Thomas Jenna, Sandefur Benjamin, Colletti James, Mullan Aidan, Homme James
Department of Emergency Medicine University of Michigan Ann Arbor Michigan USA.
Department of Emergency Medicine Mayo Clinic Rochester Minnesota USA.
AEM Educ Train. 2022 Feb 1;6(1):e10721. doi: 10.1002/aet2.10721. eCollection 2022 Feb.
In 2013 the Accreditation Council for Graduate Medical Education (ACGME) introduced "Milestones" designed to nationally standardize the assessment of resident physicians. Previous studies compare resident self-assessment on milestones to faculty assessment, with varying degrees of agreement, but integration of self-assessment into the formative feedback process has not yet been directly studied. This study uses a conceptual framework of self-determination theory, integrated with concepts from adult learning theory, to compare the perception of the feedback quality given in semiannual reviews before and after the incorporation of resident self-assessment into the feedback process.
This was an interventional study conducted in a single emergency medicine residency program at a major academic hospital over 1 calendar year. Residents first engaged in a semiannual review without self-assessment. At subsequent semiannual reviews, residents completed a Milestone-based self-assessment that was provided to the faculty member assigned to conduct their semiannual review. Residents and faculty completed surveys rating perception of feedback quality. Two-sided Wilcoxon signed-rank tests were used in comparison analysis.
One resident did not self-assess prior to the semiannual review and was excluded leaving 25 paired surveys for analysis. Residents found feedback after the self-assessment more actionable (p = 0.013), insightful (p = 0.010), and better overall (p = 0.025). Similarly, faculty felt the feedback they provided was more actionable (p < 0.001), more insightful (p < 0.001), and better communicated (p < 0.001); led to improved resident understanding of milestones (p < 0.001); and were overall more satisfied (p < 0.001). Free-text comments explore pre- and postintervention perceptions of feedback.
Integration of self-assessment into semiannual reviews improves perception of feedback given to residents as perceived by both residents and faculty. Although limited by sample size, the results are promising for a simple, evidence-based intervention to improve feedback during an existing mandated feedback opportunity.
2013年，毕业后医学教育认证委员会（ACGME）引入了“里程碑”，旨在使住院医师的评估在全国范围内标准化。先前的研究将住院医师对里程碑的自我评估与教员评估进行了比较，结果显示出不同程度的一致性，但尚未直接研究将自我评估纳入形成性反馈过程的情况。本研究使用自我决定理论的概念框架，并结合成人学习理论的概念，比较在将住院医师自我评估纳入反馈过程前后，住院医师对半年期评估中所提供反馈质量的看法。
这是一项在一家大型学术医院的单一急诊医学住院医师培训项目中进行的为期1个日历年的干预性研究。住院医师首先进行了一次没有自我评估的半年期评估。在随后的半年期评估中，住院医师完成了基于里程碑的自我评估，并将其提供给负责进行半年期评估的教员。住院医师和教员完成了对反馈质量感知的调查。比较分析采用双侧Wilcoxon符号秩检验。
一名住院医师在半年期评估前未进行自我评估，被排除在外，留下25对配对调查进行分析。住院医师发现自我评估后的反馈更具可操作性（p = 0.013）、更有洞察力（p = 0.010），总体上更好（p = 0.025）。同样，教员认为他们提供的反馈更具可操作性（p < 0.001）、更有洞察力（p < 0.001），并且沟通得更好（p < 0.001）；能提高住院医师对里程碑的理解（p < 0.001）；总体上更满意（p < 0.001）。自由文本评论探讨了干预前后对反馈的看法。
将自我评估纳入半年期评估可改善住院医师和教员对给予住院医师的反馈的看法。尽管受样本量限制，但这些结果对于在现有的强制性反馈机会中进行简单的循证干预以改善反馈很有前景。
