Examining the barriers to meaningful assessment and feedback in medical training

McQueen, Sydney; Petrisor, Bradley; Bhandari, Mohit; Fahim, Christine; McKinnon, Victoria; Sonnadara, Ranil

doi:10.1016/j.amjsurg.2015.10.002

Cited by 56 publications

(55 citation statements)

References 28 publications

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“…Yet in spite of all of its (theoretical) merits, assessment as a method has proven difficult to implement in practice. Other qualitative studies have shown that the perception and use of work-place-based assessment is often less than optimal for a number of reasons: Assessment results are not considered proof of clinical competency, 46 attachment of learning value to assessment is limited, 47,48 there is reluctance to provide constructive feedback to trainees, 49 and there is an overall negative attitude towards assessment among both trainers and trainees. 28,47,50,51 Our study adds the perspective that while formative assessment methods may in principle be beneficial for learning and patient safety, actually using assessment in the clinic can be a muddled, emotional, and inconvenient process where multiple agendas converge, and doctors may re-articulate, negotiate, and resist using the formative assessment methods as intended.…”

Section: Discussionmentioning

confidence: 99%

How are formative assessment methods used in the clinical setting? A qualitative study

Andreassen

Malling

2019

Int J Med Educ

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Objective: To explore how formative assessment methods are used and perceived by second-year junior doctors in different clinical settings. Methods: A focused ethnography study was carried out. Ten second-year junior doctors from different specialties were selected using purposive sampling. The junior doctors were observed during a day in their clinical workplace where formative assessment was in focus. They were subsequently phone interviewed using a semi-structured interview guide regarding their experiences and attitudes towards formative assessment. Field notes from observations and interview transcriptions were analyzed using an inductive content analysis approach, and the concept of "everyday resistance" was used as a theoretical lens. Results: Three themes were identified: First, there were several barriers to the use of formative assessment methods in the clinical context, including subtle tactics of everyday resistance such as avoidance, deprioritizing, and contesting formative assessment methods. Secondly, junior doctors made careful selections when arranging a formative assessment. Finally, junior doctors had ambiguous attitudes towards the use of mandatory formative assessment methods and mixed experiences with their educational impact. Conclusions: This study emphasizes that the use of formative assessment methods in the clinical setting is not a neutral and context-independent exercise, but rather is affected by a myriad of factors such as collegial relations, educational traditions, emotional issues, and subtle forms of resistance. An important implication for the health care sector will be to address these issues for formative assessment methods to be properly implemented in the clinic.

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Section: Discussionmentioning

confidence: 99%

How are formative assessment methods used in the clinical setting? A qualitative study

Andreassen

Malling

2019

Int J Med Educ

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“…Senior registrars reported that they received intermittent feedback and the heavy clinical workload they had to bear impacted on the time they had for studying and to reflect on feedback (McQueen et al 2016;Shrivastava, Shrivastava and Ramasamy 2014;Cantillon and Sargeant 2008).…”

Section: Discussionmentioning

confidence: 99%

Effects of demographic factors on provision of feedback in postgraduate medical education

Bagwandeen

Singaram²

2017

SAJHE

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A key element in the process of clinical medical education is the process of providing feedback by comparing the directly observed performance of postgraduate doctors training to become specialists to that of a previously identified and communicated 'gold standard' and incorporating a plan for improvement. This is regarded as crucial to enhance clinical competencies. Hence, a greater understanding of the clinical educational environment and the various factors that impact on the giving and receiving of feedback within such a setting is required. A mixed methods approach was adopted for this observational study regarding the perceptions of the quality of feedback given and received at a large multicultural teaching hospital. Relationships between demographics and certain important aspects of the provision of feedback were observed which impact on the context in which feedback is given and received. The study found that appropriate strategies should be implemented to improve teaching capacity of consultants, together with gender empowerment and academic support programmes for registrars.

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“…Since Dudek and colleagues' seminal 'failure to fail' article 1 in 2005, a steady stream of findings have shown that assessors can often resist providing below-average ratings and writing comments that might be interpreted negatively, even when unsatisfactory clinical performance has been recognised. [2][3][4][5][6][7][8][9][10][11] Assessors are concerned that low ratings and constructive comments will be perceived as confrontational, 12 a type of harassment, 9 a form of punishment 5 or negatively overwhelming to the trainee. 13 Grade inflation, 14 delayed submission of assessments 6 and use of informal backchannels to circumvent formal assessment documentation 15 continue amidst the implementation of counterstrategies.…”

Section: Introductionmentioning

confidence: 99%

Seeing but not believing: Insights into the intractability of failure to fail

et al. 2020

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Context: Inadequate documentation of observed trainee incompetence persists despite research-informed solutions targeting this failure to fail phenomenon. Documentation could be impeded if assessment language is misaligned with how supervisors conceptualise incompetence. Because frameworks tend to itemise competence as well as being vague about incompetence, assessment design may be improved by better understanding and describing of how supervisors experience being confronted with a potentially incompetent trainee. Methods: Following constructivist grounded theory methodology, analysis using a constant comparison approach was iterative and informed data collection. We interviewed 22 physicians about their experiences supervising trainees who demonstrate incompetence; we quickly found that they bristled at the term 'incompetence,' so we began to use 'underperformance' in its place. Results: Physicians began with a belief and an expectation: all trainees should be capable of learning and progressing by applying what they learn to subsequent clinical experiences. Underperformance was therefore unexpected and evoked disbelief in supervisors, who sought alternate explanations for the surprising evidence. Supervisors conceptualised underperformance as: an inability to engage with learning due to illness, a life event or learning disorders, so that progression was stalled, or an unwillingness to engage with learning due to lack of interest, insight or humility. Conclusion: Physicians conceptualise underperformance as problematic progression due to insufficient engagement with learning that is unresponsive to intensified supervision. Although failure to fail tends to be framed as a reluctance to document underperformance, the prior phase of disbelief prevents confident documentation of performance and delays identification of underperformance. The findings offer further insight and possible new solutions to address under-documentation of underperformance. | 1149 GINGERICH Et al.

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Examining the barriers to meaningful assessment and feedback in medical training

Cited by 56 publications

References 28 publications

How are formative assessment methods used in the clinical setting? A qualitative study

How are formative assessment methods used in the clinical setting? A qualitative study

Effects of demographic factors on provision of feedback in postgraduate medical education

Seeing but not believing: Insights into the intractability of failure to fail

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