION 2022; 56:1223-1231. [PMID: 35950329 DOI: 10.1111/medu.14911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/01/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Narrative approaches to assessment provide meaningful and valid representations of trainee performance. Yet, narratives are frequently perceived as vague, nonspecific and low quality. To date, there is little research examining factors associated with narrative evaluation quality, particularly in undergraduate medical education. The purpose of this study was to examine associations of faculty- and student-level characteristics with the quality of faculty member's narrative evaluations of clerkship students. METHODS The authors reviewed faculty narrative evaluations of 50 students' clinical performance in their inpatient medicine and neurology clerkships, resulting in 165 and 87 unique evaluations in the respective clerkships. The authors evaluated narrative quality using the Narrative Evaluation Quality Instrument (NEQI). The authors used linear mixed effects modelling to predict total NEQI score. Explanatory covariates included the following: time to evaluation completion, number of weeks spent with student, faculty total weeks on service per year, total faculty years in clinical education, student gender, faculty gender, and an interaction term between student and faculty gender. RESULTS Significantly higher narrative evaluation quality was associated with a shorter time to evaluation completion, with NEQI scores decreasing by approximately 0.3 points every 10 days following students' rotations (p = .004). Additionally, women faculty had statistically higher quality narrative evaluations with NEQI scores 1.92 points greater than men faculty (p = .012). All other covariates were not significant. CONCLUSIONS The quality of faculty members' narrative evaluations of medical students was associated with time to evaluation completion and faculty gender but not faculty experience in clinical education, faculty weeks on service, or the amount of time spent with students. Findings advance understanding on ways to improve the quality of narrative evaluations which are imperative given assessment models that will increase the volume and reliance on narratives.
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Affiliation(s)
- Christopher J Mooney
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Jennifer M Pascoe
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Amy E Blatt
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Valerie J Lang
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | | | - Melanie K Braun
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Jaclyn E Burch
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
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Branfield Day L, Rassos J, Billick M, Ginsburg S. 'Next steps are…': An exploration of coaching and feedback language in EPA assessment comments. MEDICAL TEACHER 2022; 44:1368-1375. [PMID: 35944554 DOI: 10.1080/0142159x.2022.2098098] [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: 06/15/2023]
Abstract
PURPOSE Entrustable Professional Activities (EPA) assessments are intended to facilitate meaningful, low-stakes coaching and feedback, partly through the provision of written comments. We sought to explore EPA assessment comments provided to internal medicine (IM) residents for evidence of feedback and coaching language as well as politeness. METHODS We collected all written comments from EPA assessments of communication from a first-year IM resident cohort at the University of Toronto. Sensitized by politeness theory, we analyzed data using principles of constructivist grounded theory. RESULTS Nearly all EPA assessments (94%) contained written feedback based on focused clinical encounters. The majority of comments demonstrated coaching language, including phrases like 'don't forget to,' and 'next steps are,' followed by specific suggestions for improvement. A variety of words, including 'autonomy' and 'independence' denoted entrustment decisions. Linguistic politeness strategies such as hedging were pervasive, seemingly to minimize harm to the supervisor-trainee relationship. CONCLUSION Evidence of written coaching feedback suggests that EPA assessment comments are being used as intended as a means of formative feedback to promote learning. Yet, the frequent use of polite language suggests that EPAs may be higher-stakes than expected, highlighting a need for changes to the assessment culture and improved feedback literacy.
