1
|
Schauber SK, Olsen AO, Werner EL, Magelssen M. Inconsistencies in rater-based assessments mainly affect borderline candidates: but using simple heuristics might improve pass-fail decisions. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024:10.1007/s10459-024-10328-0. [PMID: 38649529 DOI: 10.1007/s10459-024-10328-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/24/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Research in various areas indicates that expert judgment can be highly inconsistent. However, expert judgment is indispensable in many contexts. In medical education, experts often function as examiners in rater-based assessments. Here, disagreement between examiners can have far-reaching consequences. The literature suggests that inconsistencies in ratings depend on the level of performance a to-be-evaluated candidate shows. This possibility has not been addressed deliberately and with appropriate statistical methods. By adopting the theoretical lens of ecological rationality, we evaluate if easily implementable strategies can enhance decision making in real-world assessment contexts. METHODS We address two objectives. First, we investigate the dependence of rater-consistency on performance levels. We recorded videos of mock-exams and had examiners (N=10) evaluate four students' performances and compare inconsistencies in performance ratings between examiner-pairs using a bootstrapping procedure. Our second objective is to provide an approach that aids decision making by implementing simple heuristics. RESULTS We found that discrepancies were largely a function of the level of performance the candidates showed. Lower performances were rated more inconsistently than excellent performances. Furthermore, our analyses indicated that the use of simple heuristics might improve decisions in examiner pairs. DISCUSSION Inconsistencies in performance judgments continue to be a matter of concern, and we provide empirical evidence for them to be related to candidate performance. We discuss implications for research and the advantages of adopting the perspective of ecological rationality. We point to directions both for further research and for development of assessment practices.
Collapse
Affiliation(s)
- Stefan K Schauber
- Centre for Health Sciences Education, Faculty of Medicine, University of Oslo, Oslo, Norway.
- Centre for Educational Measurement (CEMO), Faculty of Educational Sciences, University of Oslo, Oslo, Norway.
| | - Anne O Olsen
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Erik L Werner
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Morten Magelssen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| |
Collapse
|
2
|
Choo EK, Woods R, Walker ME, O’Brien JM, Chan TM. The Quality of Assessment for Learning score for evaluating written feedback in anesthesiology postgraduate medical education: a generalizability and decision study. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:78-85. [PMID: 38226296 PMCID: PMC10787859 DOI: 10.36834/cmej.75876] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Background Competency based residency programs depend on high quality feedback from the assessment of entrustable professional activities (EPA). The Quality of Assessment for Learning (QuAL) score is a tool developed to rate the quality of narrative comments in workplace-based assessments; it has validity evidence for scoring the quality of narrative feedback provided to emergency medicine residents, but it is unknown whether the QuAL score is reliable in the assessment of narrative feedback in other postgraduate programs. Methods Fifty sets of EPA narratives from a single academic year at our competency based medical education post-graduate anesthesia program were selected by stratified sampling within defined parameters [e.g. resident gender and stage of training, assessor gender, Competency By Design training level, and word count (≥17 or <17 words)]. Two competency committee members and two medical students rated the quality of narrative feedback using a utility score and QuAL score. We used Kendall's tau-b co-efficient to compare the perceived utility of the written feedback to the quality assessed with the QuAL score. The authors used generalizability and decision studies to estimate the reliability and generalizability coefficients. Results Both the faculty's utility scores and QuAL scores (r = 0.646, p < 0.001) and the trainees' utility scores and QuAL scores (r = 0.667, p < 0.001) were moderately correlated. Results from the generalizability studies showed that utility scores were reliable with two raters for both faculty (Epsilon=0.87, Phi=0.86) and trainees (Epsilon=0.88, Phi=0.88). Conclusions The QuAL score is correlated with faculty- and trainee-rated utility of anesthesia EPA feedback. Both faculty and trainees can reliability apply the QuAL score to anesthesia EPA narrative feedback. This tool has the potential to be used for faculty development and program evaluation in Competency Based Medical Education. Other programs could consider replicating our study in their specialty.
Collapse
Affiliation(s)
- Eugene K Choo
- Department of Anesthesiology, College of Medicine, University of Saskatchewan, Saskatchewan, Canada;
| | - Rob Woods
- Department of Emergency Medicine, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Mary Ellen Walker
- Department of Anesthesiology, College of Medicine, University of Saskatchewan, Saskatchewan, Canada;
| | - Jennifer M O’Brien
- Department of Anesthesiology, College of Medicine, University of Saskatchewan, Saskatchewan, Canada;
| | - Teresa M Chan
- Department of Medicine (Division of Emergency Medicine; Division of Education & Innovation), Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University and Office of Continuing Professional Development & McMaster Education Research, Innovation, and Theory (MERIT) Program, Faculty of Health Sciences, McMaster University, Ontario, Canada
| |
Collapse
|
3
|
McGuire N, Acai A, Sonnadara RR. The McMaster Narrative Comment Rating Tool: Development and Initial Validity Evidence. TEACHING AND LEARNING IN MEDICINE 2023:1-13. [PMID: 37964518 DOI: 10.1080/10401334.2023.2276799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 10/05/2023] [Indexed: 11/16/2023]
Abstract
CONSTRUCT The McMaster Narrative Comment Rating Tool aims to capture critical features reflecting the quality of written narrative comments provided in the medical education context: valence/tone of language, degree of correction versus reinforcement, specificity, actionability, and overall usefulness. BACKGROUND Despite their role in competency-based medical education, not all narrative comments contribute meaningfully to the development of learners' competence. To develop solutions to mitigate this problem, robust measures of narrative comment quality are needed. While some tools exist, most were created in specialty-specific contexts, have focused on one or two features of feedback, or have focused on faculty perceptions of feedback, excluding learners from the validation process. In this study, we aimed to develop a detailed, broadly applicable narrative comment quality assessment tool that drew upon features of high-quality assessment and feedback and could be used by a variety of raters to inform future research, including applications related to automated analysis of narrative comment quality. APPROACH In Phase 1, we used the literature to identify five critical features of feedback. We then developed rating scales for each of the features, and collected 670 competency-based assessments completed by first-year surgical residents in the first six-weeks of training. Residents were from nine different programs at a Canadian institution. In Phase 2, we randomly selected 50 assessments with written feedback from the dataset. Two education researchers used the scale to independently score the written comments and refine the rating tool. In Phase 3, 10 raters, including two medical education researchers, two medical students, two residents, two clinical faculty members, and two laypersons from the community, used the tool to independently and blindly rate written comments from another 50 randomly selected assessments from the dataset. We compared scores between and across rater pairs to assess reliability. FINDINGS Single and average measures intraclass correlation (ICC) scores ranged from moderate to excellent (ICCs = .51-.83 and .91-.98) across all categories and rater pairs. All tool domains were significantly correlated (p's <.05), apart from valence, which was only significantly correlated with degree of correction versus reinforcement. CONCLUSION Our findings suggest that the McMaster Narrative Comment Rating Tool can reliably be used by multiple raters, across a variety of rater types, and in different surgical contexts. As such, it has the potential to support faculty development initiatives on assessment and feedback, and may be used as a tool to conduct research on different assessment strategies, including automated analysis of narrative comments.
Collapse
Affiliation(s)
- Natalie McGuire
- Office of Professional Development and Educational Scholarship, Queen's University, Kingston, Ontario, Canada
| | - Anita Acai
- Department of Psychiatry and Behavioural Neurosciences and McMaster Education Research, Innovation and Theory (MERIT) Program, McMaster University, and St. Joseph's Education Research Centre (SERC), St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Ranil R Sonnadara
- Office of Education Science, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
4
|
Anderson LM, Rowland K, Edberg D, Wright KM, Park YS, Tekian A. An Analysis of Written and Numeric Scores in End-of-Rotation Forms from Three Residency Programs. PERSPECTIVES ON MEDICAL EDUCATION 2023; 12:497-506. [PMID: 37929204 PMCID: PMC10624145 DOI: 10.5334/pme.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
Introduction End-of-Rotation Forms (EORFs) assess resident progress in graduate medical education and are a major component of Clinical Competency Committee (CCC) discussion. Single-institution studies suggest EORFs can detect deficiencies, but both grades and comments skew positive. In this study, we sought to determine whether the EORFs from three programs, including multiple specialties and institutions, produced useful information for residents, program directors, and CCCs. Methods Evaluations from three programs were included (Program 1, Institution A, Internal Medicine: n = 38; Program 2, Institution A, Anesthesia: n = 9; Program 3, Institution B, Anesthesia: n = 11). Two independent researchers coded each written comment for relevance (specificity and actionability) and orientation (praise or critical) using a standardized rubric. Numeric scores were analyzed using descriptive statistics. Results 4869 evaluations were collected from the programs. Of the 77,434 discrete numeric scores, 691 (0.89%) were considered "below expected level." 71.2% (2683/3767) of the total written comments were scored as irrelevant, while 3217 (85.4%) of total comments were scored positive and 550 (14.6%) were critical. When combined, 63.2% (n = 2379) of comments were scored positive and irrelevant while 6.5% (n = 246) were scored critical and relevant. Discussion <1% of comments indicated below average performance; >70% of comments scored irrelevant. Critical, relevant comments were least frequently observed, consistent across all 3 programs. The low rate of constructive feedback and the high rate of irrelevant comments are inadequate for a CCC to make informed decisions. The consistency of these findings across programs, specialties, and institutions suggests both local and systemic changes should be considered.
Collapse
Affiliation(s)
- Lauren M. Anderson
- Department of Family and Preventive Medicine, Rush University, Chicago, Illinois, US
| | - Kathleen Rowland
- Department of Family and Preventive Medicine, Rush University, Chicago, Illinois, US
| | - Deborah Edberg
- Department of Family and Preventive Medicine, Rush University, Chicago, Illinois, US
| | - Katherine M. Wright
- Department of Family & Community Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, US
| | - Yoon Soo Park
- Department of Medical Education, University of Illinois Chicago, Chicago, Illinois, US
| | - Ara Tekian
- Department of Medical Education, University of Illinois Chicago, Chicago, Illinois, US
| |
Collapse
|
5
|
Derrick GE, Zimmermann A, Greaves H, Best J, Klavans R. Targeted, actionable and fair: Reviewer reports as feedback and its effect on ECR career choices. RESEARCH EVALUATION 2023; 32:648-657. [PMID: 38312111 PMCID: PMC10831695 DOI: 10.1093/reseval/rvad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Previous studies of the use of peer review for the allocation of competitive funding agencies have concentrated on questions of efficiency and how to make the 'best' decision, by ensuring that successful applicants are also the more productive or visible in the long term. This paper examines the components of feedback received from an unsuccessful grant application, is associated with motivating applicants career decisions to persist (reapply for funding at T1), or to switch (not to reapply, or else leave academia). This study combined data from interviews with unsuccessful ECR applicants (n = 19) to The Wellcome Trust 2009-19, and manual coding of reviewer comments received by applicants (n = 81). All applicants received feedback on their application at T0 with a large proportion of unsuccessful applicants reapplying for funding at T1. Here, peer-review-comments-as-feedback sends signals to applicants to encourage them to persist (continue) or switch (not continue) even when the initial application has failed. Feedback associated by unsuccessful applicants as motivating their decision to resubmit had three characteristics: actionable; targeted; and fair. The results lead to identification of standards of feedback for funding agencies and peer-reviewers to promote when providing reviewer feedback to applicants as part of their peer review process. The provision of quality reviewer-reports-as-feedback to applicants, ensures that peer review acts as a participatory research governance tool focused on supporting the development of individuals and their future research plans.
