Vaižgėlienė Eglė, Padaiga Žilvinas, Rastenytė Daiva, Tamelis Algimantas, Petrikonis Kęstutis, Fluit Cornelia
Department of Preventive Medicine, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Department of Preventive Medicine, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Medicina (Kaunas). 2017 Dec;53(5):339-347. doi: 10.1016/j.medici.2017.08.002. Epub 2017 Sep 7.
In 2013, all residency programs at the Lithuanian University of Health Sciences were renewed into the competency-based medical education curriculum (CBME). In 2015, we implemented the validated EFFECT questionnaire together with the EFFECT-System for quality assessment of clinical teaching in residency training. The aim of this study was to investigate the influence of characteristics of the resident (year of training) and clinical teacher (gender, age, and type of academic position) on teaching quality, as well as to assess areas for teaching quality improvement.
Residents from 7 different residency study programs filled out 333 EFFECT questionnaires evaluating 146 clinical teachers. We received 143 self-evaluations of clinical teachers using the same questionnaire. Items were scored on a 6-point Likert scale. Main outcome measures were residents' mean overall (MOS), mean subdomain (MSS) and clinical teachers' self-evaluation scores. The overall comparisons of MOS and MSS across study groups and subgroups were done using Student's t test and ANOVA for trend. The intraclass correlation coefficient (ICC) was calculated in order to see how residents' evaluations match with self-evaluations for every particular teacher. To indicate areas for quality improvement items were analyzed subtracting their mean score from the respective (sub)domain score.
MOS for domains of "role modeling", "task allocation", "feedback", "teaching methodology" and "assessment" valued by residents were significantly higher than those valued by teachers (P<0.01). Teachers who filled out self-evaluation questionnaires were rated significantly higher by residents in role modeling subdomains (P<0.05). Male teachers in (sub)domains "role modeling: CanMEDS roles and reflection", "task allocation", "planning" and "personal support" were rated significantly higher than the female teachers (P<0.05). Teachers aged 40 years or younger were rated higher (P<0.01). Residents ratings by type of teachers' academic position almost in all (sub)domains differed significantly (P<0.05). No correlation observed between MOS of a particular teacher and MOS as rated by residents (ICC=0.055, P=0.399). The main areas for improvement were "feedback" and "assessment".
Resident evaluations of clinical teachers are influenced by teachers' age, gender, year of residency training, type of teachers' academic position and whether or not a clinical teacher performed self-evaluation. Development of CBME should be focused on the continuous evaluation of quality, clinical teachers educational support and the implementation of e-portfolio.
2013年，立陶宛健康科学大学的所有住院医师培训项目都更新为基于胜任力的医学教育课程（CBME）。2015年，我们采用经过验证的EFFECT问卷以及EFFECT系统对住院医师培训中的临床教学质量进行评估。本研究旨在调查住院医师特征（培训年份）和临床教师特征（性别、年龄和学术职位类型）对教学质量的影响，并评估教学质量改进的领域。
来自7个不同住院医师培训项目的住院医师填写了333份EFFECT问卷，对146名临床教师进行了评估。我们收到了143份临床教师使用相同问卷进行的自我评价。各项目采用6点李克特量表评分。主要结局指标为住院医师的总体平均得分（MOS）、各子领域平均得分（MSS）以及临床教师的自我评价得分。通过学生t检验和趋势方差分析对各研究组和亚组的MOS和MSS进行总体比较。计算组内相关系数（ICC），以了解住院医师对每位特定教师的评价与自我评价的匹配程度。为了指出质量改进领域，对各项目进行分析，用其平均得分减去相应（子）领域得分。
住院医师对“角色榜样”“任务分配”“反馈”“教学方法”和“评估”等领域的MOS显著高于教师的评价（P<0.01）。填写自我评价问卷的教师在角色榜样子领域得到住院医师的评价显著更高（P<0.05）。在“角色榜样：CanMEDS角色与反思”“任务分配”“规划”和“个人支持”（子）领域，男性教师的评价显著高于女性教师（P<0.05）。40岁及以下的教师评价更高（P<0.01）。根据教师学术职位类型，住院医师的评价在几乎所有（子）领域都存在显著差异（P<0.05）。未观察到特定教师的MOS与住院医师评价的MOS之间存在相关性（ICC=0.055，P=0.399）。主要改进领域为“反馈”和“评估”。
住院医师对临床教师的评价受教师年龄、性别、住院医师培训年份、教师学术职位类型以及临床教师是否进行自我评价的影响。CBME的发展应注重质量的持续评估、临床教师的教育支持以及电子档案袋的实施。
