S. Ginsburg is professor of medicine, Department of Medicine, Sinai Health System and Faculty of Medicine, University of Toronto, scientist, Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada, and Canada Research Chair in Health Professions Education; ORCID: http://orcid.org/0000-0002-4595-6650 .
C.J. Watling is professor and director, 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. 2021 Jul 1;96(7S):S81-S86. doi: 10.1097/ACM.0000000000004089.
The adoption of entrustment ratings in medical education is based on a seemingly simple premise: to align workplace-based supervision with resident assessment. Yet it has been difficult to operationalize this concept. Entrustment rating forms combine numeric scales with comments and are embedded in a programmatic assessment framework, which encourages the collection of a large quantity of data. The implicit assumption that more is better has led to an untamable volume of data that competency committees must grapple with. In this article, the authors explore the roles of numbers and words on entrustment rating forms, focusing on the intended and optimal use(s) of each, with a focus on the words. They also unpack the problematic issue of dual-purposing words for both assessment and feedback. Words have enormous potential to elaborate, to contextualize, and to instruct; to realize this potential, educators must be crystal clear about their use. The authors set forth a number of possible ways to reconcile these tensions by more explicitly aligning words to purpose. For example, educators could focus written comments solely on assessment; create assessment encounters distinct from feedback encounters; or use different words collected from the same encounter to serve distinct feedback and assessment purposes. Finally, the authors address the tyranny of documentation created by programmatic assessment and urge caution in yielding to the temptation to reduce words to numbers to make them manageable. Instead, they encourage educators to preserve some educational encounters purely for feedback, and to consider that not all words need to become data.
使基于工作场所的监督与住院医师评估保持一致。然而，要将这个概念付诸实践一直很困难。委托评级表将数字量表与评论结合在一起，并嵌入到一个计划性评估框架中，该框架鼓励收集大量数据。这种隐含的假设是，更多的数据更好，这导致了数据量难以控制，需要胜任力委员会来处理。在本文中，作者探讨了委托评级表中数字和文字的作用，重点关注了每个元素的预期和最佳用途，特别关注了文字。他们还剖析了将文字用于评估和反馈的双重用途这一有问题的问题。文字具有详细说明、语境化和指导的巨大潜力；为了实现这一潜力，教育者必须明确其使用目的。作者提出了一些可能的方法，通过更明确地将文字与目的联系起来，来调和这些紧张关系。例如，教育者可以将书面评论仅用于评估；创建与反馈不同的评估会议；或者使用同一会议中收集到的不同文字来满足不同的反馈和评估目的。最后，作者探讨了计划性评估所带来的文档泛滥问题，并敦促谨慎对待将文字简化为数字以使其易于管理的诱惑。相反，他们鼓励教育者将一些教育会议纯粹用于反馈，并考虑并非所有文字都需要成为数据。