Collapse
Affiliation(s)
- Gemma Elizabeth Derrick
- School of Education, Centre for Higher Education Transformations (CHET), University of Bristol, Bristol, UK
| | | | - Helen Greaves
- School of Education, Centre for Higher Education Transformations (CHET), University of Bristol, Bristol, UK
| | - Jonathan Best
- The Wellcome Trust, 215 Euston Road, London NW1 2BE, UK
| | | |
Collapse
|
6
|
Wisener K, Hart K, Driessen E, Cuncic C, Veerapen K, Eva K. Upward Feedback: Exploring Learner Perspectives on Giving Feedback to their Teachers. PERSPECTIVES ON MEDICAL EDUCATION 2023; 2:99-108. [PMID: 36969692 PMCID: PMC10038106 DOI: 10.5334/pme.818] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 03/10/2023] [Indexed: 05/05/2023]
Abstract
Introduction Feedback from learners is known to be an important motivator for medical teachers, but it can be de-motivating if delivered poorly, leaving teachers frustrated and uncertain. Research has identified challenges learners face in providing upward feedback, but has not explored how challenges influence learners' goals and approaches to giving feedback. This study explored learner perspectives on providing feedback to teachers to advance understanding of how to optimize upward feedback quality. Methods We conducted semi-structured interviews with 16 learners from the MD program at the University of British Columbia. Applying an interpretive description methodology, interviews continued until data sufficiency was achieved. Iterative analysis accounted for general trends across seniority, site of training, age and gender as well as individual variations. Findings Learners articulated well-intentioned goals in relation to upward feedback (e.g., to encourage effective teaching practices). However, conflicting priorities such as protecting one's image created tensions leading to feedback that was discordant with teaching quality. Several factors, including the number of feedback requests learners face and whether learners think their feedback is meaningful mediated the extent to which upward feedback goals or competing goals were enacted. Discussion Our findings offer a nuanced understanding of the complexities that influence learners' approaches to upward feedback when challenges arise. In particular, goal conflicts make it difficult for learners to contribute to teacher support through upward feedback. Efforts to encourage the quality of upward feedback should begin with reducing competition between goals by addressing factors that mediate goal prioritization.
Collapse
Affiliation(s)
- Katherine Wisener
- Faculty Development, Faculty of Medicine, University of British Columbia, Canada
- School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands
| | - Kimberlee Hart
- Faculty of Medicine, University of British Columbia, Canada
| | - Erik Driessen
- Department of Educational Development and Research, Faculty of Health Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Cary Cuncic
- Division of General Internal Medicine, University of British Columbia, Vancouver. BC, Canada
| | - Kiran Veerapen
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kevin Eva
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
7
|
Kogan JR, Dine CJ, Conforti LN, Holmboe ES. Can Rater Training Improve the Quality and Accuracy of Workplace-Based Assessment Narrative Comments and Entrustment Ratings? A Randomized Controlled Trial. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:237-247. [PMID: 35857396 DOI: 10.1097/acm.0000000000004819] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Prior research evaluating workplace-based assessment (WBA) rater training effectiveness has not measured improvement in narrative comment quality and accuracy, nor accuracy of prospective entrustment-supervision ratings. The purpose of this study was to determine whether rater training, using performance dimension and frame of reference training, could improve WBA narrative comment quality and accuracy. A secondary aim was to assess impact on entrustment rating accuracy. METHOD This single-blind, multi-institution, randomized controlled trial of a multifaceted, longitudinal rater training intervention consisted of in-person training followed by asynchronous online spaced learning. In 2018, investigators randomized 94 internal medicine and family medicine physicians involved with resident education. Participants assessed 10 scripted standardized resident-patient videos at baseline and follow-up. Differences in holistic assessment of narrative comment accuracy and specificity, accuracy of individual scenario observations, and entrustment rating accuracy were evaluated with t tests. Linear regression assessed impact of participant demographics and baseline performance. RESULTS Seventy-seven participants completed the study. At follow-up, the intervention group (n = 41), compared with the control group (n = 36), had higher scores for narrative holistic specificity (2.76 vs 2.31, P < .001, Cohen V = .25), accuracy (2.37 vs 2.06, P < .001, Cohen V = .20) and mean quantity of accurate (6.14 vs 4.33, P < .001), inaccurate (3.53 vs 2.41, P < .001), and overall observations (2.61 vs 1.92, P = .002, Cohen V = .47). In aggregate, the intervention group had more accurate entrustment ratings (58.1% vs 49.7%, P = .006, Phi = .30). Baseline performance was significantly associated with performance on final assessments. CONCLUSIONS Quality and specificity of narrative comments improved with rater training; the effect was mitigated by inappropriate stringency. Training improved accuracy of prospective entrustment-supervision ratings, but the effect was more limited. Participants with lower baseline rating skill may benefit most from training.
Collapse
Affiliation(s)
- Jennifer R Kogan
- J.R. Kogan is associate dean, Student Success and Professional Development, and professor of medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0001-8426-9506
| | - C Jessica Dine
- C.J. Dine is associate dean, Evaluation and Assessment, and associate professor of medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0001-5894-0861
| | - Lisa N Conforti
- L.N. Conforti is research associate for milestones evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-7317-6221
| | - Eric S Holmboe
- E.S. Holmboe is chief, research, milestones development and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-0108-6021
| |
Collapse
|
8
|
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.
Collapse
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
| | | |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Woods R, Singh S, Thoma B, Patocka C, Cheung W, Monteiro S, Chan TM. Validity evidence for the Quality of Assessment for Learning score: a quality metric for supervisor comments in Competency Based Medical Education. CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:19-35. [PMID: 36440075 PMCID: PMC9684040 DOI: 10.36834/cmej.74860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Competency based medical education (CBME) relies on supervisor narrative comments contained within entrustable professional activities (EPA) for programmatic assessment, but the quality of these supervisor comments is unassessed. There is validity evidence supporting the QuAL (Quality of Assessment for Learning) score for rating the usefulness of short narrative comments in direct observation. OBJECTIVE We sought to establish validity evidence for the QuAL score to rate the quality of supervisor narrative comments contained within an EPA by surveying the key end-users of EPA narrative comments: residents, academic advisors, and competence committee members. METHODS In 2020, the authors randomly selected 52 de-identified narrative comments from two emergency medicine EPA databases using purposeful sampling. Six collaborators (two residents, two academic advisors, and two competence committee members) were recruited from each of four EM Residency Programs (Saskatchewan, McMaster, Ottawa, and Calgary) to rate these comments with a utility score and the QuAL score. Correlation between utility and QuAL score were calculated using Pearson's correlation coefficient. Sources of variance and reliability were calculated using a generalizability study. RESULTS All collaborators (n = 24) completed the full study. The QuAL score had a high positive correlation with the utility score amongst the residents (r = 0.80) and academic advisors (r = 0.75) and a moderately high correlation amongst competence committee members (r = 0.68). The generalizability study found that the major source of variance was the comment indicating the tool performs well across raters. CONCLUSION The QuAL score may serve as an outcome measure for program evaluation of supervisors, and as a resource for faculty development.
Collapse
Affiliation(s)
- Rob Woods
- Department of Emergency Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Sim Singh
- College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Brent Thoma
- Department of Emergency Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Catherine Patocka
- Department of Emergency Medicine, University of Calgary, Alberta, Canada
| | - Warren Cheung
- Department of Emergency Medicine, University of Ottawa, Ontario, Canada
| | - Sandra Monteiro
- Department of Health Research Methods Evidence and Impact, McMaster University, Ontario, Canada
| | - Teresa M Chan
- Division of Emergency Medicine and Education & Innovation, Department of Medicine, McMaster University, Ontario, Canada
| | | |
Collapse
|
11
|
Gordon LB, Zelaya-Floyd M, White P, Hallen S, Varaklis K, Tavakolikashi M. Interprofessional bedside rounding improves quality of feedback to resident physicians. MEDICAL TEACHER 2022; 44:907-913. [PMID: 35373712 DOI: 10.1080/0142159x.2022.2049735] [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: 06/14/2023]
Abstract
PURPOSE Obtaining high quality feedback in residency education is challenging, in part due to limited opportunities for faculty observation of authentic clinical work. This study reviewed the impact of interprofessional bedside rounds ('iPACE™') on the length and quality of faculty narrative evaluations of residents as compared to usual inpatient teaching rounds. METHODS Narrative comments from faculty evaluations of Internal Medicine (IM) residents both on usual teaching service as well as the iPACE™ service (spanning 2017-2020) were reviewed and coded using a deductive content analysis approach. RESULTS Six hundred ninety-two narrative evaluations by 63 attendings of 103 residents were included. Evaluations of iPACE™ residents were significantly longer than those of residents on usual teams (109 vs. 69 words, p < 0.001). iPACE™ evaluations contained a higher average occurrence of direct observations of patient/family interactions (0.72 vs. 0.32, p < 0.001), references to interprofessionalism (0.17 vs. 0.05, p < 0.001), as well as specific (3.21 vs. 2.26, p < 0.001), actionable (1.01 vs. 0.69, p < 0.001), and corrective feedback (1.2 vs. 0.88, p = 0.001) per evaluation. CONCLUSIONS This study suggests that the iPACE™ model, which prioritizes interprofessional bedside rounds, had a positive impact on the quantity and quality of feedback, as measured via narrative comments on weekly evaluations.
Collapse
Affiliation(s)
- Lesley B Gordon
- Tufts University School of Medicine, Boston, MA, USA
- Department of Medicine, Maine Medical Center, Portland, ME, USA
| | | | - Patricia White
- Department of Medical Education, Maine Medical Center, Portland, ME, USA
| | - Sarah Hallen
- Tufts University School of Medicine, Boston, MA, USA
- Division of Geriatrics, Maine Medical Center, Portland, ME, USA
| | - Kalli Varaklis
- Tufts University School of Medicine, Boston, MA, USA
- Department of Medical Education, Maine Medical Center, Portland, ME, USA
- Department of Obstetrics and Gynecology, Maine Medical Center, Portland, ME, USA
| | - Motahareh Tavakolikashi
- Department of Medical Education, Maine Medical Center, Portland, ME, USA
- Department of System Science and Industrial Engineering, Binghamton University, Binghamton, NY, USA
| |
Collapse
|
12
|
Concordance of Narrative Comments with Supervision Ratings Provided During Entrustable Professional Activity Assessments. J Gen Intern Med 2022; 37:2200-2207. [PMID: 35710663 PMCID: PMC9296736 DOI: 10.1007/s11606-022-07509-1] [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: 09/08/2021] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Use of EPA-based entrustment-supervision ratings to determine a learner's readiness to assume patient care responsibilities is expanding. OBJECTIVE In this study, we investigate the correlation between narrative comments and supervision ratings assigned during ad hoc assessments of medical students' performance of EPA tasks. DESIGN Data from assessments completed for students enrolled in the clerkship phase over 2 academic years were used to extract a stratified random sample of 100 narrative comments for review by an expert panel. PARTICIPANTS A review panel, comprised of faculty with specific expertise related to their roles within the EPA program, provided a "gold standard" supervision rating using the comments provided by the original assessor. MAIN MEASURES Interrater reliability (IRR) between members of review panel and correlation coefficients (CC) between expert ratings and supervision ratings from original assessors. KEY RESULTS IRR among members of the expert panel ranged from .536 for comments associated with focused history taking to .833 for complete physical exam. CC (Kendall's correlation coefficient W) between panel members' assignment of supervision ratings and the ratings provided by the original assessors for history taking, physical examination, and oral presentation comments were .668, .697, and .735 respectively. The supervision ratings of the expert panel had the highest degree of correlation with ratings provided during assessments done by master assessors, faculty trained to assess students across clinical contexts. Correlation between supervision ratings provided with the narrative comments at the time of observation and supervision ratings assigned by the expert panel differed by clinical discipline, perhaps reflecting the value placed on, and perhaps the comfort level with, assessment of the task in a given specialty. CONCLUSIONS To realize the full educational and catalytic effect of EPA assessments, assessors must apply established performance expectations and provide high-quality narrative comments aligned with the criteria.
