Assessing Practice‐based Learning and Improvement

Abstract

Assessment of practice-based learning and improvement (PBLI) is a core concept identified in several competency frameworks. This paper summarizes the current state of PBLI assessment as presented at the 2012 Academic Emergency Medicine consensus conference on education research in emergency medicine. Based on these findings and consensus achieved at the conference, seven recommendations have been identified for future research.ACADEMIC EMERGENCY MEDICINE 2012; 19:1403-1410© 2012 by the Society for Academic Emergency Medicine A n important goal in education is teaching learners how to continue learning once they have finished formal training. "The main thrust of modern adult-educational technology is in the direction of inventing techniques for involving adults in everdeeper processes of self diagnosis of their own needs for continued learning, in formulating their own objectives for learning, in sharing responsibility for designing and carrying out their learning activities, and in evaluating their progress toward their objectives." 1 Practice-based learning and improvement (PBLI) has the broadest scope of all the Accreditation Council for Graduate Medical Education (ACGME) core competencies. The ACGME emergency medicine (EM) program requirements list 10 subcompetencies, 2 which can be interpreted to cover a range from individuals to entire health care systems and have a time span that lasts a resident's entire career. The overall goal is to help residents develop lifelong skills to identify areas for improvement in their own practice through both external feedback and self-reflection and then work to improve those areas through self-directed learning, quality improvement, and education of themselves and others. The concept of self-directed improvement based on a self-performance assessment is continued in the assessment of practice performance mandated as part of the maintenance of certification for practicing physicians. Thus, the habits and values emphasized in the PBLI competency serve as a foundation for the rest of a physician's career.The wide range of practice-based learning is reflected in the fact that it is not a separate core competency in the CanMEDS framework. All of the elements of the ACGME's PBLI competency can be mapped to elements of CanMEDS, with the exception of IV.A.5.c). (7) and (9): use information technology to optimize learning/ improve patient care. This mapping spans four different elements of the CanMEDS system-the scholar, professional, manager, and communicator roles (see Table 1). Assessment of PBLI as a whole is difficult due to this broad scope. Evaluation tools for various subsets of the components of PBLI have been described, but assessing all of the elements of PBLI with one tool has proven difficult. Demonstrating "improvement" also requires showing change over time, which many standard assessment tools are not built to measure. This leaves us with a choice: we can use the same tool to assess a learner at several different points in time, provided that the tool is de...

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