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Hu WCY, Dillon HCB, Wilkinson TJ. Educators as Judges: Applying Judicial Decision-Making Principles to High-Stakes Education Assessment Decisions. TEACHING AND LEARNING IN MEDICINE 2023; 35:168-179. [PMID: 35253558 DOI: 10.1080/10401334.2022.2038176] [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: 07/03/2021] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
Phenomenon: Programmatic assessment and competency-based education have highlighted the need to make robust high-stakes assessment decisions on learner performance from evidence of varying types and quality. Without guidance, lengthy deliberations by decision makers and competence committees can end inconclusively with unresolved concerns. These decisional dilemmas are heightened by their potential impacts. For learners, erroneous decisions may lead to an unjustified exit from a long-desired career, or premature promotion to clinical responsibilities. For educators, there is the risk of wrongful decision-making, leading to successful appeals and mistrust. For communities, ill-prepared graduates risk the quality and safety of care. Approaches such as psychometric analyses are limited when decision-makers are faced with seemingly contradictory qualitative and quantitative evidence about the same individual. Expertise in using such evidence to make fair and defensible decisions is well established in judicial practice but is yet to be practically applied to assessment decision-making. Approach: Through interdisciplinary exchange, we investigated medical education and judicial perspectives on decision-making to explore whether principles of decision-making in law could be applied to educational assessment decision-making. Using Dialogic Inquiry, an iterative process of scholarly and mutual critique, we contrasted assessment decision making in medical education with judicial practice to identify key principles in judicial decision-making relevant to educational assessment decisions. We developed vignettes about common but problematic high-stakes decision-making scenarios to test how these principles could apply. Findings: Over 14 sessions, we identified, described, and applied four principles for fair, reasonable, and transparent assessment decision-making. These were: The person whose interests are affected has a right to know the case against them, and to be heard.Reasons for the decision should be given.Rules should be transparent and consistently applied.Like cases should be treated alike and unlike cases treated differently.Reflecting our dialogic process, we report findings by separately presenting the medical educator and judicial perspectives, followed by a synthesis describing a preferred approach to decision-making in three vignettes. Insights: Judicial principles remind educators to consider both sides of arguments, to be consistent, and to demonstrate transparency when making assessment decisions. Dialogic Inquiry is a useful approach for generating interdisciplinary insights on challenges in medical education by critiquing difference (e.g., the meaning of objectivity) and achieving synthesis where possible (e.g., fairness is not equal treatment of all cases). Our principles and exemplars provide groundwork for promoting good practice and furthering assessment research toward fairer and more robust decisions that will assist learning.
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Affiliation(s)
- Wendy C Y Hu
- Medical Education Unit, School of Medicine, Western Sydney University, Penrith South, New South Wales, Australia
| | - Hugh C B Dillon
- Faculty of Law, University of New South Wales, Sydney, Australia
| | - Tim J Wilkinson
- Education Unit, University of Otago, Christchurch, New Zealand
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Tremblay D, Turcotte A, Touati N, Poder TG, Kilpatrick K, Bilodeau K, Roy M, Richard PO, Lessard S, Giordano É. Development and use of research vignettes to collect qualitative data from healthcare professionals: a scoping review. BMJ Open 2022; 12:e057095. [PMID: 35105654 PMCID: PMC8804653 DOI: 10.1136/bmjopen-2021-057095] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To clarify the definition of vignette-based methodology in qualitative research and to identify key elements underpinning its development and utilisation in qualitative empirical studies involving healthcare professionals. DESIGN Scoping review according to the Joanna Briggs Institute framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. DATA SOURCES Electronic databases: Academic Search Complete, CINAHL Plus, MEDLINE, PsycINFO and SocINDEX (January 2000-December 2020). ELIGIBILITY CRITERIA Empirical studies in English or French with a qualitative design including an explicit methodological description of the development and/or use of vignettes to collect qualitative data from healthcare professionals. Titles and abstracts were screened, and full text was reviewed by pairs of researchers according to inclusion/exclusion criteria. DATA EXTRACTION AND SYNTHESIS Data extraction included study characteristics, definition, development and utilisation of a vignette, as well as strengths, limitations and recommendations from authors of the included articles. Systematic qualitative thematic analysis was performed, followed by data matrices to display the findings according to the scoping review questions. RESULTS Ten articles were included. An explicit definition of vignettes was provided in only half the studies. Variations of the development process (steps, expert consultation and pretesting), data collection and analysis demonstrate opportunities for improvement in rigour and transparency of the whole research process. Most studies failed to address quality criteria of the wider qualitative design and to discuss study limitations. CONCLUSIONS Vignette-based studies in qualitative research appear promising to deepen our understanding of sensitive and challenging situations lived by healthcare professionals. However, vignettes require conceptual clarification and robust methodological guidance so that researchers can systematically plan their study. Focusing on quality criteria of qualitative design can produce stronger evidence around measures that may help healthcare professionals reflect on and learn to cope with adversity.