Collapse
|
13
|
Gold JM, Yemane L, Keppler H, Balasubramanian V, Rassbach CE. Words Matter: Examining Gender Differences in the Language Used to Evaluate Pediatrics Residents. Acad Pediatr 2022; 22:698-704. [PMID: 35158087 DOI: 10.1016/j.acap.2022.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/21/2022] [Accepted: 02/07/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gender disparities in academic medicine continue to be pervasive. Written evaluations of residents may provide insight into perceptions of residents by faculty, which may influence letters of recommendation for positions beyond residency and reinforce perceived stereotype threat experienced by trainees. OBJECTIVE To examine language used in faculty evaluations of pediatrics residents to determine if there are differences in language used with respect to gender of resident. DESIGN/METHODS All faculty evaluations of residents in 3 consecutive intern classes from 2016 to 2018 were collected and redacted for name and gender identifiers. We performed a qualitative analysis of written comments in 2 mandatory free text sections. The study team initially coded text collectively, generating a code book, then individually to apply the coding scheme. Next, evaluations were unblinded to gender. Code applications were aggregated by resident, and frequencies of code application by resident were compared by standardized mean differences to detect imbalances between genders. RESULTS A total of 448 evaluations were analyzed: 88 evaluations of 17 male residents, and 360 evaluations of 70 female residents. Codes more frequently applied to women included "enthusiasm," and "caring," while codes more frequently applied to men included "intelligence," and "prepared." A conceptual model was created to reflect potential impacts of these differences using a lens of social role theory. CONCLUSIONS We identified differences in the way male and female residents are evaluated by faculty, which may have negative downstream effects on female residents, who may experience negative self-perception, differential development of clinical skills, and divergent career opportunities as a result.
Collapse
Affiliation(s)
- Jessica M Gold
- Department of Pediatrics (JM Gold, L Yemane, and CE Rassbach), Stanford University School of Medicine, Palo Alto, Calif.
| | - Lahia Yemane
- Department of Pediatrics (JM Gold, L Yemane, and CE Rassbach), Stanford University School of Medicine, Palo Alto, Calif
| | - Hannah Keppler
- Department of Pediatrics (H Keppler), Albert Einstein College of Medicine, Bronx, NY
| | | | - Caroline E Rassbach
- Department of Pediatrics (JM Gold, L Yemane, and CE Rassbach), Stanford University School of Medicine, Palo Alto, Calif
| |
Collapse
|
14
|
Kelleher M, Kinnear B, Sall DR, Weber DE, DeCoursey B, Nelson J, Klein M, Warm EJ, Schumacher DJ. Warnings in early narrative assessment that might predict performance in residency: signal from an internal medicine residency program. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:334-340. [PMID: 34476730 PMCID: PMC8633188 DOI: 10.1007/s40037-021-00681-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Narrative assessment data are valuable in understanding struggles in resident performance. However, it remains unknown which themes in narrative data that occur early in training may indicate a higher likelihood of struggles later in training, allowing programs to intervene sooner. METHODS Using learning analytics, we identified 26 internal medicine residents in three cohorts that were below expected entrustment during training. We compiled all narrative data in the first 6 months of training for these residents as well as 13 typically performing residents for comparison. Narrative data were blinded for all 39 residents during initial phases of an inductive thematic analysis for initial coding. RESULTS Many similarities were identified between the two cohorts. Codes that differed between typical and lower entrusted residents were grouped into two types of themes: three explicit/manifest and three implicit/latent with six total themes. The explicit/manifest themes focused on specific aspects of resident performance with assessors describing 1) Gaps in attention to detail, 2) Communication deficits with patients, and 3) Difficulty recognizing the "big picture" in patient care. Three implicit/latent themes, focused on how narrative data were written, were also identified: 1) Feedback described as a deficiency rather than an opportunity to improve, 2) Normative comparisons to identify a resident as being behind their peers, and 3) Warning of possible risk to patient care. DISCUSSION Clinical competency committees (CCCs) usually rely on accumulated data and trends. Using the themes in this paper while reviewing narrative comments may help CCCs with earlier recognition and better allocation of resources to support residents' development.
Collapse
Affiliation(s)
- Matthew Kelleher
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Benjamin Kinnear
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Dana R Sall
- HonorHealth Internal Medicine Residency Program, Scottsdale, Arizona and University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Danielle E Weber
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bailey DeCoursey
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jennifer Nelson
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Melissa Klein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Eric J Warm
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Daniel J Schumacher
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
15
|
Coertjens L, Lesterhuis M, De Winter BY, Goossens M, De Maeyer S, Michels NRM. Improving Self-Reflection Assessment Practices: Comparative Judgment as an Alternative to Rubrics. TEACHING AND LEARNING IN MEDICINE 2021; 33:525-535. [PMID: 33571014 DOI: 10.1080/10401334.2021.1877709] [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: 08/29/2020] [Revised: 12/05/2020] [Accepted: 01/17/2021] [Indexed: 06/12/2023]
Abstract
CONSTRUCT The authors aimed to investigate the utility of the comparative judgment method for assessing students' written self-reflections. BACKGROUND Medical practitioners' reflective skills are increasingly considered important and therefore included in the medical education curriculum. However, assessing students' reflective skills using rubrics does not appear to guarantee adequate inter-rater reliabilities. Recently, comparative judgment was introduced as a new method to evaluate performance assessments. This study investigates the merits and limitations of the comparative judgment method for assessing students' written self-reflections. More specifically, it examines the reliability in relation to the time spent assessing, the correlation between the scores obtained using the two methods (rubrics and comparative judgment), and, raters' perceptions of the comparative judgment method. APPROACH Twenty-two self-reflections, that had previously been scored using a rubric, were assessed by a group of eight raters using comparative judgment. Two hundred comparisons were completed and a rank order was calculated. Raters' impressions were investigated using a focus group. FINDINGS Using comparative judgment, each self-reflection needed to be compared seven times with another self-reflection to reach a scale separation reliability of .55. The inter-rater reliability of rating (ICC, (1, k)) using rubrics was .56. The time investment required for these reliability levels in both methods was around 24 minutes. The Kendall's tau rank correlation indicated a strong correlation between the scores obtained via both methods. Raters reported that making comparisons made them evaluate the quality of self-reflections in a more nuanced way. Time investment was, however, considered heavy, especially for the first comparisons. Although raters appreciated that they did not have to assign a grade to each self-reflection, the fact that the method does not automatically lead to a grade or feedback was considered a downside. CONCLUSIONS First evidence was provided for the comparative judgment method as an alternative to using rubrics for assessing students' written self-reflections. Before comparative judgment can be implemented for summative assessment, more research is needed on the time investment required to ensure no contradictory feedback is given back to students. Moreover, as the comparative judgment method requires an additional standard setting exercise to obtain grades, more research is warranted on the merits and limitations of this method when a pass/fail approach is used.
Collapse
Affiliation(s)
- Liesje Coertjens
- Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
- Department of Educational Sciences, Faculty of Social Sciences, University of Antwerp, Antwerp, Belgium
| | - Marije Lesterhuis
- Department of Educational Sciences, Faculty of Social Sciences, University of Antwerp, Antwerp, Belgium
| | - Benedicte Y De Winter
- Skills Lab at the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Maarten Goossens
- Department of Educational Sciences, Faculty of Social Sciences, University of Antwerp, Antwerp, Belgium
| | - Sven De Maeyer
- Department of Educational Sciences, Faculty of Social Sciences, University of Antwerp, Antwerp, Belgium
| | - Nele R M Michels
- Skills Lab at the Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
16
|
Read EK, Brown A, Maxey C, Hecker KG. Comparing Entrustment and Competence: An Exploratory Look at Performance-Relevant Information in the Final Year of a Veterinary Program. JOURNAL OF VETERINARY MEDICAL EDUCATION 2021; 48:562-572. [PMID: 33661087 DOI: 10.3138/jvme-2019-0128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Workplace-based assessments and entrustment scales have two primary goals: providing formative information to assist students with future learning; and, determining if and when learners are ready for safe, independent practice. To date, there has not been an evaluation of the relationship between these performance-relevant information pieces in veterinary medicine. This study collected quantitative and qualitative data from a single cohort of final-year students (n = 27) across in-training evaluation reports (ITERs) and entrustment scales in a distributed veterinary hospital environment. Here we compare progression in scoring and performance within and across student, within and across method of assessment, over time. Narrative comments were quantified using the Completed Clinical Evaluation Report Rating (CCERR) instrument to assess quality of written comments. Preliminary evidence suggests that we may be capturing different aspects of performance using these two different methods. Specifically, entrustment scale scores significantly increased over time, while ITER scores did not. Typically, comments on entrustment scale scores were more learner specific, longer, and used more of a coaching voice. Longitudinal evaluation of learner performance is important for learning and demonstration of competence; however, the method of data collection could influence how feedback is structured and how performance is ultimately judged.
Collapse
|
17
|
Kalu ME, Switzer-Mclntrye S, Quesnel M, Donnelly C, Norman KE. Clinical Instructors' Perceptions of Internationally Educated Physical Therapists' Readiness to Practise during Supervised Clinical Internships in a Bridging Programme. Physiother Can 2021; 73:194-203. [PMID: 34456432 DOI: 10.3138/ptc-2019-0067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: The purpose of this study was to describe clinical instructors' (CIs) comments on the Canadian Physiotherapy Assessment of Clinical Performance (ACP) that reflect areas of strength and areas requiring improvement among internationally educated physical therapists (IEPTs) during supervised clinical internships in a bridging programme. Method: We reviewed the assessment records of 100 IEPTs' clinical performance during two internships each for three successive cohorts of learners in a Canadian bridging programme. We extracted the CIs' text from 385 comment sections of the ACP completed during these internships and analyzed them using qualitative content analysis. Results: The iterative deductive coding process resulted in 36 subcategories: 14 for areas of strength and 22 for areas requiring improvement. We merged the 36 subcategories to produce nine categories: four areas of strength (subjective assessment, treatment, patient confidentiality, and professionalism) and five areas for improvement (objective assessment, clinical reasoning, establishment of treatment goals, communication, confidence, and time management). We then grouped these categories into two broad themes: professional practice and professional conduct. Conclusions: The CIs commended the IEPTs for their clinical competence in subjective assessment, treatment, patient confidentiality, and professionalism. The areas requiring improvement typically required more complex clinical decision-making skills, which may have been challenging for these IEPTs to demonstrate as competently during a short internship.
