Reimagining Feedback for the Milestones Era

Ekpenyong, Andem; Zetkulic, Marygrace; Edgar, Laura; Holmboe, Eric S.

doi:10.4300/jgme-d-20-00840.1

Cited by 6 publications

(11 citation statements)

References 26 publications

(39 reference statements)

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“…The CCC should be structured to explicitly incorporate the useful tension between formative and summative assessment, with workplace-based formative assessment gathered through direct observation, multi-source evaluation and feedback, competency coaching, and summative assessment on the specialty-specific Milestones. 39 , 65 , 66 Coaching is the provision of support and instruction by someone acting as a learner advocate. 67 , 68 Coaching provides the opportunity to directly observe trainees and provide specific feedback in an area(s) of competency, moving trainees along the Milestones trajectory towards competence and readiness for independence.…”

Section: How Do Cccs Fare In Fulfilling These Goals?mentioning

confidence: 99%

“…24 , 30 , 67 , 68 , 73 , 74 When coaches serve a dual role of both evaluator and coach on the CCC, this undermines trust and their subsequent ability to serve as a coach. 65 , 75 Frequently, the same CCC member provides both a coach and evaluator perspective, not based on design but on coincidental intersection with individual trainees in the clinical environment; we advocate for these roles to be served by different persons who can provide distinct and individualized perspectives. 30 , 65 , 75 The “Bow Tie Framework” delineates the roles and responsibilities of the resident, competency coach, and evaluator in the CCC process (Fig.…”

Section: How Do Cccs Fare In Fulfilling These Goals?mentioning

confidence: 99%

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Reimagining the Clinical Competency Committee to Enhance Education and Prepare for Competency-Based Time-Variable Advancement

et al. 2022

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Assessing residents and clinical fellows is a high-stakes activity. Effective assessment is important throughout training so that identified areas of strength and weakness can guide educational planning to optimize outcomes. Assessment has historically been underemphasized although medical education oversight organizations have strengthened requirements in recent years. Growing acceptance of competency-based medical education and its logical extension to competency-based time-variable (CB-TV) graduate medical education (GME) further highlights the importance of implementing effective evidence-based approaches to assessment. The Clinical Competency Committee (CCC) has emerged as a key programmatic structure in graduate medical education. In the context of launching a multi-specialty pilot of CB-TV GME in our health system, we have examined several program’s CCC processes and reviewed the relevant literature to propose enhancements to CCCs. We recommend that all CCCs fulfill three core goals, regularly applied to every GME trainee: (1) discern and describe the resident’s developmental status to individualize education, (2) determine readiness for unsupervised practice, and (3) foster self-assessment ability. We integrate the literature and observations from GME program CCCs in our institutions to evaluate how current CCC processes support or undermine these goals. Obstacles and key enablers are identified. Finally, we recommend ways to achieve the stated goals, including the following: (1) assess and promote the development of competency in all trainees, not just outliers, through a shared model of assessment and competency-based advancement; (2) strengthen CCC assessment processes to determine trainee readiness for independent practice; and (3) promote trainee reflection and informed self-assessment. The importance of coaching for competency, robust workplace-based assessments, feedback, and co-production of individualized learning plans are emphasized. Individual programs and their CCCs must strengthen assessment tools and frameworks to realize the potential of competency-oriented education.

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Section: How Do Cccs Fare In Fulfilling These Goals?mentioning

confidence: 99%

Section: How Do Cccs Fare In Fulfilling These Goals?mentioning

confidence: 99%

Reimagining the Clinical Competency Committee to Enhance Education and Prepare for Competency-Based Time-Variable Advancement

et al. 2022

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“… 9 , 10 More recent definitions regard feedback as a coaching activity where supervisors facilitate trainees’ self-reflection to improve performance. 10 , 11 However, the acceptability of feedback by trainees still depends on who provides it, whether it is constructive, the trainee’s assessment literacy and the nature of supervisor-trainee relationships. 5 , 11 …”

Section: Introductionmentioning

confidence: 99%

“… 10 , 11 However, the acceptability of feedback by trainees still depends on who provides it, whether it is constructive, the trainee’s assessment literacy and the nature of supervisor-trainee relationships. 5 , 11 …”