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Affiliation(s)
- Leora Branfield Day
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - James Rassos
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maxime Billick
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Shiphra Ginsburg
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Wilson Centre for Research in Education, Toronto, Canada
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Ott MC, Pack R, Cristancho S, Chin M, Van Koughnett JA, Ott M. "The Most Crushing Thing": Understanding Resident Assessment Burden in a Competency-Based Curriculum. J Grad Med Educ 2022; 14:583-592. [PMID: 36274774 PMCID: PMC9580312 DOI: 10.4300/jgme-d-22-00050.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/21/2022] [Accepted: 08/15/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Competency-based medical education (CBME) was expected to increase the workload of assessment for graduate training programs to support the development of competence. Learning conditions were anticipated to improve through the provision of tailored learning experiences and more frequent, low-stakes assessments. Canada has adopted an approach to CBME called Competence by Design (CBD). However, in the process of implementation, learner anxiety and assessment burden have increased unexpectedly. To mitigate this unintended consequence, we need a stronger understanding of how resident assessment burdens emerge and function. OBJECTIVE This study investigates contextual factors leading to assessment burden on residents within the framework of CBD. METHODS Residents were interviewed about their experiences of assessment using constructivist grounded theory. Participants (n=21) were a purposive sample from operative and perioperative training programs, recruited from 6 Canadian medical schools between 2019 and 2020. Self-determination theory was used as a sensitizing concept to categorize findings on types of assessment burden. RESULTS Nine assessment burdens were identified and organized by threats to psychological needs for autonomy, relatedness, and competence. Burdens included: missed opportunities for self-regulated learning, lack of situational control, comparative assessment, lack of trust, constraints on time and resources, disconnects between teachers and learners, lack of clarity, unrealistic expectations, and limitations of assessment forms for providing meaningful feedback. CONCLUSIONS This study contributes a contextual understanding of how assessment burdens emerged as unmet psychological needs for autonomy, relatedness, and competence, with unintended consequences for learner well-being and intrinsic motivation.
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Affiliation(s)
- Mary C. Ott
- All authors are with Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Mary C. Ott, PhD, is Research Associate, Centre for Education Research and Innovation
| | - Rachael Pack
- All authors are with Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Rachael Pack, PhD, is Research Associate, Centre for Education Research and Innovation
| | - Sayra Cristancho
- All authors are with Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Sayra Cristancho, PhD, is Scientist, Centre for Education Research and Innovation
| | - Melissa Chin
- All authors are with Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Melissa Chin, MD, MHS, FRCPC, is CBME Lead, Department of Anesthesia and Perioperative Medicine
| | - Julie Ann Van Koughnett
- All authors are with Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Julie Ann Van Koughnett, MD, MEd, FRCSC, is Program Director, General Surgery, Department of Surgery
| | - Michael Ott
- All authors are with Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Mary C. Ott, PhD, is Research Associate, Centre for Education Research and Innovation
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Schumacher DJ, Michelson C, Winn AS, Turner DA, Elshoff E, Kinnear B. Making prospective entrustment decisions: Knowing limits, seeking help and defaulting. MEDICAL EDUCATION 2022; 56:892-900. [PMID: 35263474 DOI: 10.1111/medu.14797] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Many studies focused on entrustment have not considered prospective entrustment decisions, where clinical competency and entrustment committees determine how much supervision trainees will require in the future for tasks occurring in not completely known contexts. The authors sought to explore factors that influence and determine prospective entrustment decisions made by members of such committees in graduate medical education (GME) and undergraduate medical education (UME). METHODS The authors conducted a constructivist grounded theory study with 23 faculty participants from GME and UME clinical competency and entrustment committees in the United States between October 2020 and March 2021. Interviews sought to explore factors and considerations participants weigh in making prospective entrustment decisions about trainees. Data collection and analysis occurred in an iterative fashion, ensuring constant comparison. Theoretical sampling was used to confirm, disconfirm and elaborate on the evolving results. RESULTS Trainees' ability to know limits and seek help is the foundation of participants' prospective entrustment decision making. Most participants, however, describe a presumption of trainee readiness to progress and describe commonly making default prospective entrustment decisions unless 'red flags' in performance are present. Although participants desire sufficient and trusted data about trainee performance to inform decisions, they often lack it. Finally, the perceived permanence and consequences of prospective entrustment decisions influence how participants weigh other factors contributing to prospective entrustment decisions. CONCLUSION Trainees' ability to know limits and seek help appears to be the foundation of prospective entrustment decision making. Training programmes should strive to collect and employ robust data supporting and questioning the presence of these attributes.
