Background: The evidence surrounding the impact of COVID-19 on medical learners remains anecdotal and highly speculative despite the anticipated impact and potential consequences of the current pandemic on medical training. The purpose of this study was to explore the extent that COVID-19 initially impacted medical learners around the world and examine global trends and patterns across geographic regions and levels of training. Methods: A cross-sectional survey of medical learners was conducted between March 25–June 14, 2020, shortly after the World Health Organization declared COVID-19 a pandemic. Results: 6492 learners completed the survey from 140 countries. Most medical schools removed learners from the clinical environment and adopted online learning, but students reported concerns about the quality of their learning, training progression, and milestone fulfillment. Residents reported they could be better utilized and expressed concerns about their career timeline. Trainees generally felt under-utilized and wanted to be engaged clinically in meaningful ways; however, some felt that contributing to healthcare during a pandemic was beyond the scope of a learner. Significant differences were detected between levels of training and geographic regions for satisfaction with organizational responses as well as the impact of COVID-19 learner wellness and state-trait anxiety. Conclusions: The disruption to the status quo of medical education is perceived by learners across all levels and geographic regions to have negatively affected their training and well-being, particularly amongst postgraduate trainees. These results provide initial empirical insights into the areas that warrant future research as well as consideration for current and future policy planning.
Background: As training programs implement competency-based models of training oriented around entrustable professional activities (EPAs), the role of traditional assessment tools remains unclear. While rating scales remain emphasized, few empirical studies have explored the utility of narrative comments between methods and models of training. Objective: Compare the quality of narrative comments between in-training evaluation reports (ITERs) and workplace-based assessments (WBAs) of EPAs before and after the formal implementation of a competencybased model of training. Methods: Retrospective analysis of assessment data from 77 residents in the core Internal Medicine (IM) residency program at the University of Calgary between 2015 and 2020, including data collected during a 2-year pilot of WBAs before the official launch of Competency by Design on July 1, 2019. The quality of narrative comments from 2,928 EPAs and 3,608 ITERs was analyzed using the standardized Completed Clinical Evaluation Report Rating (CCERR). Results: CCERR scores were higher on EPAs than ITERs [F (26,213) = 210, MSE = 4,541, p < 0.001, η2 = 0.064]. CCERR scores for EPAs decreased slightly upon formal implementation of Competence by Design but remained higher than the CCERR scores for ITERs completed at that period of time. Conclusions: The quality of narrative comments may be higher on EPAs than traditional ITER evaluations. While programmatic assessment requires the use of multiple tools and methods, programs must consider whether such methods lead to complementarity or redundancy. Résumé Contexte: Alors que les programmes de formation mettent en œuvre des modèles de formation axés sur les compétences et orientés en fonction des activités professionnelles confiables (APC), le rôle des outils d’évaluation traditionnels reste flou. Si les échelles de notation restent privilégiées, peu d’études empiriques explorent l’utilité des commentaires narratifs entre les méthodes et les modèles de formation. Objectif: Comparer la qualité des commentaires narratifs entre les fiches d’évaluation en cours de formation (FECF) et les évaluations des APC sur le lieu de travail avant et après la mise en œuvre officielle d’un modèle de formation axé sur les compétences. Méthodologie: Analyse rétrospective des données d’évaluation de 77 résidents du programme de résidence en médecine interne tronc commun de l’Université de Calgary entre 2015 et 2020, comprenant les données recueillies au cours d’un projet pilote de deux ans d’évaluations en milieu de travail avant le lancement officiel de l’initiative La compétence par conception, le 1er juillet 2019. La qualité des commentaires narratifs de 2,928 APC et de 3,608 FECF a été analysée à l’aide du Completed Clinical Evaluation Report Rating (CCERR) normalisé. Résultats: Les scores du CCERR sont plus élevés pour les APC que pour les FECF [F (26,213) = 210, rétroac-tion multisources = 4,541, p < 0.001, η2 = 0.064]. Les scores du CCERR pour les APC diminuent légèrement au moment de la mise en œuvre officielle de l’initiative La compétence par conception, mais demeurent plus élevés que ceux pour les FECF effectuées à cette période. Conclusions: La qualité des commentaires narratifs serait meilleure pour les APC que pour les FECF traditionnelles. Bien que l’évaluation des programmes nécessite l’utilisation de multiples outils et méthodes, les programmes doivent se demander si l’utilisation de telles méthodes se veut complémentaire ou redondante.
To broadly explore the extent that COVID-19 has initially impacted medical learners around the world and examine global trends and patterns across geographic regions and levels of training, a cross-sectional survey of medical learners was conducted between March 25-June 14th, 2020, shortly after the World Health Organization declared concurrent COVID-19 a pandemic. 6492 medical learners completed the survey from 140 countries, Students were concerned about the quality of their learning, training progression, and milestone fulfillment. Most trainees felt under-utilized and wanted to be engaged clinically in meaningful ways; however, some trainees felt that contributing to healthcare during a pandemic was beyond the scope of a medical learner. Statistically significant differences were detected between levels of training and geographic regions for satisfaction with organizational responses, the impact of COVID-19 on wellness, and state-trait anxiety. Overall, the initial disruption to medical training has been perceived by learners across all levels and geographic regions to have negatively affected their training and well-being, particularly amongst postgraduate trainees. These results provide initial insights into the areas that warrant future research as well as consideration for current and future policy planning, such as the policies for clinical utilization of medical learners during public health emergencies.
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