School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA.
Massachusetts General Hospital, Boston, Massachusetts, USA.
Med Educ. 2022 Dec;56(12):1223-1231. doi: 10.1111/medu.14911. Epub 2022 Aug 23.
Narrative approaches to assessment provide meaningful and valid representations of trainee performance. Yet, narratives are frequently perceived as vague, nonspecific and low quality. To date, there is little research examining factors associated with narrative evaluation quality, particularly in undergraduate medical education. The purpose of this study was to examine associations of faculty- and student-level characteristics with the quality of faculty member's narrative evaluations of clerkship students.
The authors reviewed faculty narrative evaluations of 50 students' clinical performance in their inpatient medicine and neurology clerkships, resulting in 165 and 87 unique evaluations in the respective clerkships. The authors evaluated narrative quality using the Narrative Evaluation Quality Instrument (NEQI). The authors used linear mixed effects modelling to predict total NEQI score. Explanatory covariates included the following: time to evaluation completion, number of weeks spent with student, faculty total weeks on service per year, total faculty years in clinical education, student gender, faculty gender, and an interaction term between student and faculty gender.
Significantly higher narrative evaluation quality was associated with a shorter time to evaluation completion, with NEQI scores decreasing by approximately 0.3 points every 10 days following students' rotations (p = .004). Additionally, women faculty had statistically higher quality narrative evaluations with NEQI scores 1.92 points greater than men faculty (p = .012). All other covariates were not significant.
The quality of faculty members' narrative evaluations of medical students was associated with time to evaluation completion and faculty gender but not faculty experience in clinical education, faculty weeks on service, or the amount of time spent with students. Findings advance understanding on ways to improve the quality of narrative evaluations which are imperative given assessment models that will increase the volume and reliance on narratives.
叙事评估方法为学员表现提供了有意义且有效的描述。然而，叙事常常被认为是模糊、不具体和低质量的。迄今为止，很少有研究探讨与叙事评估质量相关的因素，尤其是在本科医学教育中。本研究的目的是考察教师和学生层面的特征与教师对实习学生的叙事评估质量之间的关联。
作者回顾了 50 名学生在住院内科和神经科实习期间的临床表现的教师叙事评估，分别得出内科和神经科各 165 份和 87 份独特的评估。作者使用叙事评估质量工具（NEQI）评估叙事质量。作者使用线性混合效应模型来预测总 NEQI 评分。解释性协变量包括：评估完成时间、与学生相处的周数、教师每年在服务上的总周数、教师在临床教育中的总年限、学生性别、教师性别以及学生和教师性别的交互项。
评估完成时间较短与叙事评估质量显著相关，评估完成时间每增加 10 天，NEQI 评分下降约 0.3 分（p = 0.004）。此外，女性教师的叙事评估质量明显更高，NEQI 评分比男性教师高 1.92 分（p = 0.012）。所有其他协变量均不显著。
教师对医学生叙事评估的质量与评估完成时间和教师性别有关，但与教师在临床教育方面的经验、教师在服务上的周数或与学生相处的时间无关。这些发现有助于了解提高叙事评估质量的方法，鉴于评估模式将增加叙事的数量并依赖叙事，这些方法是至关重要的。
