Gingerich Andrea, Kogan Jennifer, Yeates Peter, Govaerts Marjan, Holmboe Eric
Northern Medical Program, University of Northern British Columbia, Prince George, British Columbia, Canada.
Med Educ. 2014 Nov;48(11):1055-68. doi: 10.1111/medu.12546.
Performance assessments, such as workplace-based assessments (WBAs), represent a crucial component of assessment strategy in medical education. Persistent concerns about rater variability in performance assessments have resulted in a new field of study focusing on the cognitive processes used by raters, or more inclusively, by assessors.
An international group of researchers met regularly to share and critique key findings in assessor cognition research. Through iterative discussions, they identified the prevailing approaches to assessor cognition research and noted that each of them were based on nearly disparate theoretical frameworks and literatures. This paper aims to provide a conceptual review of the different perspectives used by researchers in this field using the specific example of WBA.
Three distinct, but not mutually exclusive, perspectives on the origins and possible solutions to variability in assessment judgements emerged from the discussions within the group of researchers: (i) the assessor as trainable: assessors vary because they do not apply assessment criteria correctly, use varied frames of reference and make unjustified inferences; (ii) the assessor as fallible: variations arise as a result of fundamental limitations in human cognition that mean assessors are readily and haphazardly influenced by their immediate context, and (iii) the assessor as meaningfully idiosyncratic: experts are capable of making sense of highly complex and nuanced scenarios through inference and contextual sensitivity, which suggests assessor differences may represent legitimate experience-based interpretations.
Although each of the perspectives discussed in this paper advances our understanding of assessor cognition and its impact on WBA, every perspective has its limitations. Following a discussion of areas of concordance and discordance across the perspectives, we propose a coexistent view in which researchers and practitioners utilise aspects of all three perspectives with the goal of advancing assessment quality and ultimately improving patient care.
绩效评估,如基于工作场所的评估(WBA),是医学教育评估策略的关键组成部分。对绩效评估中评分者变异性的持续关注导致了一个新的研究领域,该领域专注于评分者(或更广泛地说,评估者)所使用的认知过程。
一组国际研究人员定期会面,分享和批判评估者认知研究的关键发现。通过反复讨论,他们确定了评估者认知研究的主流方法,并指出每种方法都基于几乎不同的理论框架和文献。本文旨在以WBA为例,对该领域研究人员使用的不同观点进行概念性综述。
在研究人员小组的讨论中,出现了三种关于评估判断变异性的起源和可能解决方案的不同但并非相互排斥的观点:(i)可训练的评估者:评估者存在差异是因为他们没有正确应用评估标准,使用了不同的参照框架并做出了不合理的推断;(ii)易犯错的评估者:变异性是由于人类认知的基本局限性导致的,这意味着评估者很容易且随意地受到其直接环境的影响;(iii)有意义的独特评估者:专家能够通过推理和情境敏感性理解高度复杂和细微的情境,这表明评估者的差异可能代表基于经验的合理诠释。
尽管本文讨论的每种观点都增进了我们对评估者认知及其对WBA影响的理解,但每种观点都有其局限性。在讨论了各观点之间的一致和不一致领域后,我们提出一种共存的观点,即研究人员和从业者利用所有三种观点的各个方面,以提高评估质量并最终改善患者护理。