Collapse
Affiliation(s)
- Michael E Kalu
- School of Rehabilitation Science, McMaster University, Hamilton
| | | | - Martine Quesnel
- School of Rehabilitation Therapy, Queen's University, Kingston, Ont
| | | | | |
Collapse
|
18
|
Stalmeijer RE, Varpio L. The wolf you feed: Challenging intraprofessional workplace-based education norms. MEDICAL EDUCATION 2021; 55:894-902. [PMID: 33651450 PMCID: PMC8359828 DOI: 10.1111/medu.14520] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/29/2021] [Accepted: 02/26/2021] [Indexed: 05/26/2023]
Abstract
CONTEXT The trajectory towards becoming a medical professional is strongly situated within the clinical workplace. Through participatory engagement, medical trainees learn to address complex health care issues through collaboration with the interprofessional health care team. To help explain learning and teaching dynamics within the clinical workplace, many scholars have relied on socio-cultural learning theories. In the field of medical education, this research has largely adopted a limited interpretation of a crucial dimension within socio-cultural learning theory: the expert who guides the trainee into the community is almost exclusively from the same profession. We contend that this narrow interpretation is not necessary. This limited focus is one we choose to maintain-be that choice intentional or implicit. In this cross-cutting edge paper, we argue that choosing an interprofessional orientation towards workplace learning and guidance may better prepare medical trainees for their future role in health care practice. METHODS By applying Communities of Practice and Landscapes of Practice , and supported by empirical examples, we demonstrate how medical trainees are not solely on a trajectory towards the Community of Physician Practice (CoPP) but also on a trajectory towards various Landscapes of Healthcare Practice (LoHCP). We discuss some of the barriers present within health care organisations and professions that have likely inhibited adoption of the broader LoHCP perspective. We suggest three perspectives that might help to deliberately and meaningfully incorporate the interprofessional learning and teaching dynamic within the medical education continuum. CONCLUSION Systematically incorporating Landscapes of Competence, Assessment, and Guidance in workplace-based education-in addition to our current intraprofessional approach-can better prepare medical trainees for their roles within the LoHCP. By advocating and researching this interprofessional perspective, we can embark on a journey towards fully harnessing and empowering the health care team within workplace-based education.
Collapse
Affiliation(s)
- Renée E. Stalmeijer
- School of Health Professions EducationFaculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Lara Varpio
- Center for Health Professions EducationDepartment of MedicineUniformed Services University of the Health SciencesBethesdaMDUSA
| |
Collapse
|
19
|
Holm EA, Al-Bayati SJL, Barfod TS, Lembeck MA, Pedersen H, Ramberg E, Klemmensen ÅK, Sorensen JL. Feasibility, quality and validity of narrative multisource feedback in postgraduate training: a mixed-method study. BMJ Open 2021; 11:e047019. [PMID: 34321296 PMCID: PMC8319975 DOI: 10.1136/bmjopen-2020-047019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To examine a narrative multisource feedback (MSF) instrument concerning feasibility, quality of narrative comments, perceptions of users (face validity), consequential validity, discriminating capacity and number of assessors needed. DESIGN Qualitative text analysis supplemented by quantitative descriptive analysis. SETTING Internal Medicine Departments in Zealand, Denmark. PARTICIPANTS 48 postgraduate trainees in internal medicine specialties, 1 clinical supervisor for each trainee and 376 feedback givers (respondents). INTERVENTION This study examines the use of an electronic, purely narrative MSF instrument. After the MSF process, the trainee and the supervisor answered a postquestionnaire concerning their perception of the process. The authors coded the comments in the MSF reports for valence (positive or negative), specificity, relation to behaviour and whether the comment suggested a strategy for improvement. Four of the authors independently classified the MSF reports as either 'no reasons for concern' or 'possibly some concern', thereby examining discriminating capacity. Through iterative readings, the authors furthermore tried to identify how many respondents were needed in order to get a reliable impression of a trainee. RESULTS Out of all comments coded for valence (n=1935), 89% were positive and 11% negative. Out of all coded comments (n=4684), 3.8% were suggesting ways to improve. 92% of trainees and supervisors preferred a narrative MSF to a numerical MSF, and 82% of the trainees discovered performance in need of development, but only 53% had made a specific plan for development. Kappa coefficients for inter-rater correlations between four authors were 0.7-1. There was a significant association (p<0.001) between the number of negative comments and the qualitative judgement by the four authors. It was not possible to define a specific number of respondents needed. CONCLUSIONS A purely narrative MSF contributes with educational value and experienced supervisors can discriminate between trainees' performances based on the MSF reports.
Collapse
Affiliation(s)
- Ellen Astrid Holm
- Department of Internal Medicine, Zealand University Hospital Koge, Koge, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Kobenhavns, Denmark
| | | | - Toke Seierøe Barfod
- Department of Internal Medicine, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Maurice A Lembeck
- Department of Internal Medicine, Nykobing F Sygehus, Nykobing Falster, Denmark
| | - Hanne Pedersen
- Department of Internal Medicine, Glostrup, Rigshospitalet, Kobenhavn, Denmark
| | - Emilie Ramberg
- Department of Internal Medicine, Nykobing F Sygehus, Nykobing Falster, Denmark
| | | | - Jette Led Sorensen
- Juliane Marie Centre for Children, Women and Reproduction Section 4074, Rigshospitalet, Kobenhavn, Denmark
- Children Hospital Copenhagen, Rigshospitalet, Kobenhavn, Denmark
| |
Collapse
|
20
|
Tegzes JH, Frost JS. Alignment of Selected Veterinary Education Competencies With the Interprofessional Professionalism Assessment. Front Vet Sci 2021; 8:688633. [PMID: 34307528 PMCID: PMC8300899 DOI: 10.3389/fvets.2021.688633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/10/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- John H. Tegzes
- Office of Mission Integration, College of Veterinary Medicine, Western University of Health Sciences, Pomona, CA, United States
| | - Jody S. Frost
- National Academies of Practice, Lusby, MD, United States
| |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
Chan TM, Sebok‐Syer SS, Cheung WJ, Pusic M, Stehman C, Gottlieb M. Workplace-based Assessment Data in Emergency Medicine: A Scoping Review of the Literature. AEM EDUCATION AND TRAINING 2021; 5:e10544. [PMID: 34099992 PMCID: PMC8166307 DOI: 10.1002/aet2.10544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 06/01/2023]
Abstract
OBJECTIVE In the era of competency-based medical education (CBME), the collection of more and more trainee data is being mandated by accrediting bodies such as the Accreditation Council for Graduate Medical Education and the Royal College of Physicians and Surgeons of Canada. However, few efforts have been made to synthesize the literature around the current issues surrounding workplace-based assessment (WBA) data. This scoping review seeks to synthesize the landscape of literature on the topic of data collection and utilization for trainees' WBAs in emergency medicine (EM). METHODS The authors conducted a scoping review in the style of Arksey and O'Malley, seeking to synthesize and map literature on collecting, aggregating, and reporting WBA data. The authors extracted, mapped, and synthesized literature that describes, supports, and substantiates effective data collection and utilization in the context of the CBME movement within EM. RESULTS Our literature search retrieved 189 potentially relevant references (after removing duplicates) that were screened to 29 abstracts and papers relevant to collecting, aggregating, and reporting WBAs. Our analysis shows that there is an increasing temporal trend toward contributions in these topics, with the majority of the papers (16/29) being published in the past 3 years alone. CONCLUSION There is increasing interest in the areas around data collection and utilization in the age of CBME. The field, however, is only beginning to emerge, leaving more work that can and should be done in this area.
Collapse
Affiliation(s)
- Teresa M. Chan
- From theDepartment of MedicineDivision of Emergency Medicine and the Division of Education & InnovationMcMaster UniversityHamiltonOntarioCanada
- theProgram for Faculty DevelopmentFaculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
- and the McMaster Program for Education Research, Innovation, and TheoryMcMaster UniversityHamiltonOntarioCanada
| | | | - Warren J. Cheung
- theDepartment of Emergency MedicineUniversity of OttawaOttawaOntarioCanada
| | - Martin Pusic
- theDepartment of PediatricsHarvard Medical SchoolBostonMAUSA
| | | | - Michael Gottlieb
- and theDepartment of Emergency MedicineRush University Medical CenterChicagoILUSA
| |
Collapse
|
23
|
Young JQ, Holmboe ES, Frank JR. Competency-Based Assessment in Psychiatric Education: A Systems Approach. Psychiatr Clin North Am 2021; 44:217-235. [PMID: 34049645 DOI: 10.1016/j.psc.2020.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Medical education programs are failing to meet the health needs of patients and communities. Misalignments exist on multiple levels, including content (what trainees learn), pedagogy (how trainees learn), and culture (why trainees learn). To address these challenges effectively, competency-based assessment (CBA) for psychiatric medical education must simultaneously produce life-long learners who can self-regulate their own growth and trustworthy processes that determine and accelerate readiness for independent practice. The key to effectively doing so is situating assessment within a carefully designed system with several, critical, interacting components: workplace-based assessment, ongoing faculty development, learning analytics, longitudinal coaching, and fit-for-purpose clinical competency committees.
Collapse
Affiliation(s)
- John Q Young
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and the Zucker Hillside Hospital at Northwell Health, Glen Oaks, NY, USA.
| | - Eric S Holmboe
- Accreditation Council for Graduate Medical Education, 401 North Michigan Avenue, Chicago, IL 60611, USA
| | - Jason R Frank
- Royal College of Physicians and Surgeons of Canada, 774 Echo Drive, Ottawa, Ontario K15 5NB, Canada; Education, Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
24
|
Young JQ, Frank JR, Holmboe ES. Advancing Workplace-Based Assessment in Psychiatric Education: Key Design and Implementation Issues. Psychiatr Clin North Am 2021; 44:317-332. [PMID: 34049652 DOI: 10.1016/j.psc.2021.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
With the adoption of competency-based medical education, assessment has shifted from traditional classroom domains of knows and knows how to the workplace domain of doing. This workplace-based assessment has 2 purposes; assessment of learning (summative feedback) and the assessment for learning (formative feedback). What the trainee does becomes the basis for identifying growth edges and determining readiness for advancement and ultimately independent practice. High-quality workplace-based assessment programs require thoughtful choices about the framework of assessment, the tools themselves, the platforms used, and the contexts in which the assessments take place, with an emphasis on direct observation.
