Resident burnout: evaluating the role of the learning environment

Vendeloo, Stefan N. van; Godderis, Lode; Brand, Paul; Verheyen, Kees C. P. M.; Rowell, Suria A.; Hoekstra, Harm

doi:10.1186/s12909-018-1166-6

Cited by 73 publications

(68 citation statements)

References 36 publications

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“…31 Stimulating learner reflection over multiple EPA-based assessments can provide a longitudinal and more meaningful view of development 32 and strengthen learners' confidence, motivation and well-being. 33,34 Thus, in order to enhance residents' sense of competence in CBME, in line with programmatic assessment theory, 7…”

Section: Discussionmentioning

confidence: 98%

“…Furthermore, in order for feedback to truly support competence development, single ‘snapshot’ feedback moments must be aggregated and reflected upon in meaningful ways . Stimulating learner reflection over multiple EPA‐based assessments can provide a longitudinal and more meaningful view of development and strengthen learners' confidence, motivation and well‐being . Thus, in order to enhance residents' sense of competence in CBME, in line with programmatic assessment theory, EPAs should be clearly integrated such that decisions on levels of entrustment are made on the basis of rich, aggregated feedback data and multiple assessments rather than at every individual assessment moment.…”

Section: Discussionmentioning

confidence: 99%

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The impact of entrustment assessments on feedback and learning: Trainee perspectives

et al. 2020

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Context Assessment for and of learning in workplace settings is at the heart of competency‐based medical education. In postgraduate medical education (PGME), entrustable professional activities (EPAs) and entrustment scales are increasingly used to assess competence. However, the educational impacts of these assessment approaches remain unknown. Therefore, this study aimed to explore trainee perceptions regarding the impacts of EPAs and entrustment scales on feedback and learning processes in the clinical setting. Methods Four focus groups were conducted with postgraduate trainees in anaesthesia, emergency medicine, general internal medicine and nephrology at McMaster University in Hamilton, Ontario, Canada. Data collection and analysis were informed by principles of constructivist grounded theory. Results Entrustable professional activities representing well‐defined tasks are perceived as potentially effective drivers for feedback and learning. Use of EPAs and entrustment scales, however, may augment existing tensions between developmental (for learning) and decision‐making (of learning) assessment functions. Three key dilemmas seem to influence the impact of EPA‐based assessment approaches on residents' learning: (a) standardisation of outcomes versus flexibility in assessment to align with individual learning experiences; (b) assessment tasks focusing on performance standards versus opportunities for learning, and (c) feedback focusing on numeric entrustment scores versus narrative and dialogue. Use of entrustment as an assessment outcome may impact trainees' motivation and feelings of self‐efficacy, further enhancing tensions between learning and performance. Conclusions Entrustable professional activities and entrustment scales may support assessment for learning in PGME. However, their successful implementation requires the careful management of dilemmas that arise in EPA‐based assessment in order to support competence development.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

The impact of entrustment assessments on feedback and learning: Trainee perspectives

et al. 2020

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“…4 Department of Gastroenterology, Isala Hospital, Zwolle, the Netherlands. 5 MCL Academy, Medical Center Leeuwarden, Leeuwarden, the Netherlands.…”

Section: Abbreviationsmentioning

confidence: 99%

Reliability of residents’ assessments of their postgraduate medical education learning environment: an observational study

Brand

Rosingh

Meijssen

et al. 2019

Preprint

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Background. Even in anonymous evaluations of a postgraduate medical education (PGME) program, residents may be reluctant to provide an honest evaluation of their PGME program, because they fear embarrassment or repercussions from their supervisors if their anonymity as a respondent is endangered. This study was set up to test the hypothesis that current residents in a PGME program provide more positive evaluations of their PGME program than residents having completed it. We therefore compared PGME learning environment evaluations of current residents in the program to leaving residents having completed it. Methods. This observational study used data gathered routinely in the quality cycle of PGME programs at two Dutch teaching hospitals to test our hypothesis. At both hospitals, all current PGME residents are requested to complete the Scan of Postgraduate Education Environment Domains (SPEED) annually. Residents leaving the hospital after completion of the PGME program are also asked to complete the SPEED after an exit interview with the hospital’s independent residency coordinator. All SPEED evaluations are collected and analysed anonymously. We compared the residents’ grades (on a continuous scale ranging from 0 (poor) to 10 (excellent)) on the three SPEED domains (content, atmosphere, and organization of the program) and their mean (overall department grade) between current and leaving residents. Results. Mean (SD) overall SPEED department grades were 8.00 (0.52) for 287 current residents in 39 PGME programs and 8.07 (0.48) for 170 leaving residents in 39 programs. Neither the overall SPEED department grades (t test, p=0.53, 95% CI for difference -0.16 to 0.31) nor the department SPEED domain grades (MANOVA, F(3, 62)=0.79, p=0.51) were significantly different between current and leaving residents. Conclusions. Residents leaving the program did not provide more critical evaluations of their PGME learning environment than current residents in the program. This suggests that current residents’ evaluations of their postgraduate learning environment were not affected by social desirability bias or fear of repercussions from faculty.

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“…Residencies grapple with strategies that can simultaneously uphold the two ends. [1][2][3][4][5][6] An increasing body of evidence supports the premise that resident engagement in re ection and selfassessment improves learning. [7][8][9][10][11] There is also evidence that learning from peers may be equal to or more effective than learning from an attending.…”

Section: Introductionmentioning

confidence: 99%

Explicating Practice Norms and Tensions Between Values in Resident Training in Family Medicine

Achkar

2020

Preprint

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Background. Residency programs have the intricate and complex role of training health care providers. But little is known about what residents and attendings consider norms of practice or the tensions among different values residents are expected to uphold. Thus, dialogical and reflective frameworks are being explored for resident learning.Methods. This study examined the use of facilitated conversations with groups of residents and attending physicians while reviewing video-recorded resident–patient interactions. The conversations were recorded, transcribed, and qualitatively analyzed.Results. A total of 24 residents and 10 attendings participated in conversations while separately and in parallel groups reviewing 15 resident sessions. Residents explicated the norms of practice and evaluated their performance, which often agreed with those of attending physicians in calling out important learning opportunities. When disagreement occurred, residents’ explications of their reasoning were often relevant and, via reflection and dialogue, helped clarify intentions that were not apparent in the videos. Residents and attendings often judged actions on more than one domain of value. For instance, if a resident addressed problems, built relationships in a timely manner, and acted autonomously without jeopardizing the quality of care, she satisfactorily performed her duty.Conclusions. Practice norms and value struggles were addressed by participants during reviews, which provided a promising framework for learning and assessment. Also, the non-hierarchical structure opened space to acknowledge a diversity of positions and for tensions among values to be explicated.

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Resident burnout: evaluating the role of the learning environment

Cited by 73 publications

References 36 publications

The impact of entrustment assessments on feedback and learning: Trainee perspectives

The impact of entrustment assessments on feedback and learning: Trainee perspectives

Reliability of residents’ assessments of their postgraduate medical education learning environment: an observational study

Explicating Practice Norms and Tensions Between Values in Resident Training in Family Medicine

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