Kakara Anderson Hannah L, Abdulla Layla, Cabral Pricilla, Govaerts Marjan, Balmer Dorene F, Busari Jamiu O
University of Pennsylvania Perelman School of Medicine and PhD Candidate, Maastricht University School of Health Professions Education, United States.
Department of Pediatrics, The Children's Hospital of Philadelphia, United States.
Soc Sci Med. 2025 Jun;375:118092. doi: 10.1016/j.socscimed.2025.118092. Epub 2025 Apr 17.
Despite the centrality of workplace-based assessments in medical education and practice, there is troubling evidence that workplace-based assessments are inequitable. This study investigated the experience of inequity in workplace-based assessment via a phenomenological study with learners (resident physicians) and assessors (physician supervisors) in one specialty in the United States, general pediatrics, from August 2023-June 2024. The authors used critical phenomenology to prompt and iteratively analyze participants' experiences with inequity in workplace-based assessment and their lifeworlds. To understand participants' lifeworlds, the authors applied Collins' domains of power framework to examine participants' varied and unique locations within intersecting power relations. Participants described the phenomenon of inequity in workplace-based assessment as a type of abrasion, that is, an injury caused by friction that occurred when a workplace-based assessment excoriated their sense of self. Abrasion had three dimensions: physical, affective, and temporal. These findings suggest that inequity in workplace-based assessment cannot be tracked solely by measuring disparities in numbers, grades, differences in narrative language used in comments, and other common measures of inequity, rather, it can be characterized as an experienced, felt, phenomenon that has essential dimensions. These findings have major implications for how inequity is conceptualized and intervened upon in medical education.
尽管基于工作场所的评估在医学教育和实践中占据核心地位，但有令人不安的证据表明，基于工作场所的评估存在不公平现象。本研究通过对美国一个专业（普通儿科学）的学习者（住院医师）和评估者（医师主管）进行现象学研究，调查了2023年8月至2024年6月期间基于工作场所评估中的不公平经历。作者运用批判现象学来促使并迭代分析参与者在基于工作场所评估中的不公平经历及其生活世界。为了解参与者的生活世界，作者应用柯林斯的权力领域框架来审视参与者在交叉权力关系中的不同且独特的位置。参与者将基于工作场所评估中的不公平现象描述为一种磨损，也就是说，当基于工作场所的评估刺痛他们的自我意识时，由摩擦导致的一种伤害。磨损有三个维度：身体维度、情感维度和时间维度。这些发现表明，基于工作场所评估中的不公平不能仅通过衡量数量差异、成绩、评语中使用的叙述性语言差异以及其他常见的不公平衡量标准来追踪，相反，它可以被描述为一种有切身体会的现象，具有本质维度。这些发现对医学教育中如何概念化和干预不公平现象具有重大影响。