Collapse
Affiliation(s)
- John Q Young
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and, Zucker Hillside Hospital at Northwell Health, 75-59 263rd Street, Kaufman Building, Glen Oaks, NY 11004, USA.
| | - Jason R Frank
- Department of Emergency Medicine, University of Ottawa, Royal College of Physicians and Surgeons of Canada, 774 Echo Drive, Ottawa, Ontario K15 5NB, Canada
| | - Eric S Holmboe
- Accreditation Council for Graduate Medical Education, ACGME, 401 North Michigan Avenue, Chicago, IL 60611, USA
| |
Collapse
|
25
|
Valentine N, Durning S, Shanahan EM, Schuwirth L. Fairness in human judgement in assessment: a hermeneutic literature review and conceptual framework. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:713-738. [PMID: 33123837 DOI: 10.1007/s10459-020-10002-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/19/2020] [Indexed: 06/11/2023]
Abstract
Human judgement is widely used in workplace-based assessment despite criticism that it does not meet standards of objectivity. There is an ongoing push within the literature to better embrace subjective human judgement in assessment not as a 'problem' to be corrected psychometrically but as legitimate perceptions of performance. Taking a step back and changing perspectives to focus on the fundamental underlying value of fairness in assessment may help re-set the traditional objective approach and provide a more relevant way to determine the appropriateness of subjective human judgements. Changing focus to look at what is 'fair' human judgement in assessment, rather than what is 'objective' human judgement in assessment allows for the embracing of many different perspectives, and the legitimising of human judgement in assessment. However, this requires addressing the question: what makes human judgements fair in health professions assessment? This is not a straightforward question with a single unambiguously 'correct' answer. In this hermeneutic literature review we aimed to produce a scholarly knowledge synthesis and understanding of the factors, definitions and key questions associated with fairness in human judgement in assessment and a resulting conceptual framework, with a view to informing ongoing further research. The complex construct of fair human judgement could be conceptualised through values (credibility, fitness for purpose, transparency and defensibility) which are upheld at an individual level by characteristics of fair human judgement (narrative, boundaries, expertise, agility and evidence) and at a systems level by procedures (procedural fairness, documentation, multiple opportunities, multiple assessors, validity evidence) which help translate fairness in human judgement from concepts into practical components.
Collapse
Affiliation(s)
- Nyoli Valentine
- Prideaux Health Professions Education, Flinders University, Bedford Park 5042, SA, Australia.
| | - Steven Durning
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Ernst Michael Shanahan
- Prideaux Health Professions Education, Flinders University, Bedford Park 5042, SA, Australia
| | - Lambert Schuwirth
- Prideaux Health Professions Education, Flinders University, Bedford Park 5042, SA, Australia
| |
Collapse
|
26
|
Boursicot K, Kemp S, Wilkinson T, Findyartini A, Canning C, Cilliers F, Fuller R. Performance assessment: Consensus statement and recommendations from the 2020 Ottawa Conference. MEDICAL TEACHER 2021; 43:58-67. [PMID: 33054524 DOI: 10.1080/0142159x.2020.1830052] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION In 2011 the Consensus Statement on Performance Assessment was published in Medical Teacher. That paper was commissioned by AMEE (Association for Medical Education in Europe) as part of the series of Consensus Statements following the 2010 Ottawa Conference. In 2019, it was recommended that a working group be reconvened to review and consider developments in performance assessment since the 2011 publication. METHODS Following review of the original recommendations in the 2011 paper and shifts in the field across the past 10 years, the group identified areas of consensus and yet to be resolved issues for performance assessment. RESULTS AND DISCUSSION This paper addresses developments in performance assessment since 2011, reiterates relevant aspects of the 2011 paper, and summarises contemporary best practice recommendations for OSCEs and WBAs, fit-for-purpose methods for performance assessment in the health professions.
Collapse
Affiliation(s)
- Katharine Boursicot
- Department of Assessment and Progression, Duke-National University of Singapore, Singapore, Singapore
| | - Sandra Kemp
- Curtin Medical School, Curtin University, Perth, Australia
| | - Tim Wilkinson
- Dean's Department, University of Otago, Christchurch, New Zealand
| | - Ardi Findyartini
- Department of Medical Education, Universitas Indonesia, Jakarta, Indonesia
| | - Claire Canning
- Department of Assessment and Progression, Duke-National University of Singapore, Singapore, Singapore
| | - Francois Cilliers
- Department of Health Sciences Education, University of Cape Town, Cape Town, South Africa
| | | |
Collapse
|
27
|
Schuwirth LWT, van der Vleuten CPM. A history of assessment in medical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:1045-1056. [PMID: 33113056 DOI: 10.1007/s10459-020-10003-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/19/2020] [Indexed: 06/11/2023]
Abstract
The way quality of assessment has been perceived and assured has changed considerably in the recent 5 decades. Originally, assessment was mainly seen as a measurement problem with the aim to tell people apart, the competent from the not competent. Logically, reproducibility or reliability and construct validity were seen as necessary and sufficient for assessment quality and the role of human judgement was minimised. Later, assessment moved back into the authentic workplace with various workplace-based assessment (WBA) methods. Although originally approached from the same measurement framework, WBA and other assessments gradually became assessment processes that included or embraced human judgement but based on good support and assessment expertise. Currently, assessment is treated as a whole system problem in which competence is evaluated from an integrated rather than a reductionist perspective. Current research therefore focuses on how to support and improve human judgement, how to triangulate assessment information meaningfully and how to construct fairness, credibility and defensibility from a systems perspective. But, given the rapid changes in society, education and healthcare, yet another evolution in our thinking about good assessment is likely to lurk around the corner.
Collapse
Affiliation(s)
- Lambert W T Schuwirth
- FHMRI: Prideaux Research in Health Professions Education, College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, South Australia, 5042, GPO Box 2100, Adelaide, SA, 5001, Australia.
- Department of Educational Development and Research, Maastricht University, Maastricht, The Netherlands.
| | - Cees P M van der Vleuten
- FHMRI: Prideaux Research in Health Professions Education, College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, South Australia, 5042, GPO Box 2100, Adelaide, SA, 5001, Australia
- Department of Educational Development and Research, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
28
|
Ginsburg S, Gingerich A, Kogan JR, Watling CJ, Eva KW. Idiosyncrasy in Assessment Comments: Do Faculty Have Distinct Writing Styles When Completing In-Training Evaluation Reports? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:S81-S88. [PMID: 32769454 DOI: 10.1097/acm.0000000000003643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE Written comments are gaining traction as robust sources of assessment data. Compared with the structure of numeric scales, what faculty choose to write is ad hoc, leading to idiosyncratic differences in what is recorded. This study offers exploration of what aspects of writing styles are determined by the faculty offering comment and what aspects are determined by the trainee being commented upon. METHOD The authors compiled in-training evaluation report comment data, generated from 2012 to 2015 by 4 large North American Internal Medicine training programs. The Linguistic Index and Word Count (LIWC) was used to categorize and quantify the language contained. Generalizability theory was used to determine whether faculty could be reliably discriminated from one another based on writing style. Correlations and ANOVAs were used to determine what styles were related to faculty or trainee demographics. RESULTS Datasets contained 23-142 faculty who provided 549-2,666 assessments on 161-989 trainees. Faculty could easily be discriminated from one another using a variety of LIWC metrics including word count, words per sentence, and the use of "clout" words. These patterns appeared person specific and did not reflect demographic factors such as gender or rank. These metrics were similarly not consistently associated with trainee factors such as postgraduate year or gender. CONCLUSIONS Faculty seem to have detectable writing styles that are relatively stable across the trainees they assess, which may represent an under-recognized source of construct irrelevance. If written comments are to meaningfully contribute to decision making, we need to understand and account for idiosyncratic writing styles.
Collapse
Affiliation(s)
- Shiphra Ginsburg
- S. Ginsburg is professor of medicine, Department of Medicine, Faculty of Medicine, University of Toronto, scientist, Wilson Centre for Research in Education, University Health Network, University of Toronto, Toronto, Ontario, Canada, and Canada Research Chair in Health Professions Education; ORCID: http://orcid.org/0000-0002-4595-6650
| | - 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
| | - Jennifer R Kogan
- J.R. Kogan is professor and associate dean for student success and professional development, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0001-8426-9506
| | - 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
| | - Kevin W Eva
- K.W. Eva is professor and director of education research and scholarship, Department of Medicine, and associate director and senior scientist, Centre for Health Education Scholarship, University of British Columbia, Vancouver, British Columbia, Canada; ORCID: http://orcid.org/0000-0002-8672-2500
| |
Collapse
|
29
|
Tam J, Wadhwa A, Martimianakis MA, Fernando O, Regehr G. The role of previously undocumented data in the assessment of medical trainees in clinical competency committees. PERSPECTIVES ON MEDICAL EDUCATION 2020; 9:286-293. [PMID: 33025382 PMCID: PMC7550499 DOI: 10.1007/s40037-020-00624-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 09/26/2020] [Accepted: 09/28/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The clinical competency committee (CCC) comprises a group of clinical faculty tasked with assessing a medical trainee's progress from multiple data sources. The use of previously undocumented data, or PUD, during CCC deliberations remains controversial. This study explored the use of previously undocumented data in conjunction with documented data in creating a meaningful assessment in a CCC. METHODS An instrumental case study of a CCC that uses previously undocumented data was conducted. A single CCC meeting was observed, followed by semi-structured individual interviews with all CCC members (n = 7). Meeting and interview transcripts were analyzed iteratively. RESULTS Documented data were perceived as limited by inaccurate or superficial data, but sometimes served as a starting point for invoking previously undocumented data. Previously undocumented data were introduced as summary impressions, contextualizing factors, personal anecdotes and, rarely, hearsay. The purpose was to raise a potential issue for discussion, enhance and elaborate an impression, or counter an impression. Various mechanisms allowed for the responsible use of previously undocumented data: embedding these data within a structured format; sharing relevant information without commenting beyond one's scope of experience; clarifying allowable disclosure of personal contextual factors with the trainee pre-meeting; excluding previously undocumented data not widely agreed upon in decision-making; and expecting these data to have been provided as direct feedback to trainees pre-meeting. DISCUSSION Previously undocumented data appear to play a vital part of the group conversation in a CCC to create meaningful, developmentally focused trainee assessments that cannot be achieved by documented data alone. Consideration should be given to ensuring the thoughtful incorporation of previously undocumented data as an essential part of the CCC assessment process.
