Making judgments based on reported observations of trainee performance: a scoping review in Health Professions Education
DOI:
https://doi.org/10.36834/cmej.75522Abstract
Background: Educators now use reported observations when assessing trainees’ performance. Unfortunately, they have little information about how to design and implement assessments based on reported observations.
Objective: The purpose of this scoping review was to map the literature on the use of reported observations in judging health professions education (HPE) trainees' performances.
Methods: Arksey and O'Malley’s (2005) method was used with four databases (sources: ERIC, CINAHL, MEDLINE, PsycINFO). Eligibility criteria for articles were: documents in English or French, including primary data, and initial or professional training; (2) training in an HPE program; (3) workplace-based assessment; and (4) assessment based on reported observations. The inclusion/exclusion, and data extraction steps were performed (agreement rate > 90%). We developed a data extraction grid to chart the data. Descriptive analyses were used to summarize quantitative data, and the authors conducted thematic analysis for qualitative data.
Results: Based on 36 papers and 13 consultations, the team identified six steps characterizing trainee performance assessment based on reported observations in HPE: (1) making first contact, (2) observing and documenting the trainee performance, (3) collecting and completing assessment data, (4) aggregating assessment data, (5) inferring the level of competence, and (6) documenting and communicating the decision to the stakeholders.
Discussion: The design and implementation of assessment based on reported observations is a first step towards a quality implementation by guiding educators and administrators responsible for graduating competent professionals. Future research might focus on understanding the context beyond assessor cognition to ensure the quality of meta-assessors’ decisions.
Metrics
References
Gofton W, Dudek N, Barton G, Bhanji F. Workplace-based assessment implementation guide: formative tips for medical teaching practice. R Coll Physicians Surg Can. 2017;1‑12.
Holmboe ES, Sherbino J, Long DM, Swing SR, Frank JR. The role of assessment in competency-based medical education. Med Teach. 2010;32(8):676‑82. https://doi.org/10.3109/0142159X.2010.500704
Gingerich A, Kogan J, Yeates P, Govaerts M, Holmboe E. Seeing the « black box » differently: assessor cognition from three research perspectives. Med Educ. 2014;48(11):1055‑68. https://doi.org/10.1111/medu.12546
Kinnear B, Warm EJ, Hauer KE. Twelve tips to maximize the value of a clinical competency committee in postgraduate medical education. Med Teach. 2018;40(11):1110‑5. https://doi.org/10.1080/0142159X.2018.1474191
Schuwirth LWT, van der Vleuten CPM. A history of assessment in medical education. Adv Health Sci Educ. 2020;25(5):1045‑56. https://doi.org/10.1007/s10459-020-10003-0
van der Vleuten CPM, Schuwirth LWT, Driessen EW, et al. A model for programmatic assessment fit for purpose. Med Teach. 2012;34(3):205‑14. https://doi.org/10.3109/0142159X.2012.652239
Hodges B. Assessment in the post-psychometric era: learning to love the subjective and collective. Med Teach. 2013;35(7):564‑8. https://doi.org/10.3109/0142159X.2013.789134
Colbert CY, French JC, Herring ME, Dannefer EF. Fairness: the hidden challenge for competency-based postgraduate medical education programs. Perspect Med Educ. 2017;6:347‑55. https://doi.org/10.1007/s40037-017-0359-8
Colbert CY, Dannefer EF, French JC. Clinical competency committees and assessment: changing the conversation in graduate medical education. J Grad Med Educ. 2015;7(2):162‑5. https://doi.org/10.4300/JGME-D-14-00448.1