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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
- Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, 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
| | | | - Benjamin Kinnear
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Coaching the Fundamentals: Exploring the Applicability and Usefulness of a Novel Skills-Based Feedback Modality. Acad Pediatr 2022; 22:689-697. [PMID: 34963653 DOI: 10.1016/j.acap.2021.12.023] [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: 07/05/2021] [Revised: 12/05/2021] [Accepted: 12/13/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Receiving and integrating feedback is a key to medical trainee development. To assist trainees seeking improvement through daily formative feedback and deliberate practice, the authors created a new skills-based framework called microskills, derived from the Accreditation Council for Graduate Medical Education (ACMGE) milestones and entrustable professional activities. The authors then explored pediatric resident perceptions around the applicability and usefulness of microskills. METHODS The authors conducted 4 qualitative semistructured focus groups of 28 pediatric residents. Focus group prompts asked participants to reflect on microskills as a new feedback modality and microskills in relation to existing feedback and assessment approaches. Focus group transcripts were analyzed through inductive thematic analysis through an iterative process until theoretical saturation was reached. RESULTS Participants felt microskills could facilitate skill-building and improvement, allow for consistent, targeted feedback, and establish a practice of coaching. Participants also perceived microskills' future success to be dependent on how the modality is adopted and utilized alongside existing assessment tools. CONCLUSIONS Trainees found microskills to be a granular, context-based, coaching tool that could improve skill-building and the feedback process. Microskills' emphasis on feedback and their delineation of clinical skills that can be repeatedly practiced has the potential to provide a roadmap for trainee growth. Though microskills could fill a current need in the medical training landscape, they are not a substitute for existing assessment frameworks.
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Cadieux M, Healy M, Petrusa E, Cooke L, Traeger L, Kesselheim JC, Riva-Cambrin J, Phitayakorn R. Implementation of competence by design in Canadian neurosurgery residency programs. MEDICAL TEACHER 2022; 44:380-387. [PMID: 34726559 DOI: 10.1080/0142159x.2021.1994937] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The Royal College of Physicians and Surgeons of Canada (RCPSC) recently redesigned the Canadian neurosurgery residency training curriculum by implementing a competency-based model of training known as Competence by Design (CBD) centered around the assessment of Entrustable Professional Activities (EPAs). This sequential explanatory mixed-methods study evaluated potential benefits and pitfalls of CBD in Canadian neurosurgery residency education. METHODS Two four-month interval surveys were distributed to all Canadian neurosurgery residents participating in CBD. The surveys assessed important educational components: CBD knowledge of key stakeholders, potential system barriers, and educational/psychological impacts on residents. Paired t-tests were done to assess changes over time. Based on longitudinal survey responses, semi-structured interviews were conducted to investigate in-depth residents' experience with CBD in neurosurgery. The qualitative analysis followed an explanatory approach, and a thematic analysis was performed. RESULTS Surveys had 82% average response rate (n = 25). Over time, most residents self-reported that they retrospectively understood concepts around CBD intentions (p = 0.02). Perceived benefits included faculty evaluations with more feedback that was clearer and more objective (53% and 51%). Pitfalls included the amount of time needed to navigate through EPAs (90%) and residents forgetting to initiate EPA forms (71%). There was no significant change over time. During interviews, five key themes were found. Potential solutions identified by residents to enhance their experience included learning analytics data availability, mobile app refinement, and dedicated time to integrate EPAs in the workflow. CONCLUSION This study was the first to assess resident-perceived benefits and pitfalls of the neurosurgery CBD training program in an educational framework context. In general, residents believed that theoretical principles behind CBD were valuable, but that technological ability and having enough time to request EPA assessments were significant barriers to success. Long-term studies are required to determine the definitive outcomes of CBD on residents' performance and ultimately, on patient care.
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Affiliation(s)
- Magalie Cadieux
- Harvard Medical School, Boston, MA, USA
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Michael Healy
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Lara Cooke
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Lara Traeger
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer C Kesselheim
- Harvard Medical School, Boston, MA, USA
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Jay Riva-Cambrin
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Roy Phitayakorn
- Harvard Medical School, Boston, MA, USA
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
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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.
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Baranova K, Goebel EA, Wasserman J, Osmond A. A Survey on Changes to the Canadian Anatomical Pathology Certification Examination Due to Coronavirus Disease 2019 and Implications for Competency-Based Medical Education. Acad Pathol 2021; 8:23742895211060711. [PMID: 34926797 PMCID: PMC8679023 DOI: 10.1177/23742895211060711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/07/2021] [Accepted: 10/12/2021] [Indexed: 01/09/2023] Open
Abstract
The coronavirus disease 2019 pandemic resulted in a dramatic change in the Royal
College of Physicians and Surgeons of Canada assessment process through
elimination of the oral and practical components of the 2020 Anatomical
Pathology examination. Our study sought to determine stakeholder opinions and
experiences on these changes in the context of the 2019 implementation of
competency-based medical education. Surveys were designed for residents and
practicing pathologists. In total, 57 residents (estimated response rate 29%)
and 185 pathologists (estimated response rate 19%) participated across Canada;
67% of pathologists disagreed with the 2020 Royal College examination changes,
compared with 30% for residents (P = <.00001). When asked whether the Royal
College examination should be eliminated, 95% of pathologists indicated they
would be against this, compared to only 34% of residents (P = <.00001).