Collapse
Affiliation(s)
- Jennifer Tam
- Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
- Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Anupma Wadhwa
- Division of Infectious Diseases, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Maria Athina Martimianakis
- Wilson Centre for Research in Education, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Oshan Fernando
- Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Glenn Regehr
- Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
30
|
Young JQ, Sugarman R, Schwartz J, O'Sullivan PS. Overcoming the Challenges of Direct Observation and Feedback Programs: A Qualitative Exploration of Resident and Faculty Experiences. TEACHING AND LEARNING IN MEDICINE 2020; 32:541-551. [PMID: 32529844 DOI: 10.1080/10401334.2020.1767107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Problem: Prior studies have reported significant negative attitudes amongst both faculty and residents toward direct observation and feedback. Numerous contributing factors have been identified, including insufficient time for direct observation and feedback, poorly understood purpose, inadequate training, disbelief in the formative intent, inauthentic resident-patient clinical interactions, undermining of resident autonomy, lack of trust between the faculty-resident dyad, and low-quality feedback information that lacks credibility. Strategies are urgently needed to overcome these challenges and more effectively engage faculty and residents in direct observation and feedback. Otherwise, the primary goals of supporting both formative and summative assessment will not be realized and the viability of competency-based medical education will be threatened. Intervention: Toward this end, recent studies have recommended numerous strategies to overcome these barriers: protected time for direct observation and feedback; ongoing faculty and resident training on goals and bidirectional, co-constructed feedback; repeated direct observations and feedback within a longitudinal resident-supervisor relationship; utilization of assessment tools with evidence for validity; and monitoring for engagement. Given the complexity of the problem, it is likely that bundling multiple strategies together will be necessary to overcome the challenges. The Direct Observation Structured Feedback Program (DOSFP) incorporated many of the recommended features, including protected time for direct observation and feedback within longitudinal faculty-resident relationships. Using a qualitative thematic approach the authors conducted semi-structured interviews, during February and March, 2019, with 10 supervisors and ten residents. Participants were asked to reflect on their experiences. Interview guide questions explored key themes from the literature on direct observation and feedback. Transcripts were anonymized. Two authors independently and iteratively coded the transcripts. Coding was theory-driven and differences were discussed until consensus was reached. The authors then explored the relationships between the codes and used a semantic approach to construct themes. Context: The DOSFP was implemented in a psychiatry continuity clinic for second and third year residents. Impact: Faculty and residents were aligned around the goals. They both perceived the DOSFP as focused on growth rather than judgment even though residents understood that the feedback had both formative and summative purposes. The DOSFP facilitated educational alliances characterized by trust and respect. With repeated practice within a longitudinal relationship, trainees dropped the performance orientation and described their interactions with patients as authentic. Residents generally perceived the feedback as credible, described feedback quality as high, and valued the two-way conversation. However, when receiving feedback with which they did not agree, residents demurred or, at most, would ask a clarifying question, but then internally discounted the feedback. Lessons Learned: Direct observation and structured feedback programs that bundle recent recommendations may overcome many of the challenges identified by previous research. Yet, residents discounted disagreeable feedback, illustrating a significant limitation and the need for other strategies that help residents reconcile conflict between external data and one's self-appraisal.
Collapse
Affiliation(s)
- John Q Young
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Rebekah Sugarman
- Department of Psychiatry, The Zucker Hillside Hospital at Northwell Health, Glen Oaks, New York, USA
| | - Jessica Schwartz
- Department of Psychiatry, The Zucker Hillside Hospital at Northwell Health, Glen Oaks, New York, USA
| | - Patricia S O'Sullivan
- Office of Medical Education, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
31
|
Schuwirth LWT, Durning SJ, King SM. Assessment of clinical reasoning: three evolutions of thought. Diagnosis (Berl) 2020; 7:191-196. [PMID: 32182208 DOI: 10.1515/dx-2019-0096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 02/12/2020] [Indexed: 02/17/2024]
Abstract
Although assessing clinical reasoning is almost universally considered central to medical education it is not a straightforward issue. In the past decades, our insights into clinical reasoning as a phenomenon, and consequently the best ways to assess it, have undergone significant changes. In this article, we describe how the interplay between fundamental research, practical applications, and evaluative research has pushed the evolution of our thinking and our practices in assessing clinical reasoning.
Collapse
Affiliation(s)
- Lambert W T Schuwirth
- Prideaux Centre for Research in Health Professions Education, Flinders University, Adelaide, South Australia, Australia
| | | | - Svetlana M King
- Prideaux Centre for Research in Health Professions Education, Flinders University, Adelaide, South Australia, Australia
| |
Collapse
|
32
|
Egan R, Chaplin T, Szulewski A, Braund H, Cofie N, McColl T, Hall AK, Dagnone D, Kelley L, Thoma B. A case for feedback and monitoring assessment in competency-based medical education. J Eval Clin Pract 2020; 26:1105-1113. [PMID: 31851772 DOI: 10.1111/jep.13338] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/31/2019] [Accepted: 11/29/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Within competency-based medical education, self-regulated learning (SRL) requires residents to leverage self-assessment and faculty feedback. We sought to investigate the potential for competency-based assessments to foster SRL by quantifying the relationship between faculty feedback and entrustment ratings as well as the congruence between faculty assessment and resident self-assessment. MATERIALS AND METHODS We collected comments in (a) an emergency medicine objective structured clinical examination group (objective structured clinical examinations [OSCE] and emergency medicine OSCE group [EMOG]) and (b) a first-year resident multidisciplinary resuscitation "Nightmares" course assessment group (NCAG) and OSCE group (NOG). We assessed comments across five domains including Initial Assessment (IA), Diagnostic Action (DA), Therapeutic Action (TA), Communication (COM), and entrustment. Analyses included structured qualitative coding and (non)parametric and descriptive analyses. RESULTS In the EMOG, faculty's positive comments in the entrustment domain corresponded to lower entrustment score Mean Ranks (MRs) for IA (<11.1), DA (<11.2), and entrustment (<11.6). In NOG, faculty's negative comments resulted in lower entrustment score MRs for TA (<11.8 and <10) and DA (<12.4), and positive comments resulted in higher entrustment score MRs for IA (>15.4) and COM (>17.6). In the NCAG, faculty's positive IA comments were negatively correlated with entrustment scores (ρ = -.27, P = .04). Across programs, faculty and residents made similar domain-specific comments 13% of the time. CONCLUSIONS Minimal and inconsistent associations were found between narrative and numerical feedback. Performance monitoring accuracy and feedback should be included in assessment validation.
Collapse
Affiliation(s)
- Rylan Egan
- School of Nursing, Health Quality Programs, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Timothy Chaplin
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Adam Szulewski
- Department of Emergency 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
| | - Nicholas Cofie
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Tamara McColl
- Educational Scholarship, Department of Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrew K Hall
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Damon Dagnone
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Leah Kelley
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Brent Thoma
- Department of Emergency Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
33
|
Thoma B, Hall AK, Clark K, Meshkat N, Cheung WJ, Desaulniers P, Ffrench C, Meiwald A, Meyers C, Patocka C, Beatty L, Chan TM. Evaluation of a National Competency-Based Assessment System in Emergency Medicine: A CanDREAM Study. J Grad Med Educ 2020; 12:425-434. [PMID: 32879682 PMCID: PMC7450748 DOI: 10.4300/jgme-d-19-00803.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/11/2020] [Accepted: 05/20/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In 2018, Canadian postgraduate emergency medicine (EM) programs began implementing a competency-based medical education (CBME) assessment program. Studies evaluating these programs have focused on broad outcomes using data from national bodies and lack data to support program-specific improvement. OBJECTIVE We evaluated the implementation of a CBME assessment program within and across programs to identify successes and opportunities for improvement at the local and national levels. METHODS Program-level data from the 2018 resident cohort were amalgamated and analyzed. The number of entrustable professional activity (EPA) assessments (overall and for each EPA) and the timing of resident promotion through program stages were compared between programs and to the guidelines provided by the national EM specialty committee. Total EPA observations from each program were correlated with the number of EM and pediatric EM rotations. RESULTS Data from 15 of 17 (88%) programs containing 9842 EPA observations from 68 of 77 (88%) EM residents in the 2018 cohort were analyzed. Average numbers of EPAs observed per resident in each program varied from 92.5 to 229.6, correlating with the number of blocks spent on EM and pediatric EM (r = 0.83, P < .001). Relative to the specialty committee's guidelines, residents were promoted later than expected (eg, one-third of residents had a 2-month delay to promotion from the first to second stage) and with fewer EPA observations than suggested. CONCLUSIONS There was demonstrable variation in EPA-based assessment numbers and promotion timelines between programs and with national guidelines.
Collapse
|
34
|
Ginsburg S, Kogan JR, Gingerich A, Lynch M, Watling CJ. Taken Out of Context: Hazards in the Interpretation of Written Assessment Comments. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1082-1088. [PMID: 31651432 DOI: 10.1097/acm.0000000000003047] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE Written comments are increasingly valued for assessment; however, a culture of politeness and the conflation of assessment with feedback lead to ambiguity. Interpretation requires reading between the lines, which is untenable with large volumes of qualitative data. For computer analytics to help with interpreting comments, the factors influencing interpretation must be understood. METHOD Using constructivist grounded theory, the authors interviewed 17 experienced internal medicine faculty at 4 institutions between March and July, 2017, asking them to interpret and comment on 2 sets of words: those that might be viewed as "red flags" (e.g., good, improving) and those that might be viewed as signaling feedback (e.g., should, try). Analysis focused on how participants ascribed meaning to words. RESULTS Participants struggled to attach meaning to words presented acontextually. Four aspects of context were deemed necessary for interpretation: (1) the writer; (2) the intended and potential audiences; (3) the intended purpose(s) for the comments, including assessment, feedback, and the creation of a permanent record; and (4) the culture, including norms around assessment language. These contextual factors are not always apparent; readers must balance the inevitable need to interpret others' language with the potential hazards of second-guessing intent. CONCLUSIONS Comments are written for a variety of intended purposes and audiences, sometimes simultaneously; this reality creates dilemmas for faculty attempting to interpret these comments, with or without computer assistance. Attention to context is essential to reduce interpretive uncertainty and ensure that written comments can achieve their potential to enhance both assessment and feedback.
Collapse
Affiliation(s)
- Shiphra Ginsburg
- S. Ginsburg is professor of medicine, Department of Medicine, Faculty of Medicine, University of Toronto, scientist, Wilson Centre for Research in Education, University Health Network, University of Toronto, Toronto, Ontario, Canada, and Canada Research Chair in Health Professions Education; ORCID: http://orcid.org/0000-0002-4595-6650. J.R. Kogan is professor of medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. A. Gingerich is assistant professor, Northern Medical Program, University of Northern British Columbia, Prince George, British Columbia, Canada; ORCID: http://orcid.org/0000-0001-5765-3975. M. Lynch is postdoctoral fellow, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. C.J. Watling is professor, Department of Clinical Neurological Sciences, scientist, Centre for Education Research and Innovation, and associate dean of postgraduate medical education, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; ORCID: http://orcid.org/0000-0001-9686-795X
| | | | | | | | | |
Collapse
|
35
|
Tenny SO, Schmidt KP, Thorell WE. Pilot project to assess and improve neurosurgery resident and staff perception of feedback to residents for self-improvement goal formation. J Neurosurg 2020; 132:1261-1264. [DOI: 10.3171/2018.11.jns181664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/21/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe Accreditation Council for Graduate Medical Education (ACGME) has pushed for more frequent and comprehensive feedback for residents during their training, but there is scant evidence for how neurosurgery residents view the current feedback system as it applies to providing information for self-improvement and goal formation. The authors sought to assess neurosurgery resident and staff perceptions of the current resident feedback system in providing specific, meaningful, achievable, realistic, and timely (SMART) goals. The authors then created a pilot project to improve the most unfavorably viewed aspect of the feedback system.METHODSThe authors conducted an anonymous survey of neurosurgery residents and staff at an academic medical institution to assess SMART goals for resident feedback and used the results to create a pilot intervention to address the most unfavorably viewed aspect of the feedback system. The authors then conducted a postintervention survey to see if perceptions had improved for the target of the intervention.RESULTSNeurosurgery residents and staff completed an anonymous online survey, for which the results indicated that resident feedback was not occurring in a timely manner. The authors created a simple anonymous feedback form. The form was distributed monthly to neurosurgery residents, neurosurgical staff, and nurses, and the results were reported monthly to each resident for 6 months. A postintervention survey was then administered, and the results indicated that the opinions of the neurosurgery residents and staff on the timeliness of resident feedback had changed from a negative to a nonnegative opinion (p = 0.01).CONCLUSIONSThe required ACGME feedback methods may not be providing adequate feedback for goal formation for self-improvement for neurosurgery residents. Simple interventions, such as anonymous feedback questionnaires, can improve neurosurgery resident and staff perception of feedback to residents for self-improvement and goal formation.