French JC, Dannefer EF, Colbert CY. A systematic approach toward building a fully operational clinical competency committee. J Surg Educ. 2014;71(6):e22‑7. https://doi.org/10.1016/j.jsurg.2014.04.005
Larocque S, Luhanga FL. Exploring the issue of failure to fail in a nursing program. Int J Nurs Educ Scholarsh. 2013;10(1):115‑22. https://doi.org/10.1515/ijnes-2012-0037
Kane M. The argument-based approach to validation. Sch Psychol Rev. 2013;42(4):448‑57. https://doi.org/10.1080/02796015.2013.12087465
Kane MT. Validating the interpretations and uses of test scores. J Educ Meas. 2013;50(1):1‑73. https://doi.org/10.1111/jedm.12000
Zumbo BD, Chan EKH. Validity and validation in social, behavioral, and health sciences. Cham: Springer; 2014. https://doi.org/10.1007/978-3-319-07794-9
Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19‑32. https://doi.org/10.1080/1364557032000119616
Peters MDJ, Marnie C, Tricco AC, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020;18(10):2119‑26. https://doi.org/10.11124/JBIES-20-00167
Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010;5:69. https://doi.org/10.1186/1748-5908-5-69
Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467‑73. https://doi.org/10.7326/M18-0850
Thomas A, Lubarsky S, Durning SJ, Young ME. Knowledge syntheses in medical education: demystifying scoping reviews. Acad Med. 2017;92(2):161‑6. https://doi.org/10.1097/ACM.0000000000001452
Braun V, Clarke V. Can I use TA? Should I use TA? Should I not use TA? Comparing reflexive thematic analysis and other pattern‐based qualitative analytic approaches. Couns Psychother Res. 2021;21(1):37‑47. https://doi.org/10.1002/capr.12360
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77‑101. https://doi.org/10.1191/1478088706qp063oa
Donato AA, Alweis R, Wenderoth S. Design of a clinical competency committee to maximize formative feedback. J Community Hosp Intern Med Perspect JCHIMP. 2016;6(6):33533. https://doi.org/10.3402/jchimp.v6.33533
Moonen-van Loon JMW, Overeem K, Govaerts MJB, Verhoeven BH, van der Vleuten CPM, Driessen EW. The reliability of multisource feedback in competency-based assessment programs: the effects of multiple occasions and assessor groups. Acad Med. 2015;90(8):1093‑9. https://doi.org/10.1097/ACM.0000000000000763
Keeley MG, Gusic ME, Morgan HK, Aagaard EM, Santen SA. Moving toward summative competency assessment to individualize the postclerkship phase. Acad Med. 2019;94(12):1858‑64. https://doi.org/10.1097/ACM.0000000000002830
Hemmer PA, Hawkins R, Jackson JL, Pangaro LN. Assessing how well three evaluation methods detect deficiencies in medical students’ professionalism in two settings of an internal medicine clerkship. Acad Med. 2000;75(2):167‑73. https://doi.org/10.1097/00001888-200002000-00016
Murray KE, Lane JL, Carraccio C, et al. Crossing the gap: using competency-based assessment to determine whether learners are ready for the undergraduate-to-graduate transition. Acad Med. 2019;94(3):338‑45. https://doi.org/10.1097/ACM.0000000000002535
Hicks PJ, Margolis MJ, Carraccio CL, et al. A novel workplace-based assessment for competency-based decisions and learner feedback. Med Teach. 2018;40(11):1143‑50. https://doi.org/10.1080/0142159X.2018.1461204
Rich JV, Fostaty Young S, Donnelly C, et al. Competency-based education calls for programmatic assessment: but what does this look like in practice? J Eval Clin Pract. 2019;26(4):95. https://doi.org/10.1111/jep.13328
Driessen EW, van Tartwijk J, Govaerts M, Teunissen P, van der Vleuten CP. The use of programmatic assessment in the clinical workplace: a Maastricht case report. Med Teach. 2012;34(3):226‑31. https://doi.org/10.3109/0142159X.2012.652242