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Affiliation(s)
- Dominique Tremblay
- School of Nursing, Université de Sherbrooke, Longueuil, Quebec, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, Quebec, Canada
| | - Annie Turcotte
- School of Nursing, Université de Sherbrooke, Longueuil, Quebec, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, Quebec, Canada
| | - Nassera Touati
- École Nationale d'Administration Publique, Montreal, Quebec, Canada
| | - Thomas G Poder
- School of Public Health, Université de Montréal, Montreal, Quebec, Canada
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Kelley Kilpatrick
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Susan E. French Chair in Nursing Research and Innovative Practice, Montreal, Quebec, Canada
| | - Karine Bilodeau
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
| | - Mathieu Roy
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Patrick O Richard
- Department of Surgery, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Sylvie Lessard
- Centre de recherche Charles-Le Moyne, Longueuil, Quebec, Canada
| | - Émilie Giordano
- Centre de recherche Charles-Le Moyne, Longueuil, Quebec, Canada
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Lim E, Wynaden D, Heslop K. Using Q-methodology to explore mental health nurses' knowledge and skills to use recovery-focused care to reduce aggression in acute mental health settings. Int J Ment Health Nurs 2021; 30:413-426. [PMID: 33084220 DOI: 10.1111/inm.12802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 12/01/2022]
Abstract
When nurses practise recovery-focused care, they contribute positively to the consumer's mental health recovery journey and empower the person to be actively engaged in the management of their illness. While using recovery-focused care is endorsed in mental health policy, many health professionals remain uncertain about its application with consumers who have a risk for aggression during their admission to an acute mental health inpatient setting. This paper reports on Australian research using Q-methodology that examined the knowledge and skill components of recovery-focused care that nurses use to reduce the risk for aggression. The data from forty mental health nurses revealed five factors that when implemented as part of routine practice improved the recovery outcomes for consumers with risk of aggression in the acute mental health settings. These factors were as follows: (I) acknowledge the consumers' experience of hospitalization; (II) reassure consumers who are going through a difficult time; (III) interact to explore the impact of the consumer's negative lived experiences; (IV) support co-production to reduce triggers for aggression; and (V) encourage and support consumers to take ownership of their recovery journey. These findings provide nurses with a pragmatic approach to use recovery-focused care for consumers with risk for aggression and contribute positively to the consumers' personal recovery.
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Affiliation(s)
- Eric Lim
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Dianne Wynaden
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Karen Heslop
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
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Deering K, Williams J, Stayner K, Pawson C. Giving a voice to patient experiences through the insights of pragmatism. Nurs Philos 2020; 22:e12329. [PMID: 32951310 DOI: 10.1111/nup.12329] [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] [Received: 05/26/2020] [Revised: 08/24/2020] [Accepted: 09/04/2020] [Indexed: 11/28/2022]
Abstract
As a philosophical position, pragmatism can be critiqued to distinguish truth only with methods that bring about desired results, predominantly with scientific enquiry. The article hopes to dismiss this oversimplification and propose that within mental health nursing, enquiry enlightened by pragmatism can be anchored to methods helping to tackle genuine human problems. Whilst pragmatists suggest one reality exists, fluctuating experiences and shifting beliefs about the world can inhabit within; hence, pragmatists propose reality has the potential to change. Moreover, pragmatism includes being cognisant of what works to whom reality concerns, making reality context-driven, with a view to understand how actions shape experiences so what is generated has usefulness. Hence, it somewhat follows pragmatism can inform mental health nursing, after all, nursing is a discipline of action, and awareness is needed in how actions produce experiences that patients find helpful. Given the principles of recovery are preferably adopted in mental health care, the paper will explore how pragmatism can help nurses move towards that goal; specifically, with patients voicing their experiences. This is because like pragmatism, recovery subscribes to hope that reality can progress, and through meaningful experiences and beliefs, patients have expertise about personal difficulties alongside how life may flourish, despite mental illness.