Collapse
|
36
|
Torre DM, Schuwirth LWT, Van der Vleuten CPM. Theoretical considerations on programmatic assessment. MEDICAL TEACHER 2020; 42:213-220. [PMID: 31622126 DOI: 10.1080/0142159x.2019.1672863] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Introduction: Programmatic assessment (PA) is an approach to assessment aimed at optimizing learning which continues to gain educational momentum. However, the theoretical underpinnings of PA have not been clearly described. An explanation of the theoretical underpinnings of PA will allow educators to gain a better understanding of this approach and, perhaps, facilitate its use and effective implementation. The purpose of this article is twofold: first, to describe salient theoretical perspectives on PA; second to examine how theory may help educators to develop effective PA programs, helping to overcome challenges around PA.Results: We outline a number of learning theories that underpin key educational principles of PA: constructivist and social constructivist theory supporting meaning making, and longitudinality; cognitivist and cognitive development orientation scaffolding the practice of a continuous feedback process; theory of instructional design underpinning assessment as learning; self-determination theory (SDT), self-regulation learning theory (SRL), and principles of deliberate practice providing theoretical tenets for student agency and accountability.Conclusion: The construction of a plausible and coherent link between key educational principles of PA and learning theories should enable educators to pose new and important inquiries, reflect on their assessment practices and help overcome future challenges in the development and implementation of PA in their programs.
Collapse
Affiliation(s)
- Dario M Torre
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - L W T Schuwirth
- Department of Education and Health Profession Education, Flinders Medical School, Adelaide, Australia
| | - C P M Van der Vleuten
- Department of Educational Development and Research, Maastricht University, Maastricht, The Netherlands
- Faculty of Health Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
37
|
Kelly MS, Mooney CJ, Rosati JF, Braun MK, Thompson Stone R. Education Research: The Narrative Evaluation Quality Instrument: Development of a tool to assess the assessor. Neurology 2020; 94:91-95. [PMID: 31932402 DOI: 10.1212/wnl.0000000000008794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Determining the quality of narrative evaluations to assess medical student neurology clerkship performance remains a challenge. This study sought to develop a tool to comprehensively and systematically assess quality of student narrative evaluations. METHODS The Narrative Evaluation Quality Instrument (NEQI) was created to assess several components within clerkship narrative evaluations: performance domains, specificity, and usefulness to learner. In this retrospective study, 5 investigators scored 123 narrative evaluations using the NEQI. Inter-rater reliability was estimated by calculating interclass correlation coefficients (ICC) across 615 NEQI scores. RESULTS The average overall NEQI score was 6.4 (SD 2.9), with mean component arm scores of 2.6 for performance domains (SD 0.9), 1.8 for specificity (SD 1.1), and 2.0 for usefulness (SD 1.4). Each component arm exhibited moderate reliability: performance domains ICC 0.65 (95% confidence interval [CI] 0.58-0.72), specificity ICC 0.69 (95% CI 0.61-0.77), and usefulness ICC 0.73 (95% CI 0.66-0.80). Overall NEQI score exhibited good reliability (0.81; 95% CI 0.77-0.86). CONCLUSION The NEQI is a novel, reliable tool to comprehensively assess the quality of narrative evaluation of neurology clerks and will enhance the study of interventions seeking to improve clerkship evaluation.
Collapse
Affiliation(s)
- Michael S Kelly
- From the Department of Neurology (R.T.S., J.R., M.B.), University of Rochester School of Medicine and Dentistry (C.M., M.K.), NY
| | - Christopher J Mooney
- From the Department of Neurology (R.T.S., J.R., M.B.), University of Rochester School of Medicine and Dentistry (C.M., M.K.), NY
| | - Justin F Rosati
- From the Department of Neurology (R.T.S., J.R., M.B.), University of Rochester School of Medicine and Dentistry (C.M., M.K.), NY
| | - Melanie K Braun
- From the Department of Neurology (R.T.S., J.R., M.B.), University of Rochester School of Medicine and Dentistry (C.M., M.K.), NY
| | - Robert Thompson Stone
- From the Department of Neurology (R.T.S., J.R., M.B.), University of Rochester School of Medicine and Dentistry (C.M., M.K.), NY
| |
Collapse
|
38
|
Tekian A, Park YS, Tilton S, Prunty PF, Abasolo E, Zar F, Cook DA. Competencies and Feedback on Internal Medicine Residents' End-of-Rotation Assessments Over Time: Qualitative and Quantitative Analyses. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1961-1969. [PMID: 31169541 PMCID: PMC6882536 DOI: 10.1097/acm.0000000000002821] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To examine how qualitative narrative comments and quantitative ratings from end-of-rotation assessments change for a cohort of residents from entry to graduation, and explore associations between comments and ratings. METHOD The authors obtained end-of-rotation quantitative ratings and narrative comments for 1 cohort of internal medicine residents at the University of Illinois at Chicago College of Medicine from July 2013-June 2016. They inductively identified themes in comments, coded orientation (praising/critical) and relevance (specificity and actionability) of feedback, examined associations between codes and ratings, and evaluated changes in themes and ratings across years. RESULTS Data comprised 1,869 assessments (828 comments) on 33 residents. Five themes aligned with ACGME competencies (interpersonal and communication skills, professionalism, medical knowledge, patient care, and systems-based practice), and 3 did not (personal attributes, summative judgment, and comparison to training level). Work ethic was the most frequent subtheme. Comments emphasized medical knowledge more in year 1 and focused more on autonomy, leadership, and teaching in later years. Most comments (714/828 [86%]) contained high praise, and 412/828 (50%) were very relevant. Average ratings correlated positively with orientation (β = 0.46, P < .001) and negatively with relevance (β = -0.09, P = .01). Ratings increased significantly with each training year (year 1, mean [standard deviation]: 5.31 [0.59]; year 2: 5.58 [0.47]; year 3: 5.86 [0.43]; P < .001). CONCLUSIONS Narrative comments address resident attributes beyond the ACGME competencies and change as residents progress. Lower quantitative ratings are associated with more specific and actionable feedback.
Collapse
Affiliation(s)
- Ara Tekian
- A. Tekian is professor and associate dean for international affairs, Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-9252-1588
| | - Yoon Soo Park
- Y.S. Park is associate professor, Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0001-8583-4335
| | - Sarette Tilton
- S. Tilton is a PharmD candidate, University of Illinois at Chicago College of Pharmacy, Chicago, Illinois
| | - Patrick F. Prunty
- P.F. Prunty is a PharmD candidate, University of Illinois at Chicago College of Pharmacy, Chicago, Illinois
| | - Eric Abasolo
- E. Abasolo is a PharmD candidate, University of Illinois at Chicago College of Pharmacy, Chicago, Illinois
| | - Fred Zar
- F. Zar is professor and program director, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - David A. Cook
- D.A. Cook is professor of medicine and medical education and associate director, Office of Applied Scholarship and Education Science, and consultant, Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-2383-4633
| |
Collapse
|
39
|
Young JQ. Advancing Our Understanding of Narrative Comments Generated by Direct Observation Tools: Lessons From the Psychopharmacotherapy-Structured Clinical Observation. J Grad Med Educ 2019; 11:570-579. [PMID: 31636828 PMCID: PMC6795331 DOI: 10.4300/jgme-d-19-00207.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/07/2019] [Accepted: 08/05/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND While prior research has focused on the validity of quantitative ratings generated by direct observation tools, much less is known about the written comments. OBJECTIVE This study examines the quality of written comments and their relationship with checklist scores generated by a direct observation tool, the Psychopharmacotherapy-Structured Clinical Observation (P-SCO). METHODS From 2008 to 2012, faculty in a postgraduate year 3 psychiatry outpatient clinic completed 601 P-SCOs. Twenty-five percent were randomly selected from each year; the sample included 8 faculty and 57 residents. To assess quality, comments were coded for valence (reinforcing or corrective), behavioral specificity, and content. To assess the relationship between comments and scores, the authors calculated the correlation between comment and checklist score valence and examined the degree to which comments and checklist scores addressed the same content. RESULTS Ninety-one percent of the comments were behaviorally specific. Sixty percent were reinforcing, and 40% were corrective. Eight themes were identified, including 2 constructs not adequately represented by the checklist. Comment and checklist score valence was moderately correlated (Spearman's rho = 0.57, P < .001). Sixty-seven percent of high and low checklist scores were associated with a comment of the same valence and content. Only 50% of overall comments were associated with a checklist score of the same valence and content. CONCLUSIONS A direct observation tool such as the P-SCO can generate high-quality written comments. Narrative comments both explain checklist scores and convey unique content. Thematic coding of comments can improve the content validity of a checklist.
Collapse
|
40
|
Scarff CE. Towards a greater understanding of narrative data on trainee performance. MEDICAL EDUCATION 2019; 53:962-964. [PMID: 31402480 DOI: 10.1111/medu.13940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Catherine Elizabeth Scarff
- Department of Medical Education, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
41
|
Schuwirth LW, van der Vleuten CP. How ‘Testing’ Has Become ‘Programmatic Assessment for Learning’. HEALTH PROFESSIONS EDUCATION 2019. [DOI: 10.1016/j.hpe.2018.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
42
|
Milestone Implementation's Impact on Narrative Comments and Perception of Feedback for Internal Medicine Residents: a Mixed Methods Study. J Gen Intern Med 2019; 34:929-935. [PMID: 30891692 PMCID: PMC6544770 DOI: 10.1007/s11606-019-04946-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Feedback is a critical element of graduate medical education. Narrative comments on evaluation forms are a source of feedback for residents. As a shared mental model for performance, milestone-based evaluations may impact narrative comments and resident perception of feedback. OBJECTIVE To determine if milestone-based evaluations impacted the quality of faculty members' narrative comments on evaluations and, as an extension, residents' perception of feedback. DESIGN Concurrent mixed methods study, including qualitative analysis of narrative comments and survey of resident perception of feedback. PARTICIPANTS Seventy internal medicine residents and their faculty evaluators at the University of Utah. APPROACH Faculty narrative comments from 248 evaluations pre- and post-milestone implementation were analyzed for quality and Accreditation Council for Graduate Medical Education competency by area of strength and area for improvement. Seventy residents were surveyed regarding quality of feedback pre- and post-milestone implementation. KEY RESULTS Qualitative analysis of narrative comments revealed nearly all evaluations pre- and post-milestone implementation included comments about areas of strength but were frequently vague and not related to competencies. Few evaluations included narrative comments on areas for improvement, but these were of higher quality compared to areas of strength (p < 0.001). Overall resident perception of quality of narrative comments was low and did not change following milestone implementation (p = 0.562) for the 86% of residents (N = 60/70) who completed the pre- and post-surveys. CONCLUSIONS The quality of narrative comments was poor, and there was no evidence of improved quality following introduction of milestone-based evaluations. Comments on areas for improvement were of higher quality than areas of strength, suggesting an area for targeted intervention. Residents' perception of feedback quality did not change following implementation of milestone-based evaluations, suggesting that in the post-milestone era, internal medicine educators need to utilize additional interventions to improve quality of feedback.