Perceptions on changes to and importance of different components of assessment
in competency-based medical education were similar between pathologists and
residents, with participants perceiving assessment practices to have changed
fairly little since its implementation, with the exception of more frequent
feedback. Analysis of narrative comments identified several common themes around
assessment, including the need for objectivity and standardization and the
problem of failure-to-fail. However, residents identified numerous elements of
their performance that can be assessed only through longitudinal evaluation.
Pathologists, on the other hand, tended to view these aspects of performance as
laden with bias. Our results will hopefully help guide future innovation in
assessment by characterizing different stakeholder perspectives on key issues in
medical education.
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Affiliation(s)
- Katherina Baranova
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Emily A. Goebel
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Jason Wasserman
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ontario, Canada
| | - Allison Osmond
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Kappy B, Herrmann LE, Schumacher DJ, Statile AM. Building a doctor, one skill at a time: Rethinking clinical training through a new skills-based feedback modality. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:304-311. [PMID: 34037967 PMCID: PMC8505598 DOI: 10.1007/s40037-021-00666-9] [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] [Received: 10/20/2020] [Revised: 03/30/2021] [Accepted: 04/21/2021] [Indexed: 05/12/2023]
Abstract
The Accreditation Council for Graduate Medical Education milestones and entrustable professional activities (EPAs) are important assessment approaches but may lack specificity for learners seeking improvement through daily feedback. As in other professions, clinicians grow best when they engage in deliberate practice of well-defined skills in familiar contexts. This growth is augmented by specific, actionable coaching from supervisors. This article proposes a new feedback modality called microskills, which are derived from the psychology, negotiation, and business literature, and are unique in their ability to elicit targeted feedback for trainee development. These microskills are grounded in both clinical and situational contexts, thereby mirroring learners' cognitive schemas and allowing for more natural skill selection and adoption. When taken as a whole, microskills are granular actions that map to larger milestones, competencies, and EPAs. This article outlines the theoretical justification for this new skills-based feedback modality, the methodology behind the creation of clinical microskills, and provides a worked example of microskills for a pediatric resident on a hospital medicine rotation. Ultimately, microskills have the potential to complement milestones and EPAs and inform feedback that is specific, actionable, and relevant to medical learners.
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Affiliation(s)
- Brandon Kappy
- Department of Pediatrics, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Lisa E Herrmann
- Department of Pediatrics, Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Daniel J Schumacher
- Department of Pediatrics, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Angela M Statile
- Department of Pediatrics, Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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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.
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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
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Baumgardner DJ. The Weight of a Word. J Patient Cent Res Rev 2021; 8:229-231. [PMID: 34322574 PMCID: PMC8297492 DOI: 10.17294/2330-0698.1879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Dennis J Baumgardner
- Department of Family Medicine, Aurora UW Medical Group, Advocate Aurora Health, Milwaukee, WI
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Hall J, Oswald A, Hauer KE, Hall AK, Englander R, Cheung WJ. Twelve tips for learners to succeed in a CBME program. MEDICAL TEACHER 2021; 43:745-750. [PMID: 34020580 DOI: 10.1080/0142159x.2021.1925233] [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
The international movement to competency-based medical education (CBME) marks a major transition in medical education that requires a shift in educators' and learners' approach to clinical experiences, the way assessment data are collected and integrated, and in learners' mindsets. Learners entering a CBME curriculum must actively drive their learning experiences and education goals. For some, this expectation may be a significant change from their previous approach to learning in medicine. This paper highlights 12 tips to help learners succeed within a CBME model.
