Prideaux Discipline of Clinical Education, Flinders University, Bedford Park, South Australia, Australia.
Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
Perspect Med Educ. 2023 Aug 24;12(1):338-347. doi: 10.5334/pme.994. eCollection 2023.
Workplace-based assessment occurs in authentic, dynamic clinical environments where reproducible, measurement-based assessments can often not be implemented. In these environments, research approaches that respect these multiple dynamic interactions, such as complexity perspectives, are encouraged. Previous research has shown that fairness in assessment is a nonlinear phenomenon that emerges from interactions between its components and behaves like a complex adaptative system. The aim of this study was to understand the external forces on the complex adaptive system which may disrupt fairness from emerging.
We conducted online focus groups with a purposeful sample of nineteen academic leaders in the Netherlands. We used an iterative approach to collection, analysis and coding of the data and interpreted the results using a lens of complexity, focusing on how individual elements of fairness work in concert to create systems with complex behaviour.
We identified three themes of forces which can disrupt fairness: forces impairing interactivity, forces impairing adaption and forces impairing embeddedness. Within each of these themes, we identified subthemes: assessor and student forces, tool forces and system forces.
Consistent with complexity theory, this study suggests there are multiple forces which can hamper the emergence of fairness. Whilst complexity thinking does not reduce the scale of the challenge, viewing forces through this lens provides insight into why and how these forces are disrupting fairness. This allows for more purposeful, meaningful changes to support the use of fair judgement in assessment in dynamic authentic clinical workplaces.
工作场所评估发生在真实、动态的临床环境中,在这些环境中,通常无法实施可重复、基于测量的评估。在这些环境中,鼓励采用尊重这些多种动态交互的研究方法,例如复杂性视角。先前的研究表明,评估中的公平性是一种非线性现象,它源于其组成部分之间的相互作用,并表现得像一个复杂适应系统。本研究的目的是了解可能破坏公平性出现的复杂适应系统的外部力量。
我们对荷兰的 19 名学术领导者进行了在线焦点小组讨论。我们采用迭代方法收集、分析和编码数据,并使用复杂性视角对结果进行解释,重点关注公平性的各个要素如何协同工作,以创建具有复杂行为的系统。
我们确定了三个可能破坏公平性的力量主题:削弱互动性的力量、削弱适应性的力量和削弱嵌入性的力量。在每个主题中,我们都确定了子主题:评估者和学生的力量、工具的力量和系统的力量。
与复杂性理论一致,本研究表明,有多种力量可能会阻碍公平性的出现。虽然复杂性思维并不能减轻挑战的规模,但通过这种视角看待力量,可以深入了解为什么以及这些力量如何破坏公平性。这使得我们能够更有针对性、更有意义地进行变革,以支持在动态真实的临床工作场所中使用公平判断进行评估。