工作场所评估评分员培训后对变革的承诺及实施变革的挑战

Commitment to Change and Challenges to Implementing Changes After Workplace-Based Assessment Rater Training.

作者信息

Kogan Jennifer R, Conforti Lisa N, Yamazaki Kenji, Iobst William, Holmboe Eric S

机构信息

J.R. Kogan is professor of medicine and assistant dean of faculty development, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. L.N. Conforti is research associate for milestones evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois. When this study was conducted, she was research associate for academic programs, American Board of Internal Medicine, Philadelphia, Pennsylvania. K. Yamazaki is outcome assessment project associate, Accreditation Council for Graduate Medical Education, Chicago, Illinois. W. Iobst is vice president for academic and clinical affairs and vice dean, Commonwealth Medical College, Scranton, Pennsylvania. When this study was conducted, he was vice president of academic affairs, American Board of Internal Medicine, Philadelphia, Pennsylvania. E.S. Holmboe is senior vice president for milestones development and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois. When this study was conducted, he was chief medical officer and senior vice president, American Board of Internal Medicine, Philadelphia, Pennsylvania.

出版信息

Acad Med. 2017 Mar;92(3):394-402. doi: 10.1097/ACM.0000000000001319.

DOI:10.1097/ACM.0000000000001319

PMID:27465231

Abstract

PURPOSE

Faculty development for clinical faculty who assess trainees is necessary to improve assessment quality and impor tant for competency-based education. Little is known about what faculty plan to do differently after training. This study explored the changes faculty intended to make after workplace-based assessment rater training, their ability to implement change, predictors of change, and barriers encountered.

METHOD

In 2012, 45 outpatient internal medicine faculty preceptors (who supervised residents) from 26 institutions participated in rater training. They completed a commitment to change form listing up to five commitments and ranked (on a 1-5 scale) their motivation for and anticipated difficulty implementing each change. Three months later, participants were interviewed about their ability to implement change and barriers encountered. The authors used logistic regression to examine predictors of change.

RESULTS

Of 191 total commitments, the most common commitments focused on what faculty would change about their own teaching (57%) and increasing direct observation (31%). Of the 183 commitments for which follow-up data were available, 39% were fully implemented, 40% were partially implemented, and 20% were not implemented. Lack of time/competing priorities was the most commonly cited barrier. Higher initial motivation (odds ratio [OR] 2.02; 95% confidence interval [CI] 1.14, 3.57) predicted change. As anticipated difficulty increased, implementation became less likely (OR 0.67; 95% CI 0.49, 0.93).

CONCLUSIONS

While higher baseline motivation predicted change, multiple system-level barriers undermined ability to implement change. Rater-training faculty development programs should address how faculty motivation and organizational barriers interact and influence ability to change.

摘要

目的

对评估实习生的临床教师进行师资培训，对于提高评估质量以及基于能力的教育至关重要。对于教师在培训后计划做出哪些不同的改变，我们知之甚少。本研究探讨了教师在基于工作场所的评估评分员培训后打算做出的改变、他们实施改变的能力、改变的预测因素以及所遇到的障碍。

方法

2012年，来自26个机构的45名门诊内科教师导师（指导住院医师）参加了评分员培训。他们填写了一份改变承诺表，列出多达五项承诺，并对实施每项改变的动机和预期难度进行评分（1 - 5分）。三个月后，对参与者进行访谈，了解他们实施改变的能力和遇到的障碍。作者使用逻辑回归分析来检验改变的预测因素。

结果

在总共191项承诺中，最常见的承诺集中在教师自身教学方面的改变（57%）以及增加直接观察（31%）。在有后续数据的183项承诺中，39%得到了完全实施，40%得到了部分实施，20%未得到实施。时间不足/相互冲突的优先事项是最常提到的障碍。较高的初始动机（优势比[OR] 2.02；95%置信区间[CI] 1.14，3.57）预测会发生改变。随着预期难度的增加，实施改变的可能性降低（OR 0.67；95% CI 0.49，0.93）。