Section: Introductionmentioning

confidence: 99%

“…9,10 More recent definitions regard feedback as a coaching activity where supervisors facilitate trainees' self-reflection to improve performance. 10,11 However, the acceptability of feedback by trainees still depends on who provides it, whether it is constructive, the trainee's assessment literacy and the nature of supervisor-trainee relationships. 5,11 The role of feedback in postgraduate family medicine training http://www.phcfm.org Open Access supervision includes identifying trainees' learning objectives and providing feedback on their personal development plans and progress in their LPs.…”

Section: Introductionmentioning

confidence: 99%

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Evaluating postgraduate family medicine supervisor feedback in registrars’ learning portfolios

Erumeda

George

Jenkins

2022

African Journal of Primary Health Care & Family Medicine

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Background: Postgraduate supervision forms a vital component of decentralised family medicine training. While the components of effective supervisory feedback have been explored in high-income countries, how this construct is delivered in resource-constrained low- to middle-income countries has not been investigated adequately.Aim: This article evaluated supervisory feedback in family medicine registrars’ learning portfolios (LPs) as captured in their learning plans and mini-Clinical Evaluation Exercise (mini-CEX) forms and whether the training district or the year of training affected the nature of the feedback.Setting: Registrars’ LPs from 2020 across five decentralised sites affiliated with the University of the Witwatersrand in South Africa were analysed.Methods: Two modified tools were used to evaluate the quantity of the written feedback in 38 learning plans and 57 mini-CEX forms. Descriptive statistics, Fisher’s exact and Wilcoxon rank-sum tests were used for analysis. Content analysis was used to derive counts of areas of feedback.Results: Most learning plans (61.2%) did not refer to registrars’ clinical knowledge or offer an improvement strategy (86.1%). The ‘extent of supervisors’ feedback’ was rated as ‘poor’ (63.2%), with only 14.0% rated as ‘good.’ The ‘some’ and ‘no’ feedback categories in the mini-CEX competencies (p 0.001 to p = 0.014) and the ‘extent of supervisors’ feedback’ (p 0.001) were significantly associated with training district. Feedback focused less on clinical reasoning and negotiation skills.Conclusion: Supervisors should provide specific and constructive narrative feedback and an action plan to improve registrars’ future performance.Contribution: Supervisory feedback in postgraduate family medicine training needs overall improvement to develop skilled family physicians.

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Using learning analytics in clinical competency committees: Increasing the impact of competency-based medical education

Carney

Sebok‐Syer

Pusic

et al. 2023

Medical Education Online

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Graduate medical education (GME) and Clinical Competency Committees (CCC) have been evolving to monitor trainee progression using competency-based medical education principles and outcomes, though evidence suggests CCCs fall short of this goal. Challenges include that evaluation data are often incomplete, insufficient, poorly aligned with performance, conflicting or of unknown quality, and CCCs struggle to organize, analyze, visualize, and integrate data elements across sources, collection methods, contexts, and time-periods, which makes advancement decisions difficult. Learning analytics have significant potential to improve competence committee decision making, yet their use is not yet commonplace. Learning analytics (LA) is the interpretation of multiple data sources gathered on trainees to assess academic progress, predict future performance, and identify potential issues to be addressed with feedback and individualized learning plans. What distinguishes LA from other educational approaches is systematic data collection and advanced digital interpretation and visualization to inform educational systems. These data are necessary to: 1) fully understand educational contexts and guide improvements; 2) advance proficiency among stakeholders to make ethical and accurate summative decisions; and 3) clearly communicate methods, findings, and actionable recommendations for a range of educational stakeholders. The ACGME released the third edition CCC Guidebook for Programs in 2020 and the 2021 Milestones 2.0 supplement of the Journal of Graduate Medical Education (JGME Supplement) presented important papers that describe evaluation and implementation features of effective CCCs. Principles of LA underpin national GME outcomes data and training across specialties; however, little guidance currently exists on how GME programs can use LA to improve the CCC process. Here we outline recommendations for implementing learning analytics for supporting decision making on trainee progress in two areas: 1) Data Quality and Decision Making, and 2) Educator Development.

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Reimagining Feedback for the Milestones Era

Cited by 6 publications

References 26 publications

Reimagining the Clinical Competency Committee to Enhance Education and Prepare for Competency-Based Time-Variable Advancement

Reimagining the Clinical Competency Committee to Enhance Education and Prepare for Competency-Based Time-Variable Advancement

Evaluating postgraduate family medicine supervisor feedback in registrars’ learning portfolios

Using learning analytics in clinical competency committees: Increasing the impact of competency-based medical education

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