S. Burm is education specialist, Centre for Education Research and Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada. S.S. Sebok-Syer is instructor, Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California; ORCID: https://orcid.org/0000-0002-3572-5971. 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 & Dentistry, Western University, London, Ontario, Canada. T. VanHooren is assistant professor, Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada. S. Chahine is assistant professor, Department of Medicine and Faculty of Education, and scientist, Centre for Education Research and Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; ORCID: https://orcid.org/0000-0003-0488-773X. M. Goldszmidt is professor, Department of Medicine, and associate director and scientist, Centre for Education Research and Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; ORCID: https://orcid.org/0000-0002-5861-5222. C.J. Watling is professor, Department of Clinical Neurological Sciences and Department of Oncology, associate dean, Postgraduate Medical Education, and scientist, Centre for Education Research and Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; ORCID: https://orcid.org/0000-0001-9686-795X.
Acad Med. 2019 Oct;94(10):1478-1482. doi: 10.1097/ACM.0000000000002771.
Competency-based medical education (CBME) demands that residents be directly observed performing clinical tasks; however, many faculty lack assessment expertise, and some programs lack resources and faculty numbers to fulfill CBME's mandate. To maximize limited faculty resources, the authors explored training and deploying faculty to assess residents in specialties outside their own.
In spring 2017, 10 MD and 2 PhD assessors at a medium-sized medical school in Ontario, Canada, participated in a 4-hour training session, which focused on providing formative assessments of patient handover, a core competency of medical practice. Assessors were deployed to 2 clinical settings outside their own specialty-critical care and pediatrics-each completing 11 to 26 assessments of residents delivering patient handover. Assessors were subsequently interviewed regarding their experiences.
While assessors felt able to judge handover performance outside their specialty, their sense of comfort varied with their own prior experiences in the given settings. Lack of familiarity with the process of handover in a specific setting directly influenced assessors' perceptions of their own credibility. Although assessors identified the potential benefits of cross-specialty assessment, they also cited challenges to sustaining this approach.
Findings indicate a possible "contextual threshold" for cross-specialty assessment: tasks with high context specificity might not be suitable for cross-specialty assessment. Introducing higher-fidelity simulation into the training protocol and ensuring faculty members are remunerated for their time are necessary to establish future opportunities for shared assessment resources across training programs.
以能力为基础的医学教育（CBME）要求住院医师直接进行临床任务的操作；然而，许多教师缺乏评估专业知识，并且一些项目缺乏资源和教师人数来满足 CBME 的要求。为了最大限度地利用有限的教师资源，作者探索了培训和部署教师来评估专业以外的住院医师的方法。
2017 年春季，加拿大安大略省一所中等规模医学院的 10 名医学博士和 2 名哲学博士评估员参加了一个 4 小时的培训课程，该课程侧重于对患者交接的形成性评估，这是医疗实践的核心能力。评估员被部署到他们自己专业以外的 2 个临床环境中——重症监护和儿科——每个环境完成 11 至 26 次对交接患者的住院医师的评估。随后对评估员进行了关于他们经验的访谈。
尽管评估员认为自己能够在专业以外的情况下判断交接表现，但他们的舒适感因自身在特定环境中的先前经验而有所不同。缺乏对特定环境中交接过程的熟悉程度直接影响评估员对自己可信度的看法。尽管评估员认识到跨专业评估的潜在好处，但他们也指出了维持这种方法的挑战。
研究结果表明，跨专业评估可能存在“语境门槛”：具有高度语境特异性的任务可能不适合跨专业评估。在培训协议中引入更高保真度的模拟，并确保教师获得报酬，是在培训计划之间建立共享评估资源的未来机会的必要条件。
