Sebok-Syer Stefanie S, Shepherd Lisa, McConnell Allison, Dukelow Adam M, Sedran Robert, Lingard Lorelei
Department of Emergency Medicine at Stanford University School of Medicine Stanford University Palo Alto CA USA.
Division of Emergency Medicine at Schulich School of Medicine and Dentistry Western University London Ontario Canada.
AEM Educ Train. 2020 Aug 9;5(2):e10501. doi: 10.1002/aet2.10501. eCollection 2021 Apr.
Competency-based medical education requires that residents are provided with frequent opportunities to demonstrate competence as well as receive effective feedback about their clinical performance. To meet this goal, we investigated how data collected by the electronic health record (EHR) might be used to assess emergency medicine (EM) residents' independent and interdependent clinical performance and how such information could be represented in an EM resident report card.
Following constructivist grounded theory methodology, individual semistructured interviews were conducted in 2017 with 10 EM faculty and 11 EM residents across all 5 postgraduate years. In addition to open-ended questions, participants were presented with an emerging list of EM practice metrics and asked to comment on how valuable each would be in assessing resident performance. Additionally, we asked participants the extent to which each metric captured independent or interdependent performance. Data collection and analysis were iterative; analysis employed constant comparative inductive methods.
Participants refined and eliminated metrics as well as added new metrics specific to the assessment of EM residents (e.g., time between signup and first orders). These clinical practice metrics based on data from our EHR database were organized along a spectrum of independent/interdependent performance. We conclude with discussions about the relationship among these metrics, issues in interpretation, and implications of using EHR for assessment purposes.
Our findings document a systematic approach for developing EM resident assessments, based on EHR data, which incorporate the perspectives of both clinical faculty and residents. Our work has important implications for capturing residents' contributions to clinical performances and distinguishing between independent and interdependent metrics in collaborative workplace-based settings.
基于胜任力的医学教育要求为住院医师提供频繁的机会来展示其胜任力，并就其临床绩效获得有效的反馈。为实现这一目标，我们研究了如何利用电子健康记录（EHR）收集的数据来评估急诊医学（EM）住院医师的独立和协作临床表现，以及此类信息如何在EM住院医师报告卡中呈现。
遵循建构主义扎根理论方法，2017年对5个研究生年级的10名EM教员和11名EM住院医师进行了个人半结构化访谈。除了开放式问题外，还向参与者展示了一份新兴的EM实践指标清单，并要求他们就每项指标在评估住院医师绩效方面的价值发表评论。此外，我们还询问参与者每项指标在多大程度上反映了独立或协作表现。数据收集和分析是迭代的；分析采用持续比较归纳法。
参与者对指标进行了完善和筛选，并添加了特定于评估EM住院医师的新指标（例如，挂号到首次开医嘱的时间）。这些基于我们EHR数据库数据的临床实践指标是按照独立/协作表现的范围进行组织的。我们最后讨论了这些指标之间的关系、解释中的问题以及将EHR用于评估目的的意义。
我们的研究结果记录了一种基于EHR数据制定EM住院医师评估的系统方法，该方法纳入了临床教员和住院医师的观点。我们的工作对于捕捉住院医师对临床绩效的贡献以及在基于工作场所的协作环境中区分独立和协作指标具有重要意义。