Cianciolo AT, Hingle S, Hudali T, Beason AM. Evaluating clerkship competency without exams. Clin Teach. 2020;17(6):624‑8. https://doi.org/10.1111/tct.13114
Lass SL, Kornreich HK, Hoffmann KI, Friedman DB. Consistency in ratings of clinical performance of the same students throughout medical school and internship. Annual Conference on Research in Medical Education. Conference on Research in Medical Education. 1977;16:147‑52. PMID: 606069
Perry M, Linn A, Munzer BW, et al. Programmatic assessment in emergency medicine: implementation of best practices. J Grad Med Educ. 2018;10(1):84‑90. https://doi.org/10.4300/JGME-D-17-00094.1
Helminen K, Tossavainen K, Turunen H. Assessing clinical practice of student nurses: views of teachers, mentors and students. Nurse Educ Today. 2014;34(8):1161‑6. https://doi.org/10.1016/j.nedt.2014.04.007
Duitsman ME, Fluit CRMG, van der Goot WE, et al. Judging residents’ performance: a qualitative study using grounded theory. BMC Med Educ. 2019;19(1):13. https://doi.org/10.1186/s12909-018-1446-1
Hemmer PA, Dadekian GA, Terndrup C, et al. Regular formal evaluation sessions are effective as frame-of-reference training for faculty evaluators of clerkship medical students. J Gen Intern Med. 2015;30(9):1313‑8. https://doi.org/10.1007/s11606-015-3294-6
Yonge O, Myrick F, Ferguson LM. Preceptored students in rural settings want feedback. Int J Nurs Educ Scholarsh. 2011;8(1). https://doi.org/10.2202/1548-923X.2047
Battistone M, Pendleton B, Milne C, et al. Global descriptive evaluations are more responsive than global numeric ratings in detecting students’ progress during the inpatient portion of an internal medicine clerkship. Acad Med. 2001;76(10):S105‑7. https://doi.org/10.1097/00001888-200110001-00035
Wu XV, Enskär K, Pua LH, Heng DGN, Wang W. Clinical nurse leaders’ and academics’ perspectives in clinical assessment of final‐year nursing students: a qualitative study. Nurs Health Sci. 2017;19(3):287‑93. https://doi.org/10.1111/nhs.12342
Borman KR, Augustine R, Leibrandt T, Pezzi CM, Kukora JS. Initial performance of a modified milestones global evaluation tool for semiannual evaluation of residents by faculty. J Surg Educ. 2013;70(6):739‑49. https://doi.org/10.1016/j.jsurg.2013.08.004
Hauer KE, Chesluk B, Iobst W, et al. Reviewing residents’ competence: a qualitative study of the role of clinical competency committees in performance assessment. Acad Med. 2015;90(8):1084‑92. https://doi.org/10.1097/acm.0000000000000736
Goodyear HM, Lakshminarayana I, Wall D, Bindal T. A multisource feedback tool to assess ward round leadership skills of senior paediatric trainees: (2) Testing reliability and practicability. Postgrad Med J. 2015;91(1075):268‑73. https://doi.org/10.1136/postgradmedj-2015-133308
Ekpenyong A, Baker E, Harris I, et al. How do clinical competency committees use different sources of data to assess residents’ performance on the internal medicine milestones? A mixed methods pilot study. Med Teach. 2017;39(10):1074‑83. https://doi.org/10.1080/0142159X.2017.1353070
Swing SR, Clyman SG, Holmboe ES, Williams RG. Advancing resident assessment in graduate medical education. J Grad Med Educ. 2009;1(2):278‑86. https://doi.org/10.4300/JGME-D-09-00010.1
Berger JS, Pan E, Thomas J. A randomized, controlled crossover study to discern the value of 360-degree versus traditional, faculty-only evaluation for performance improvement of anesthesiology residents. J Educ Perioper Med JEPM. 2009;11(2):E053. https://doi.org/10.46374/volxi-issue2-berger
Nabors C, Forman L, Peterson SJ, et al. Milestones: a rapid assessment method for the Clinical Competency Committee. Arch Med Sci. 2017;13(1):201‑9. https://doi.org/10.5114/aoms.2016.64045
