S.S. Sebok-Syer is instructor, Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California; ORCID: http://orcid.org/0000-0002-3572-5971. M. Goldszmidt is professor, Department of Medicine, and associate director and scientist, Centre for Education, Research, and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; ORCID: https://orcid.org/0000-0002-5861-5222. C.J. Watling is professor, Departments of Clinical Neurological Sciences and Oncology, associate dean, Postgraduate Medical Education, and scientist, Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; ORCID: https://orcid.org/0000-0001-9686-795X. S. Chahine is assistant professor, Department of Medicine and Faculty of Education, and scientist, Centre for Education, Research, and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; ORCID: https://orcid.org/0000-0003-0488-773X. S.L. Venance is associate professor, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; ORCID: https://orcid.org/0000-0003-4146-2263. L. Lingard is professor, Department of Medicine and Faculty of Education, and founding director and senior scientist, Centre for Education, Research, and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; ORCID: https://orcid.org/0000-0002-1524-0723.
Acad Med. 2019 Jun;94(6):853-860. doi: 10.1097/ACM.0000000000002672.
Novel approaches are required to meet assessment demands and cultivate authentic feedback in competency-based medical education. One potential source of data to help meet these demands is the electronic health record (EHR). However, the literature offers limited guidance regarding how EHR data could be used to support workplace teaching and learning. Furthermore, given its sheer volume and availability, there exists a risk of exploiting the educational potential of EHR data. This qualitative study examined how EHR data might be effectively integrated and used to support meaningful assessments of residents' clinical performance.
Following constructivist grounded theory, using both purposive and theoretical sampling, in 2016-2017 the authors conducted individual interviews with 11 clinical teaching faculty and 10 senior residents across 12 postgraduate specialties within the Schulich School of Medicine and Dentistry at Western University. Constant comparative inductive analysis was conducted.
Analysis identified key issues related to affordances and challenges of using EHRs to assess resident performance. These include the nature of EHR data; the potential of using EHR data for assessment; and the dangers of using EHR data for assessment. Findings offer considerations for using EHR data to assess resident performance in appropriate and meaningful ways.
EHR data have potential to support formative assessment practices and guide feedback discussions with residents, but evaluators must take context into account. The EHR was not designed with the purpose of assessing resident performance; therefore, adoption and use of these data for educational purposes require careful thought, consideration, and care.
在以能力为基础的医学教育中，需要新的方法来满足评估需求并培养真实的反馈。帮助满足这些需求的一个潜在数据来源是电子健康记录 (EHR)。然而，文献对于如何使用 EHR 数据来支持工作场所的教学和学习提供的指导有限。此外，鉴于其巨大的数量和可用性，存在利用 EHR 数据的教育潜力的风险。这项定性研究考察了如何有效地整合和使用 EHR 数据来支持对居民临床表现进行有意义的评估。
根据建构主义扎根理论，作者在 2016-2017 年使用有目的和理论抽样，对 12 个研究生专业的 11 名临床教学教师和 10 名高级住院医师进行了个人访谈。进行了持续的比较归纳分析。
分析确定了与使用 EHR 评估居民绩效的优势和挑战相关的关键问题。这些问题包括 EHR 数据的性质；使用 EHR 数据进行评估的潜力；以及使用 EHR 数据进行评估的危险。研究结果为以适当和有意义的方式使用 EHR 数据评估居民绩效提供了考虑因素。
EHR 数据有可能支持形成性评估实践并指导与居民的反馈讨论，但评估人员必须考虑背景。EHR 不是为评估居民绩效而设计的；因此，为教育目的而采用和使用这些数据需要仔细考虑、考虑和谨慎。