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Affiliation(s)
- Jena Hall
- Queen's University, Kingston, Canada
| | - Anna Oswald
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
- University of Alberta, Edmonton, Canada
| | | | - Andrew K Hall
- Queen's University, Kingston, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
| | | | - Warren J Cheung
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
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Ginsburg S, Watling CJ, Schumacher DJ, Gingerich A, Hatala R. Numbers Encapsulate, Words Elaborate: Toward the Best Use of Comments for Assessment and Feedback on Entrustment Ratings. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S81-S86. [PMID: 34183607 DOI: 10.1097/acm.0000000000004089] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The adoption of entrustment ratings in medical education is based on a seemingly simple premise: to align workplace-based supervision with resident assessment. Yet it has been difficult to operationalize this concept. Entrustment rating forms combine numeric scales with comments and are embedded in a programmatic assessment framework, which encourages the collection of a large quantity of data. The implicit assumption that more is better has led to an untamable volume of data that competency committees must grapple with. In this article, the authors explore the roles of numbers and words on entrustment rating forms, focusing on the intended and optimal use(s) of each, with a focus on the words. They also unpack the problematic issue of dual-purposing words for both assessment and feedback. Words have enormous potential to elaborate, to contextualize, and to instruct; to realize this potential, educators must be crystal clear about their use. The authors set forth a number of possible ways to reconcile these tensions by more explicitly aligning words to purpose. For example, educators could focus written comments solely on assessment; create assessment encounters distinct from feedback encounters; or use different words collected from the same encounter to serve distinct feedback and assessment purposes. Finally, the authors address the tyranny of documentation created by programmatic assessment and urge caution in yielding to the temptation to reduce words to numbers to make them manageable. Instead, they encourage educators to preserve some educational encounters purely for feedback, and to consider that not all words need to become data.
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Affiliation(s)
- Shiphra Ginsburg
- S. Ginsburg is professor of medicine, Department of Medicine, Sinai Health System and Faculty of Medicine, University of Toronto, scientist, Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada, and Canada Research Chair in Health Professions Education; ORCID: http://orcid.org/0000-0002-4595-6650
| | - Christopher J Watling
- C.J. Watling is professor and director, Centre for Education Research and Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; ORCID: https://orcid.org/0000-0001-9686-795X
| | - Daniel J Schumacher
- D.J. Schumacher is associate professor of pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0001-5507-8452
| | - Andrea Gingerich
- A. Gingerich is assistant professor, Northern Medical Program, University of Northern British Columbia, Prince George, British Columbia, Canada; ORCID: https://orcid.org/0000-0001-5765-3975
| | - Rose Hatala
- R. Hatala is professor, Department of Medicine, and director, Clinical Educator Fellowship, Center for Health Education Scholarship, University of British Columbia, Vancouver, British Columbia, Canada; ORCID: https://orcid.org/0000-0003-0521-2590
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47
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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.
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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
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Phaneuf JC, Wood D. Adult Gastroenterology Trainees’ Experience of Receiving Feedback on Their Performance of Endoscopy in the Workplace. J Can Assoc Gastroenterol 2021; 5:18-24. [PMID: 35118223 PMCID: PMC8806046 DOI: 10.1093/jcag/gwab011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/23/2021] [Indexed: 11/28/2022] Open
Abstract
Background Competency-based gastrointestinal endoscopy training is concerned with outcomes of the learning experience. Feedback allows for trainees to achieve the expected outcomes. However, little is known about trainees’ experience of receiving feedback. Gaining understanding of their experience could help improve feedback practices. The study was conducted to explore what it means for adult gastroenterology trainees to receive feedback on their performance of endoscopy in the workplace. Methods An interpretative phenomenological approach was used. Individual semi-structured interviews were conducted with six trainees from three Canadian adult gastroenterology residency programs. Interviews were audio-recorded and transcribed verbatim for analysis. Analysis was conducted to identify the phenomenological themes across participants’ accounts of lived experience to provide an insight into the meaning of experiencing the studied phenomenon. Findings Three phenomenological themes of experience were identified: taking pauses, negotiating understandings and accepting asymmetry. Taking pauses allowed for participants to receive feedback on their performance of endoscopy. Participants needed to negotiate attending gastroenterologists’ different understandings of gastrointestinal endoscopy while carrying their own whenever feedback was provided. They had to accept the asymmetry between the roles of care provider and learner as well. Discussion The study has captured the uniqueness and the complexity of the lived experience of receiving feedback on the performance of endoscopy in the workplace from the perspective of study participants. The gained understanding of this experience has enabled the authors to suggest how attending gastroenterologists’ feedback practices may be improved.
