Attending Emergency Physicians’ Perceptions of a Programmatic Workplace-Based Assessment System: The McMaster Modular Assessment Program (McMAP)

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Objectives Emergency medicine is a fast‐paced specialty that demands emergency physicians to respond to rapidly evolving patient presentations, while engaging in clinical supervision. Most research on supervisory roles has focused on the behaviors of attending physicians, including their individual preferences of supervision and level of entrustment of clinical tasks to trainees. However, less research has investigated how the clinical context (patient case complexity, workflow) influences clinical supervision. In this study, we examined how the context of the emergency department (ED) shapes the ways in which emergency physicians reconcile their competing roles in patient care and clinical supervision to optimize learning and ensure patient safety. Methods Emergency physicians who regularly participated in clinical supervision in several academic teaching hospitals were individually interviewed using a semi‐structured format. The interviews were transcribed and analyzed using a constructivist grounded theory approach. Results Sixteen emergency physicians were asked to reflect on their clinical supervisory roles in the ED. We conceptualized a model that describes three prominent roles: teacher, assessor, and patient protector. Contextual features such as trainee competence, pace of the ED, patient complexity, and the culture of academic medicine influenced the extent to which certain roles were considered salient at any given time. Conclusions This conceptual model can inform researchers and medical educators about the role of context in accentuating or minimizing various roles of emergency physicians. Identifying how context interfaces with these roles may help design faculty development initiatives aimed to navigate the tension between urgent patient care and medical education for emergency physicians.

Section: Limitationsmentioning

confidence: 99%

The Teacher, the Assessor, and the Patient Protector: A Conceptual Model Describing How Context Interfaces With the Supervisory Roles of Academic Emergency Physicians

Acai

Sherbino

et al. 2020

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“…34 Each clinical task is linked to a global end-of-shift rating. 34 Both resident and faculty reflections on the implementation of this tool have been published. 34,43 Key benefits described by faculty were the inclusion of a wide range of clinical tasks, learner-driven emphasis, and the facilitation of more targeted specific and global feedback.…”

Section: Mcmapmentioning

confidence: 99%

“…34 Both resident and faculty reflections on the implementation of this tool have been published. 34,43 Key benefits described by faculty were the inclusion of a wide range of clinical tasks, learner-driven emphasis, and the facilitation of more targeted specific and global feedback. 34 However, the faculty also noted that there was a learning curve associated with the 76 unique assessment instruments.…”

Section: Mcmapmentioning

confidence: 99%

Direct Observation Tools in Emergency Medicine: A Systematic Review of the Literature

Gottlieb¹,

Jordan²,

Siegelman³

et al. 2020

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Objectives: Direct observation is important for assessing the competency of medical learners. Multiple tools have been described in other fields, although the degree of emergency medicine-specific literature is unclear. This review sought to summarize the current literature on direct observation tools in the emergency department (ED) setting. Methods:We searched PubMed, Scopus, CINAHL, the Cochrane Central Register of Clinical Trials, the Cochrane Database of Systematic Reviews, ERIC, PsycINFO, and Google Scholar from 2012 to 2020 for publications on direct observation tools in the ED setting. Data were dual extracted into a predefined worksheet, and quality analysis was performed using the Medical Education Research Study Quality Instrument.Results: We identified 38 publications, comprising 2,977 learners. Fifteen different tools were described. The most commonly assessed tools included the Milestones (nine studies), Observed Structured Clinical Exercises (seven studies), the McMaster Modular Assessment Program (six studies), Queen's Simulation Assessment Test (five studies), and the mini-Clinical Evaluation Exercise (four studies). Most of the studies were performed in a single institution, and there were limited validity or reliability assessments reported. Conclusions:The number of publications on direct observation tools for the ED setting has markedly increased.However, there remains a need for stronger internal and external validity data.

“…The reviewed publications consisted of six different methodologies. Nine studies were quantitative, 12,14,33,36,38,39,41,43,48,56 six were qualitative, 35,37,42,45,47,49 and two included mixed methodologies. 17,34 Many of the remaining publications were conceptual pieces, [50][51][52][53][54][55] innovation reports without results, 8,40 or consensus conference proceedings.…”

Section: The Forms Of Evidencementioning

confidence: 99%

“…17,34,37,52 Assessor training was also recognized as important and necessary for supporting facultydriven collection of learner assessment. 37,52 The paper by Lockyer et al 52 provides a review of the literature addressing collection of WBA data in the context of CBME, highlighting best-practices, and challenges, while offering suggestions to optimize the process.…”

Section: The Forms Of Evidencementioning

confidence: 99%

Workplace‐based Assessment Data in Emergency Medicine: A Scoping Review of the Literature

Chan

Sebok‐Syer

Cheung

et al. 2020

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Objective: In the era of competency-based medical education (CBME), the collection of more and more trainee data is being mandated by accrediting bodies such as the Accreditation Council for Graduate Medical Education and the Royal College of Physicians and Surgeons of Canada. However, few efforts have been made to synthesize the literature around the current issues surrounding workplace-based assessment (WBA) data. This scoping review seeks to synthesize the landscape of literature on the topic of data collection and utilization for trainees' WBAs in emergency medicine (EM). Methods:The authors conducted a scoping review in the style of Arksey and O'Malley, seeking to synthesize and map literature on collecting, aggregating, and reporting WBA data. The authors extracted, mapped, and synthesized literature that describes, supports, and substantiates effective data collection and utilization in the context of the CBME movement within EM.Results: Our literature search retrieved 189 potentially relevant references (after removing duplicates) that were screened to 29 abstracts and papers relevant to collecting, aggregating, and reporting WBAs. Our analysis shows that there is an increasing temporal trend toward contributions in these topics, with the majority of the papers (16/29) being published in the past 3 years alone. Conclusion:There is increasing interest in the areas around data collection and utilization in the age of CBME.The field, however, is only beginning to emerge, leaving more work that can and should be done in this area.M cGaghie and colleagues first proposed competency-based medical education (CBME) in their World Health Organization report in 1978, 1 where they detailed the need to transition from a subjectbased curriculum or even an integrated curriculum to CBME in order to truly produce physicians that "can practice medicine at a defined level of proficiency, in accord with local conditions, to meet local needs." 1 The first step in transitioning to CBME (and realizing its full potential) is to define professional competence and its components. 1 In the late 1990s, medical education took this first step in the form of the Canadian Medical Education Directives for Specialists (Can-MEDS) roles 2,3 and the Accreditation Council for