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Affiliation(s)
- Kris Deering
- Nursing and Midwifery Department, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Jo Williams
- Nursing and Midwifery Department, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Kay Stayner
- Southmead Hospital, Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
| | - Chris Pawson
- Psychology Department, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
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López-Martínez AE, Ramírez-Maestre C, Serrano-Ibáñez ER, Ruiz-Párraga GT, Peters ML, Esteve R. Using vignettes to assess the contribution of goal adjustment in the adaptation to chronic musculoskeletal pain. Qual Life Res 2020; 29:2137-2148. [PMID: 32236774 DOI: 10.1007/s11136-020-02487-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE The quality of life of individuals with chronic musculoskeletal pain partly depends on their capacity to adjust their personal goals. Vignettes have been rarely used to assess this ability. Therefore, this study aimed to test the relationships between vignettes assessing different goal strategies and chronic pain adaptation (i.e., daily functioning, pain-related impairment, and psychological well-being). METHODS The sample comprised 258 individuals with chronic musculoskeletal pain who completed a series of questionnaires and vignettes. The vignettes presented a short description of a situation in which a person with chronic pain experienced a threat to a valued domain-specific goal and had to choose a possible goal management solution (i.e., goal persistence, flexibility reengagement, and disengagement). Hierarchical regression analyses were used to predict chronic pain adaptation using the selected vignette strategies as predictors. RESULTS After controlling for age, sex, pain intensity, and the responses to the dispositional goal management scales, persistence, reengagement, and disengagement goal strategies presented in the case scenarios predicted daily functioning (p < .001). Persistence, flexibility, disengagement (p < .001), and reengagement (p < .05) predicted pain-related impairment. Persistence, disengagement (p < .001), and flexibility (p < .05) predicted psychological well-being scores. CONCLUSION The use of vignettes could be useful to assess goal adjustment because this methodology enables respondents to provide more context-specific responses. The results of this approach could be used to improve clinical practice aimed at helping people with chronic musculoskeletal pain to better cope with this health condition.
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Affiliation(s)
- Alicia E López-Martínez
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Facultad de Psicología, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, S/N, Spain.
| | - Carmen Ramírez-Maestre
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Facultad de Psicología, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, S/N, Spain
| | - Elena R Serrano-Ibáñez
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Facultad de Psicología, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, S/N, Spain
| | - Gema T Ruiz-Párraga
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Facultad de Psicología, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, S/N, Spain
| | - Madelon L Peters
- Department of Psychology and Neuroscience, Clinical Psychological Science, Behavioural Medicine, Maastricht University, Maastricht, The Netherlands
| | - Rosa Esteve
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Facultad de Psicología, Universidad de Málaga, Campus de Teatinos, 29071, Málaga, S/N, Spain
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Owens C, Carter M, Shenton D, Byng R, Quinn C. Engaging Without Exposing: Use of a Fictional Character to Facilitate Mental Health Talk in Focus Groups With Men Who Have Been Subject to the Criminal Justice System. QUALITATIVE HEALTH RESEARCH 2018; 28:2102-2114. [PMID: 30066600 PMCID: PMC6187490 DOI: 10.1177/1049732318785359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In an effort to encourage men with experience of being subject to the criminal justice system to contribute to focus group discussions on the sensitive topic of mental health, while also doing our utmost to protect them from discomfort or risk of exploitation, we used a novel technique involving the creation of a fictional character, supplemented by an audio-recorded vignette. We studied the role played by this technique in achieving our stated aims of "engaging without exposing." In this article, we report on the use of this technique in three focus groups, showing how in very different ways it shaped the interaction between participants and generated crucial insights into the lives and service needs of each group. We conclude that the technique may lend itself to being used in focus groups with other marginalized or seldom-heard populations.
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Affiliation(s)
| | - Mary Carter
- University of Exeter, Exeter, United Kingdom
| | | | | | - Cath Quinn
- Plymouth University, Plymouth, United Kingdom
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