Collapse
|
43
|
Yeates P, Cope N, Hawarden A, Bradshaw H, McCray G, Homer M. Developing a video-based method to compare and adjust examiner effects in fully nested OSCEs. MEDICAL EDUCATION 2019; 53:250-263. [PMID: 30575092 PMCID: PMC6519246 DOI: 10.1111/medu.13783] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/14/2018] [Accepted: 11/07/2018] [Indexed: 05/09/2023]
Abstract
BACKGROUND Although averaging across multiple examiners' judgements reduces unwanted overall score variability in objective structured clinical examinations (OSCE), designs involving several parallel circuits of the OSCE require that different examiner cohorts collectively judge performances to the same standard in order to avoid bias. Prior research suggests the potential for important examiner-cohort effects in distributed or national examinations that could compromise fairness or patient safety, but despite their importance, these effects are rarely investigated because fully nested assessment designs make them very difficult to study. We describe initial use of a new method to measure and adjust for examiner-cohort effects on students' scores. METHODS We developed video-based examiner score comparison and adjustment (VESCA): volunteer students were filmed 'live' on 10 out of 12 OSCE stations. Following the examination, examiners additionally scored station-specific common-comparator videos, producing partial crossing between examiner cohorts. Many-facet Rasch modelling and linear mixed modelling were used to estimate and adjust for examiner-cohort effects on students' scores. RESULTS After accounting for students' ability, examiner cohorts differed substantially in their stringency or leniency (maximal global score difference of 0.47 out of 7.0 [Cohen's d = 0.96]; maximal total percentage score difference of 5.7% [Cohen's d = 1.06] for the same student ability by different examiner cohorts). Corresponding adjustment of students' global and total percentage scores altered the theoretical classification of 6.0% of students for both measures (either pass to fail or fail to pass), whereas 8.6-9.5% students' scores were altered by at least 0.5 standard deviations of student ability. CONCLUSIONS Despite typical reliability, the examiner cohort that students encountered had a potentially important influence on their score, emphasising the need for adequate sampling and examiner training. Development and validation of VESCA may offer a means to measure and adjust for potential systematic differences in scoring patterns that could exist between locations in distributed or national OSCE examinations, thereby ensuring equivalence and fairness.
Collapse
Affiliation(s)
- Peter Yeates
- Medical School Education Research Group (MERG)Keele University School of MedicineKeeleUK
- Department of Acute MedicineFairfield General HospitalPennine Acute Hospitals NHS TrustBuryUK
| | - Natalie Cope
- Medical School Education Research Group (MERG)Keele University School of MedicineKeeleUK
| | - Ashley Hawarden
- Royal Stoke HospitalUniversity Hospital of North Midlands NHS TrustStoke on TrentUK
| | - Hannah Bradshaw
- Royal Stoke HospitalUniversity Hospital of North Midlands NHS TrustStoke on TrentUK
| | - Gareth McCray
- Institute for Primary Care and Health SciencesKeele UniversityKeeleUK
| | - Matt Homer
- School of EducationUniversity of LeedsLeedsUK
| |
Collapse
|
44
|
Baines R, Regan de Bere S, Stevens S, Read J, Marshall M, Lalani M, Bryce M, Archer J. The impact of patient feedback on the medical performance of qualified doctors: a systematic review. BMC MEDICAL EDUCATION 2018; 18:173. [PMID: 30064413 PMCID: PMC6069829 DOI: 10.1186/s12909-018-1277-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 07/11/2018] [Indexed: 05/21/2023]
Abstract
BACKGROUND Patient feedback is considered integral to quality improvement and professional development. However, while popular across the educational continuum, evidence to support its efficacy in facilitating positive behaviour change in a postgraduate setting remains unclear. This review therefore aims to explore the evidence that supports, or refutes, the impact of patient feedback on the medical performance of qualified doctors. METHODS Electronic databases PubMed, EMBASE, Medline and PsycINFO were systematically searched for studies assessing the impact of patient feedback on medical performance published in the English language between 2006-2016. Impact was defined as a measured change in behaviour using Barr's (2000) adaptation of Kirkpatrick's four level evaluation model. Papers were quality appraised, thematically analysed and synthesised using a narrative approach. RESULTS From 1,269 initial studies, 20 articles were included (qualitative (n=8); observational (n=6); systematic review (n=3); mixed methodology (n=1); randomised control trial (n=1); and longitudinal (n=1) design). One article identified change at an organisational level (Kirkpatrick level 4); six reported a measured change in behaviour (Kirkpatrick level 3b); 12 identified self-reported change or intention to change (Kirkpatrick level 3a), and one identified knowledge or skill acquisition (Kirkpatrick level 2). No study identified a change at the highest level, an improvement in the health and wellbeing of patients. The main factors found to influence the impact of patient feedback were: specificity; perceived credibility; congruence with physician self-perceptions and performance expectations; presence of facilitation and reflection; and inclusion of narrative comments. The quality of feedback facilitation and local professional cultures also appeared integral to positive behaviour change. CONCLUSION Patient feedback can have an impact on medical performance. However, actionable change is influenced by several contextual factors and cannot simply be guaranteed. Patient feedback is likely to be more influential if it is specific, collected through credible methods and contains narrative information. Data obtained should be fed back in a way that facilitates reflective discussion and encourages the formulation of actionable behaviour change. A supportive cultural understanding of patient feedback and its intended purpose is also essential for its effective use.
Collapse
Affiliation(s)
- Rebecca Baines
- Collaboration for the Advancement of Medical Education Research & Assessment (CAMERA), Faculty of Medicine and Dentistry, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
| | - Sam Regan de Bere
- Collaboration for the Advancement of Medical Education Research & Assessment (CAMERA), Faculty of Medicine and Dentistry, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
| | - Sebastian Stevens
- Collaboration for the Advancement of Medical Education Research & Assessment (CAMERA), Faculty of Medicine and Dentistry, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
| | - Jamie Read
- Collaboration for the Advancement of Medical Education Research & Assessment (CAMERA), Faculty of Medicine and Dentistry, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
| | - Martin Marshall
- Improvement Science London, University College London, London, UK
| | - Mirza Lalani
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Marie Bryce
- Collaboration for the Advancement of Medical Education Research & Assessment (CAMERA), Faculty of Medicine and Dentistry, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK
| | - Julian Archer
- Collaboration for the Advancement of Medical Education Research & Assessment (CAMERA), Faculty of Medicine and Dentistry, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK.
| |
Collapse
|
45
|
Chan T, Sebok‐Syer S, Thoma B, Wise A, Sherbino J, Pusic M. Learning Analytics in Medical Education Assessment: The Past, the Present, and the Future. AEM EDUCATION AND TRAINING 2018; 2:178-187. [PMID: 30051086 PMCID: PMC6001721 DOI: 10.1002/aet2.10087] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 05/09/2023]
Abstract
With the implementation of competency-based medical education (CBME) in emergency medicine, residency programs will amass substantial amounts of qualitative and quantitative data about trainees' performances. This increased volume of data will challenge traditional processes for assessing trainees and remediating training deficiencies. At the intersection of trainee performance data and statistical modeling lies the field of medical learning analytics. At a local training program level, learning analytics has the potential to assist program directors and competency committees with interpreting assessment data to inform decision making. On a broader level, learning analytics can be used to explore system questions and identify problems that may impact our educational programs. Scholars outside of health professions education have been exploring the use of learning analytics for years and their theories and applications have the potential to inform our implementation of CBME. The purpose of this review is to characterize the methodologies of learning analytics and explore their potential to guide new forms of assessment within medical education.
Collapse
Affiliation(s)
- Teresa Chan
- McMaster program for Education Research, Innovation, and Theory (MERIT)HamiltonOntarioCanada
| | - Stefanie Sebok‐Syer
- Centre for Education Research & InnovationSchulich School of Medicine and DentistrySaskatoonSaskatchewanCanada
| | - Brent Thoma
- Department of Emergency MedicineUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Alyssa Wise
- Steinhardt School of Culture, Education, and Human DevelopmentNew York UniversityNew YorkNY
| | - Jonathan Sherbino
- Faculty of Health ScienceDivision of Emergency MedicineDepartment of MedicineMcMaster UniversityHamiltonOntarioCanada
- McMaster program for Education Research, Innovation, and Theory (MERIT)HamiltonOntarioCanada
| | - Martin Pusic
- Department of Emergency MedicineNYU School of MedicineNew YorkNY
| |
Collapse
|
46
|
Cheung WJ, Dudek NL, Wood TJ, Frank JR. Supervisor-trainee continuity and the quality of work-based assessments. MEDICAL EDUCATION 2017; 51:1260-1268. [PMID: 28971502 DOI: 10.1111/medu.13415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/30/2017] [Accepted: 07/11/2017] [Indexed: 05/12/2023]
Abstract
CONTEXT Work-based assessments (WBAs) represent an increasingly important means of reporting expert judgements of trainee competence in clinical practice. However, the quality of WBAs completed by clinical supervisors is of concern. The episodic and fragmented interaction that often occurs between supervisors and trainees has been proposed as a barrier to the completion of high-quality WBAs. OBJECTIVES The primary purpose of this study was to determine the effect of supervisor-trainee continuity on the quality of assessments documented on daily encounter cards (DECs), a common form of WBA. The relationship between trainee performance and DEC quality was also examined. METHODS Daily encounter cards representing three differing degrees of supervisor-trainee continuity (low, intermediate, high) were scored by two raters using the Completed Clinical Evaluation Report Rating (CCERR), a previously published nine-item quantitative measure of DEC quality. An analysis of variance (anova) was performed to compare mean CCERR scores among the three groups. Linear regression analysis was conducted to examine the relationship between resident performance and DEC quality. RESULTS Differences in mean CCERR scores were observed between the three continuity groups (p = 0.02); however, the magnitude of the absolute differences was small (partial eta-squared = 0.03) and not educationally meaningful. Linear regression analysis demonstrated a significant inverse relationship between resident performance and CCERR score (p < 0.001, r2 = 0.18). This inverse relationship was observed in both groups representing on-service residents (p = 0.001, r2 = 0.25; p = 0.04, r2 = 0.19), but not in the Off-service group (p = 0.62, r2 = 0.05). CONCLUSIONS Supervisor-trainee continuity did not have an educationally meaningful influence on the quality of assessments documented on DECs. However, resident performance was found to affect assessor behaviours in the On-service group, whereas DEC quality remained poor regardless of performance in the Off-service group. The findings suggest that greater attention should be given to determining ways of improving the quality of assessments reported for off-service residents, as well as for those residents demonstrating appropriate clinical competence progression.
Collapse
Affiliation(s)
- Warren J Cheung
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nancy L Dudek
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Timothy J Wood
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada
| | - Jason R Frank
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
| |
Collapse
|