Department of Pediatrics and Department of Education, Innovation and Technology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
Diagnosis (Berl). 2022 Sep 8;9(4):476-484. doi: 10.1515/dx-2022-0020. eCollection 2022 Nov 1.
Idiosyncratic approaches to reasoning among teachers and limited reliable workplace-based assessment and feedback methods make teaching diagnostic reasoning challenging. The Assessment of Reasoning Tool (ART) was developed to fill this gap, but its utility and feasibility in providing feedback to residents has not been studied. We evaluated how the ART was used to assess, teach, and guide feedback on diagnostic reasoning to pediatric interns.
We used an integrated mixed-methods approach to evaluate how the ART facilitates the feedback process between clinical teachers and learners. We collected data from surveys of pediatric interns and interviews of hospital medicine faculty at Baylor College of Medicine from 2019 to 2020. Interns completed the survey each time they received feedback from their attending that was guided by the ART. The preliminary intern survey results informed the faculty interview questions. We integrated descriptive statistics of the survey with the thematic analysis of the transcribed interviews.
Survey data (52 survey responses from 38 interns) and transcribed interviews (10 faculty) were analyzed. The ART framework provided a shared mental model which facilitated a feedback conversation. The ART-guided feedback was highly rated in terms of structure, content, and clarity in goal-setting while enabling new learning opportunities. Barriers to using the ART included limited time and inter-faculty variability of its use.
The ART facilitated effective and feasible faculty feedback to interns on their diagnostic reasoning skills.
教师推理的独特方法和有限的可靠基于工作场所的评估和反馈方法使得教学诊断推理具有挑战性。评估推理工具（ART）就是为了弥补这一差距而开发的，但它在为住院医师提供反馈方面的效用和可行性尚未得到研究。我们评估了 ART 如何用于评估、教授和指导对儿科住院医师诊断推理的反馈。
我们采用综合混合方法评估了 ART 如何促进临床教师和学习者之间的反馈过程。我们从 2019 年至 2020 年在贝勒医学院收集了儿科住院医师的调查数据和医院医学教师的访谈数据。每次住院医师从主治医生那里获得由 ART 指导的反馈时，他们都会完成调查。初步的住院医师调查结果为教师访谈问题提供了信息。我们将调查的描述性统计数据与转录访谈的主题分析相结合。
对调查数据（来自 38 名住院医师中的 52 份调查回复）和转录访谈（10 位教师）进行了分析。ART 框架提供了一个共享的心理模型，促进了反馈对话。ART 指导的反馈在结构、内容和目标设定的清晰度方面得到了高度评价，同时为新的学习机会提供了可能。使用 ART 的障碍包括时间有限和其使用的教师间差异。
ART 促进了教师对住院医师诊断推理技能的有效和可行的反馈。