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Affiliation(s)
- Julien-Carl Phaneuf
- Département de médecine, Faculté de médecine, Université Laval, Quebec City, Quebec, Canada
| | - Dawn Wood
- Centre for Medical Education, School of Medicine, University of Dundee, Dundee, Scotland, UK
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Edgar L, Jones MD, Harsy B, Passiment M, Hauer KE. Better Decision-Making: Shared Mental Models and the Clinical Competency Committee. J Grad Med Educ 2021; 13:51-58. [PMID: 33936533 PMCID: PMC8078083 DOI: 10.4300/jgme-d-20-00850.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/13/2020] [Accepted: 12/01/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Shared mental models (SMMs) help groups make better decisions. Clinical competency committees (CCCs) can benefit from the development and use of SMMs in their decision-making as a way to optimize the quality and consistency of their decisions. OBJECTIVE We reviewed the use of SMMs for decision making in graduate medical education, particularly their use in CCCs. METHODS In May 2020, the authors conducted a narrative review of the literature related to SMMs. This review included the SMM related to teams, team functioning, CCCs, and graduate medical education. RESULTS The literature identified the general use of SMMs, SMMs in graduate medical education, and strategies for building SMMs into the work of the CCC. Through the use of clear communication and guidelines, and a shared understanding of goals and expectations, CCCs can make better decisions. SMMs can be applied to Milestones, resident performance, assessment, and feedback. CONCLUSIONS To ensure fair and robust decision-making, the CCC must develop and maintain SMMs through excellent communication and understanding of expectations among members.
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Affiliation(s)
- Laura Edgar
- Laura Edgar, EdD, CAE, is Vice President, Milestones Development, Accreditation Council for Graduate Medical Education (ACGME)
| | - M. Douglas Jones
- M. Douglas Jones Jr, MD, is Professor of Pediatrics, University of Colorado School of Medicine
| | - Braden Harsy
- Braden Harsy, MA, is Milestones Administrator, ACGME
| | - Morgan Passiment
- Morgan Passiment, MS, is Director, Institutional Outreach and Collaboration, ACGME
| | - Karen E. Hauer
- Karen E. Hauer, MD, PhD, is Associate Dean, Competency Assessment and Professional Standards, and Professor of Medicine, University of California, San Francisco
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Upadhyaya S, Rashid M, Davila-Cervantes A, Oswald A. Exploring resident perceptions of initial competency based medical education implementation. CANADIAN MEDICAL EDUCATION JOURNAL 2021; 12:e42-e56. [PMID: 33995719 PMCID: PMC8105577 DOI: 10.36834/cmej.70943] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Competence by design (CBD) is a nationally developed hybrid competency based medical education (CBME) curricular model that focuses on residents' abilities to promote successful practice and better meet societal needs. CBD is based on a commonly used framework of five core components of CBME: outcome competencies, sequenced progression, tailored learning experiences, competency-focused instruction and programmatic assessment. There is limited literature concerning residents' perceptions of implementation of CBME. OBJECTIVE We explored resident perceptions of this transformation and their views as they relate to the intended framework. METHODS We recruited residents enrolled in current CBME implementation between August 2018 and January 2019. We interviewed residents representing eight disciplines from the initial two CBME implementation cohorts. Inductive thematic analysis was used to analyse the data through iterative consensus building until saturation. RESULTS We identified five themes: 1) Value of feedback for residents; 2) Resident strategies for successful Entrustable Professional Activity observation completion; 3) Residents experience challenges; 4) Resident concerns regarding CBME; and 5) Resident recommendations to improve existing challenges. We found that while there was clear alignment with residents' perceptions of the programmatic assessment core CBME component, alignment was not as clear for other components. CONCLUSIONS Residents perceived aspects of this transformation as helpful but overall had mixed perceptions and variable understanding of the intended underlying framework. Understanding and disseminating successes and challenges from the resident lens may assist programs at different stages of CBME implementation.
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Affiliation(s)
- Shivani Upadhyaya
- Core Internal Medicine Resident, Department of Medicine, PGY3, University of Alberta, Alberta, Canada
| | - Marghalara Rashid
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
| | - Andrea Davila-Cervantes
- Office of Lifelong Learning, Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
| | - Anna Oswald
- Division of Rheumatology, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
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