Lee Ann, Jere Anoushka, Du Plessis Lihani, Van Gerven Pascal W M, Heeneman Sylvia, Ross Shelley
Department of Family Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
School of Public Health, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
Med Educ. 2025 Jun;59(6):596-605. doi: 10.1111/medu.15595. Epub 2024 Dec 19.
Meaningful supervisor-resident relationships enhance feedback and learning, yet not all relationships reach this potential. While there is increasing interest in continuity of supervision (CoS) to build relationships that support feedback and promote learning, there remains a limited understanding of how relationships develop and influence assessment over time. The aim of this study was to explore how supervisors and learners in postgraduate medical education perceive CoS relationships and their impact on feedback and assessment.
We used constructivist grounded theory informed by the educational alliance to develop insight into how supervisor and resident perceptions of episodic and continuous relationships impact feedback and assessment. We interviewed 22 participants, including 14 family medicine residents and eight faculty advisors. We iteratively analysed the data concurrently with data collection.
In episodic relationships, participants accepted superficiality for variety and diversity in feedback. In continuous relationships, we identified four sub-types. Our participants described how each of these relationships impacted their perceptions of the feedback and assessment information given or received and resulted in different steps taken in response to their perceptions: (i) Not developing-tolerate feedback and seek out additional assessors, (ii) deteriorating-avoid feedback and seek out alternative assessors, (iii) developing-value and tailor feedback and (iv) becoming a friendship-question bias in feedback and advocate for more assessors.
Episodic and continuous relationships offered feedback and assessment value. However, deeper analysis of the continuous relationships revealed additional complexity. Understanding the nuances of CoS relationships is important for supporting successful relationships and improving feedback and assessment.
有意义的上级-住院医师关系可增强反馈与学习效果，但并非所有关系都能发挥出这种潜力。尽管人们对监督的连续性（CoS）越来越感兴趣，希望建立起支持反馈并促进学习的关系，但对于关系如何随着时间发展以及如何影响评估，仍知之甚少。本研究的目的是探讨研究生医学教育中的上级和学员如何看待CoS关系及其对反馈和评估的影响。
我们运用了基于教育联盟的建构主义扎根理论，以深入了解上级和住院医师对阶段性和连续性关系的认知如何影响反馈和评估。我们采访了22名参与者，包括14名家庭医学住院医师和8名教员顾问。我们在收集数据的同时对数据进行迭代分析。
在阶段性关系中，参与者接受反馈的多样性和差异性所带来的表面性。在连续性关系中，我们识别出四种亚型。我们的参与者描述了每种关系如何影响他们对所给予或收到的反馈及评估信息的认知，并导致他们根据自己的认知采取不同的应对措施：（i）未发展型——容忍反馈并寻找其他评估者，（ii）恶化型——回避反馈并寻找替代评估者，（iii）发展型——重视并调整反馈，（iv）成为友谊型——质疑反馈中的偏见并主张增加评估者。
阶段性和连续性关系都具有反馈和评估价值。然而，对连续性关系的深入分析揭示了更多的复杂性。理解CoS关系的细微差别对于支持成功的关系以及改善反馈和评估至关重要。
