Prideaux Discipline of Clinical Education, Flinders University, SA, Australia.
Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Med Educ. 2021 Sep;55(9):1056-1066. doi: 10.1111/medu.14574. Epub 2021 Jun 23.
Optimising the use of subjective human judgement in assessment requires understanding what makes judgement fair. Whilst fairness cannot be simplistically defined, the underpinnings of fair judgement within the literature have been previously combined to create a theoretically-constructed conceptual model. However understanding assessors' and learners' perceptions of what is fair human judgement is also necessary. The aim of this study is to explore assessors' and learners' perceptions of fair human judgement, and to compare these to the conceptual model.
A thematic analysis approach was used. A purposive sample of twelve assessors and eight post-graduate trainees undertook semi-structured interviews using vignettes. Themes were identified using the process of constant comparison. Collection, analysis and coding of the data occurred simultaneously in an iterative manner until saturation was reached.
This study supported the literature-derived conceptual model suggesting fairness is a multi-dimensional construct with components at individual, system and environmental levels. At an individual level, contextual, longitudinally-collected evidence, which is supported by narrative, and falls within ill-defined boundaries is essential for fair judgement. Assessor agility and expertise are needed to interpret and interrogate evidence, identify boundaries and provide narrative feedback to allow for improvement. At a system level, factors such as multiple opportunities to demonstrate competence and improvement, multiple assessors to allow for different perspectives to be triangulated, and documentation are needed for fair judgement. These system features can be optimized through procedural fairness. Finally, appropriate learning and working environments which considers patient needs and learners personal circumstances are needed for fair judgments.
This study builds on the theory-derived conceptual model demonstrating the components of fair judgement can be explicitly articulated whilst embracing the complexity and contextual nature of health-professions assessment. Thus it provides a narrative to support dialogue between learner, assessor and institutions about ensuring fair judgements in assessment.
为了优化主观人类判断在评估中的使用,需要了解是什么使判断公平。虽然公平不能简单地定义,但文献中公平判断的基础以前曾被结合起来创建一个理论构建的概念模型。然而,了解评估者和学习者对公平的人类判断的看法也是必要的。本研究的目的是探讨评估者和学习者对公平的人类判断的看法,并将其与概念模型进行比较。
采用主题分析方法。十二名评估者和八名研究生学员使用案例进行了半结构式访谈。使用恒比比较法确定主题。数据的收集、分析和编码同时进行,以迭代的方式进行,直到达到饱和。
本研究支持文献中推导的概念模型,即公平是一个多维度的构念,其组成部分包括个体、系统和环境层面。在个体层面上,需要有上下文、纵向收集的证据,这些证据得到叙述的支持,并且处于定义不明确的边界内,这对公平判断至关重要。评估者的灵活性和专业知识是必要的,以解释和审查证据,确定边界,并提供叙述性反馈,以促进改进。在系统层面上,需要有多个机会来展示能力和改进,多个评估者来允许不同的视角进行三角测量,以及文件记录,以实现公平判断。这些系统特征可以通过程序公平来优化。最后,需要有适当的学习和工作环境,考虑到患者的需求和学习者的个人情况,以实现公平判断。
本研究在理论推导的概念模型基础上进一步发展,展示了公平判断的组成部分可以被明确表达,同时也包含了卫生专业评估的复杂性和背景性质。因此,它提供了一个叙述,以支持学习者、评估者和机构之间关于确保评估中公平判断的对话。