Chan TM, Sherbino J, Mercuri M. Nuance and noise: lessons learned from longitudinal aggregated assessment data. J Grad Med Educ. 2017;9(6):724‑9. https://doi.org/10.4300/JGME-D-17-00086.1
Hauer KE, Clauser J, Lipner RS, et al. The internal medicine reporting milestones: cross-sectional description of initial implementation in U.S. residency programs. Ann Intern Med. 2016;165(5):356‑62. https://doi.org/10.7326/M15-2411
Friedman KA, Balwan S, Cacace F, Katona K, Sunday S, Chaudhry S. Impact on house staff evaluation scores when changing from a Dreyfus- to a Milestone-based evaluation model: one internal medicine residency program’s findings. Med Educ Online. 2014;19(1). https://doi.org/10.3402/meo.v19.25185
Aagaard E, Kane GC, Conforti L, et al. Early feedback on the use of the internal medicine reporting milestones in assessment of resident performance. J Grad Med Educ. 2013;5(3):433‑8. https://doi.org/10.4300/JGME-D-13-00001.1
Chan TM, Sebok-Syer SS, Sampson C, Monteiro S. The quality of assessment of learning (Qual) score: validity evidence for a scoring system aimed at rating short, workplace-based comments on trainee performance. Teach Learn Med. 2020;32(3):319‑29. https://doi.org/10.1080/10401334.2019.1708365
Ogunyemi D, Eno M, Rad S, Fong A, Alexander C, Azziz R. Evaluating professionalism, practice-based learning and improvement, and systems-based practice: utilization of a compliance form and correlation with conflict styles. J Grad Med Educ. 2010;2(3):423‑9. https://doi.org/10.4300/JGME-D-10-00048.1
Engström M, Löfmark A, Vae KJU, Mårtensson G. Nursing students’ perceptions of using the Clinical Education Assessment tool AssCE and their overall perceptions of the clinical learning environment - A cross-sectional correlational study. Nurse Educ Today. 2017;51:63‑7. https://doi.org/10.1016/j.nedt.2017.01.009
Park YS, Zar FA, Norcini JJ, Tekian A. Competency evaluations in the next accreditation system: contributing to guidelines and implications. Teach Learn Med. 2016;28(2):135‑45. https://doi.org/10.1080/10401334.2016.1146607
Watson RS, Borgert AJ, O Heron CT, et al. A multicenter prospective comparison of the accreditation council for graduate medical education milestones: clinical competency committee vs. resident self-assessment. J Surg Educ. 2017;74(6):e8‑14. https://doi.org/10.1016/j.jsurg.2017.06.009
Ginsburg S, Regehr G, Lingard L, Eva KW. Reading between the lines: faculty interpretations of narrative evaluation comments. Med Educ. 2015;49(3):296‑306. https://doi.org/10.1111/medu.12637
Douglass KA, Jacquet GA, Hayward AS, et al. Development of a global health milestones tool for learners in emergency medicine: a pilot project. AEM Educ Train. 2017;1(4):269‑79. https://doi.org/10.1002/aet2.10046
Bartlett KW, Whicker SA, Bookman J, et al. Milestone-based assessments are superior to likert-type assessments in illustrating trainee progression. J Grad Med Educ. 2015;7(1):75‑80. https://doi.org/10.4300/JGME-D-14-00389.1
The Royal College of Physicians and Surgeons of Canada. CanMEDS Milestones. Ottawa (ON): The Royal College of Physicians and Surgeon of Canada; 2015. Available from: https://canmeds.royalcollege.ca/en/milestones
Marceau M, Gallagher F, Young M, St-Onge C. Validity as a social imperative for assessment in health professions education: a concept analysis. Med Educ. 2018;52(6):641‑53. https://doi.org/10.1111/medu.13574
American Educational Research Association., American Psychological Association., National Council on Measurement in Education., Joint Committee on Standards for Educational and Psychological Testing (U.S.). Standards for educational and psychological testing. Washington (DC): American Educational Research Association; 2014.
