PurposeMultiple studies demonstrate that assessment of residents differs by gender, yet little is known about how these differences are experienced by women and men. The authors sought to understand whether the experience of being assessed and receiving feedback differs between men and women internal medicine (IM) residents and how women respond to these experiences. MethodA constructivist grounded theory approach to data collection and interpretation was used. The authors invited all IM residents in postgraduate years 1-3 at the University of Toronto to participate in semistructured focus groups (August-October 2019). Twentytwo residents participated (8 men, 14 women). Focus groups were divided by gender and training level.

Purpose A key unit of assessment in competency-based medical education (CBME) is the entrustable professional activity. The variations in how entrustment is perceived and enacted across specialties are not well understood. This study aimed to develop a thorough understanding of the process, concept, and language of entrustment as it pertains to internal medicine (IM). Method Attending supervisors of IM trainees on the clinical teaching unit were purposively sampled. Sixteen semistructured interviews were conducted and analyzed using constructivist grounded theory. The study was conducted at the University of Toronto from January to September 2018. Results Five major themes were elucidated. First, the concepts of entrustment, trust, and competence are not easily distinguished and sometimes conflated. Second, entrustment decisions are not made by attendings, but rather are often automatic and predetermined by program or trainee level. Third, entrustment is not a discrete, point-in-time assessment due to longitudinality of tasks and supervisor relationships with trainees. Fourth, entrustment scale language does not reflect attendings’ decision making. Fifth, entrustment decisions affect the attending more than the resident. Conclusions A tension arises between the need for a common language of CBME and the need for authentic representation of supervision within each specialty. With new assessment instruments required to operationalize the tenets of CBME, it becomes critically important to understand the nuanced and specialty-specific language of entrustment to ensure validity of assessments.

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Background: In-hospital transfers such as from the intensive care unit (ICU) to the general internal medicine (GIM) ward place patients at risk of adverse events. A structured handover tool may improve transitions from the ICU to the GIM ward. Objective: To develop, implement, and evaluate a customized user-designed transfer tool to improve transitions from the ICU to the GIM ward. Methods: This was a pre–post intervention study at a tertiary academic hospital. We developed and implemented a user-designed, structured, handwritten ICU-to-GIM transfer tool. The tool included active medical issues, functional status, medications and medication changes, consulting services, code status, and emergency contact information. Transfer tool users included GIM physicians, ICU physicians, and critical care rapid response team nurses. An implementation audit and mixed qualitative and quantitative analysis of pre–post survey responses was used to evaluate clinician satisfaction and the perceived quality of patient transfers. Results: The pre–post survey response rate was 51.8% (99/191). Respondents included GIM residents (58.5%), ICU rapid response team physicians and nurses (24.2%), and GIM attending physicians (17.2%). Less than half of clinicians (48.8%) reported that the preintervention transfer process was adequate. Clinicians who used the transfer tool reported that the transfer process was improved (93.3% vs. 48.8%, P = 0.03). Clinician-reported understanding of medication changes in the ICU increased (69.2% vs. 29.1%, P = 0.004), as did their ability to plan for a safe hospital discharge (69.2% vs. 31.0%, P = 0.01). However, only 64.2% of audited transfers used the tool. Frequently omitted sections included home medications (missing in 83.4% of audits), new medications (33.3%), and secondary diagnosis (33.3%). Thematic analysis of free-text responses identified areas for improvement including clarifying the course of ICU events and enhancing tool usability. Conclusion: A user-designed, structured, handwritten transfer tool may improve the perceived quality of patient transfers from the ICU to the GIM wards.

Purpose The oral case presentation (OCP) is an essential part of daily clinical practice in internal medicine (IM) and a key competency in medical education. It is not known how supervisors and trainees perceive OCPs in workplace-based learning and assessment. Method Using a constructivist grounded theory approach, 26 semistructured interviews were held with trainees and supervisors (18 clinical clerks and first- through third-year postgraduate trainees, and 8 supervisors) on the IM clinical teaching unit at the University of Toronto, 2015–2016. Interviews focused on how the OCP was viewed by both trainees and supervisors in clinical practice as a tool for patient care, learning, and assessment. Iterative, constant comparative techniques were used to analyze the interviews and develop a framework to understand trainee and supervisor perspectives. Results Supervisors and trainees viewed the OCP as an important part of informal trainee assessment in IM. Supervisors used OCPs to understand the patient through trainee-demonstrated skills including the use of narratives, information synthesis, and management of uncertainty. However, because of awareness of assessment, trainees sought to control the OCP, viewing it as a performance demonstrating their competence, mediated by senior residents and tailored to supervisor preferences. Conclusions Preoccupied with assessment around OCPs, trainees often lost sight of the valuable learning taking place. Use of OCPs in assessment necessitates optimization of the educational activity for trainees. Providing explicit direction to both trainees and supervisors, defining expectations, and clarifying the assessment activity of the OCP can optimize the encounter for best educational practice.

PurposeWith the introduction of competencybased medical education, senior residents have taken on a new, formalized role of completing assessments of their junior colleagues. However, no prior studies have explored the role of near-peer assessment within the context of entrustable professional activities (EPAs) and competency-based medical education. This study explored internal medicine residents' perceptions of near-peer feedback and assessment in the context of EPAs.

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