Rassos James, Ginsburg Shiphra, Stalmeijer Renée E, Melvin Lindsay J
J. Rassos is assistant professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
S. Ginsburg is professor, Department of Medicine, and scientist, Wilson Centre for Education, University of Toronto, Toronto, Ontario, Canada.
Acad Med. 2022 May 1;97(5):711-717. doi: 10.1097/ACM.0000000000004552. Epub 2022 Apr 27.
With the introduction of competency-based medical education, senior residents have taken on a new, formalized role of completing assessments of their junior colleagues. However, no prior studies have explored the role of near-peer assessment within the context of entrustable professional activities (EPAs) and competency-based medical education. This study explored internal medicine residents' perceptions of near-peer feedback and assessment in the context of EPAs.
Semistructured interviews were conducted from September 2019 to March 2020 with 16 internal medicine residents (8 first-year residents and 8 second- and third-year residents) at the University of Toronto, Toronto, Ontario, Canada. Interviews were conducted and coded iteratively within a constructivist grounded theory approach until sufficiency was reached.
Senior residents noted a tension in their dual roles of coach and assessor when completing EPAs. Senior residents managed the relationship with junior residents to not upset the learner and potentially harm the team dynamic, leading to the documentation of often inflated EPA ratings. Junior residents found senior residents to be credible providers of feedback; however, they were reticent to find senior residents credible as assessors.
Although EPAs have formalized moments of feedback, senior residents struggled to include constructive feedback comments, all while knowing the assessment decisions may inform the overall summative decision of their peers. As a result, EPA ratings were often inflated. The utility of having senior residents serve as assessors needs to be reexamined because there is concern that this new role has taken away the benefits of having a senior resident act solely as a coach.
随着基于胜任力的医学教育的引入，高级住院医师承担了一项新的、正式的任务，即对初级同事进行评估。然而，此前尚无研究在可托付专业活动（EPA）和基于胜任力的医学教育背景下探讨近伴评估的作用。本研究探讨了内科住院医师对EPA背景下近伴反馈和评估的看法。
2019年9月至2020年3月，对加拿大多伦多大学的16名内科住院医师（8名一年级住院医师和8名二、三年级住院医师）进行了半结构化访谈。采用建构主义扎根理论方法进行访谈并反复编码，直至达到饱和。
高级住院医师指出，在完成EPA时，他们作为教练和评估者的双重角色存在紧张关系。高级住院医师管理与初级住院医师的关系，以免让学习者不安并可能损害团队动态，导致EPA评分往往被夸大。初级住院医师认为高级住院医师是可靠的反馈提供者；然而，他们不愿认为高级住院医师作为评估者是可靠的。
尽管EPA有正式的反馈环节，但高级住院医师难以给出建设性的反馈意见，同时他们也知道评估决定可能会影响对同行的总体总结性决定。结果，EPA评分往往被夸大。高级住院医师担任评估者的效用需要重新审视，因为有人担心这一新角色剥夺了高级住院医师单纯担任教练的好处。
