Interprofessional education through simulation offers a promising approach to preparing future healthcare professionals for the collaborative models of healthcare delivery being developed internationally.
Rationale, aims, and objectivesProgrammatic assessment has been identified as a system‐oriented approach to achieving the multiple purposes for assessment within Competency‐Based Medical Education (CBME, i.e., formative, summative, and program improvement). While there are well‐established principles for designing and evaluating programs of assessment, few studies illustrate and critically interpret, what a system of programmatic assessment looks like in practice. This study aims to use systems thinking and the ‘two communities’ metaphor to interpret a model of programmatic assessment and to identify challenges and opportunities with operationalization.MethodAn interpretive case study was used to investigate how programmatic assessment is being operationalized within one competency‐based residency program at a Canadian university. Qualitative data were collected from residents, faculty, and program leadership via semi‐structured group and individual interviews conducted at nine months post‐CBME implementation. Data were analyzed using a combination of data‐based inductive analysis and theory‐derived deductive analysis.ResultsIn this model, Academic Advisors had a central role in brokering assessment data between communities responsible for producing and using residents' performance information for decision making (i.e., formative, summative/evaluative, and program improvement). As system intermediaries, Academic Advisors were in a privileged position to see how the parts of the assessment system contributed to the functioning of the whole and could identify which system components were not functioning as intended. Challenges were identified with the documentation of residents' performance information (i.e., system inputs); use of low‐stakes formative assessments to inform high‐stakes evaluative judgments about the achievement of competence standards; and gaps in feedback mechanisms for closing learning loops.ConclusionsThe findings of this research suggest that program stakeholders can benefit from a systems perspective regarding how their assessment practices contribute to the efficacy of the system as a whole. Academic Advisors are well positioned to support educational development efforts focused on overcoming challenges with operationalizing programmatic assessment.
Background Simulation is increasingly being used in postgraduate medical education as an opportunity for competency assessment. However, there is limited direct evidence that supports performance in the simulation lab as a surrogate of workplace-based clinical performance for non-procedural tasks such as resuscitation in the emergency department (ED). We sought to directly compare entrustment scoring of resident performance in the simulation environment to clinical performance in the ED. Methods The resuscitation assessment tool (RAT) was derived from the previously implemented and studied Queen’s simulation assessment tool (QSAT) via a modified expert review process. The RAT uses an anchored global assessment scale to generate an entrustment score and narrative comments. Emergency medicine (EM) residents were assessed using the RAT on cases in simulation-based examinations and in the ED during resuscitation cases from July 2016 to June 2017. Resident mean entrustment scores were compared using Pearson’s correlation coefficient to determine the relationship between entrustment in simulation cases and in the ED. Inductive thematic analysis of written commentary was conducted to compare workplace-based with simulation-based feedback. Results There was a moderate, positive correlation found between mean entrustment scores in the simulated and workplace-based settings, which was statistically significant ( r = 0.630, n = 17, p < 0.01). Further, qualitative analysis demonstrated overall management and leadership themes were more common narratives in the workplace, while more specific task-based feedback predominated in the simulation-based assessment. Both workplace-based and simulation-based narratives frequently commented on communication skills. Conclusions In this single-center study with a limited sample size, assessment of residents using entrustment scoring in simulation settings was demonstrated to have a moderate positive correlation with assessment of resuscitation competence in the workplace. This study suggests that resuscitation performance in simulation settings may be an indicator of competence in the clinical setting. However, multiple factors contribute to this complicated and imperfect relationship. It is imperative to consider narrative comments in supporting the rationale for numerical entrustment scores in both settings and to include both simulation and workplace-based assessment in high-stakes decisions of progression. Electronic supplementary material The online version of this article (10.1186/s41077-019-0099-4) contains supplementary material, which is available to authorized users.
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