Gauthier G, St‐Onge C, Tavares W. Rater cognition: review and integration of research findings. Med Educ. 2016;50(5):511‑22. https://doi.org/10.1111/medu.12973
St-Onge C, Chamberland M, Lévesque A, Varpio L. Expectations, observations, and the cognitive processes that bind them: expert assessment of examinee performance. Adv Health Sci Educ. 2016;21:627‑42. https://doi.org/10.1007/s10459-015-9656-3
Govaerts M, van der Vleuten CPM. Validity in work‐based assessment: expanding our horizons. Med Educ. 2013;47(12):1164‑74. https://doi.org/10.1111/medu.12289
Kogan JR, Conforti L, Bernabeo E, Iobst W, Holmboe E. Opening the black box of clinical skills assessment via observation: a conceptual model. Med Educ. 2011;45(10):1048‑60. https://doi.org/10.1111/j.1365-2923.2011.04025.x
Yeates P, Cardell J, Byrne G, Eva KW. Relatively speaking: contrast effects influence assessors’ scores and narrative feedback. Med Educ. 2015;49(9):909‑19. https://doi.org/10.1111/medu.12777
Lee V, Brain K, Martin J. From opening the ‘black box’ to looking behind the curtain: cognition and context in assessor-based judgements. Adv Health Sci Educ. 2019;24:85‑102. https://doi.org/10.1007/s10459-018-9851-0
Pack R, Lingard L, Watling CJ, Chahine S, Cristancho SM. Some assembly required: tracing the interpretative work of Clinical Competency Committees. Med Educ. 2019;53(7):723‑34. https://doi.org/10.1111/medu.13884
Hauer KE, Cate O ten, Boscardin CK, et al. Ensuring resident competence: a narrative review of the literature on group decision making to inform the work of Clinical Competency Committees. J Grad Med Educ. 2016;8(2):156‑64. https://doi.org/10.4300/JGME-D-15-00144.1
Cheung WJ, Patey AM, Frank JR, Mackay M, Boet S. Barriers and enablers to direct observation of trainees’ clinical performance: a qualitative study using the theoretical domains framework. Acad Med. 2019;94(1):101‑14. https://doi.org/10.1097/ACM.0000000000002396
Watling C, LaDonna KA, Lingard L, Voyer S, Hatala R. ‘Sometimes the work just needs to be done’: socio‐cultural influences on direct observation in medical training. Med Educ. 2016;50(10):1054‑64. https://doi.org/10.1111/medu.13062
St-Onge C. Enjeux et défis de l’évaluation longitudinale: quelques pistes de réflexion préalables à son implantation. Pédagogie Médicale. 2018;19(3):137‑42. https://doi.org/10.1051/pmed/2019022
Madan R, Conn D, Dubo E, Voore P, Wiesenfeld L. The enablers and barriers to the use of direct observation of trainee clinical skills by supervising faculty in a psychiatry residency program. Can J Psychiatry. 2012;57(4):269‑72. https://doi.org/10.1177/070674371205700411
Kogan JR, Conforti LN, Yamazaki K, Iobst W, Holmboe ES. Commitment to change and challenges to implementing changes after workplace-based assessment rater training. Acad Med. 2017;92(3):394‑402. https://doi.org/10.1097/ACM.0000000000001319
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Patricia Blanchette, Marie-Eve Poitras, Audrey-Ann Lefebvre, Christina St-Onge
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Submission of an original manuscript to the Canadian Medical Education Journal will be taken to mean that it represents original work not previously published, that it is not being considered elsewhere for publication. If accepted for publication, it will be published online and it will not be published elsewhere in the same form, for commercial purposes, in any language, without the consent of the publisher.
Authors who publish in the Canadian Medical Education Journal agree to release their articles under the Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 Canada Licence. This licence allows anyone to copy and distribute the article for non-commercial purposes provided that appropriate attribution is given. For details of the rights an author grants users of their work, please see the licence summary and the full licence.
