Leora Branfield Day1, Amy Miles2, Shiphra Ginsburg3, Lindsay Melvin4. 1. L. Branfield Day is a fourth-year chief medical resident, internal medicine training program, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. 2. A. Miles is a fourth-year resident, geriatric medicine subspecialty training program, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. 3. S. Ginsburg is staff physician, Division of Respirology, Mount Sinai Hospital and University Health Network, professor, Department of Medicine, Faculty of Medicine, University of Toronto, and scientist, Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada. 4. L. Melvin is assistant professor, Department of Medicine, Faculty of Medicine, University of Toronto, and staff physician, Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada.
Abstract
PURPOSE: As key participants in the assessment dyad, residents must be engaged with the process. However, residents' experiences with competency-based medical education (CBME), and specifically with entrustable professional activity (EPA)-based assessments, have not been well studied. The authors explored junior residents' perceptions regarding the implementation of EPA assessment and feedback initiatives in an internal medicine program. METHOD: From May to November 2018, 5 focus groups were conducted with 28 first-year internal medicine residents from the University of Toronto, exploring their experiences with facilitators and barriers to EPA-based assessments in the first years of the CBME initiative. Residents were exposed to EPA-based feedback tools from early in residency. Themes were identified using constructivist grounded theory to develop a framework to understand the resident perception of EPA assessment and feedback initiatives. RESULTS: Residents' discussions reflected a growth mindset orientation, as they valued the idea of meaningful feedback through multiple low-stakes assessments. However, in practice, feedback seeking was onerous. While the quantity of feedback had increased, the quality had not; some residents felt it had worsened, by reducing it to a form-filling exercise. The assessments were felt to have increased daily workload with consequent disrupted workflow and to have blurred the lines between formative and summative assessment. CONCLUSIONS: Residents embraced the driving principles behind CBME, but their experience suggested that changes are needed for CBME in the study site program to meet its goals. Efforts may be needed to reconcile the tension between assessment and feedback and to effectively embed meaningful feedback into CBME learning environments.
PURPOSE: As key participants in the assessment dyad, residents must be engaged with the process. However, residents' experiences with competency-based medical education (CBME), and specifically with entrustable professional activity (EPA)-based assessments, have not been well studied. The authors explored junior residents' perceptions regarding the implementation of EPA assessment and feedback initiatives in an internal medicine program. METHOD: From May to November 2018, 5 focus groups were conducted with 28 first-year internal medicine residents from the University of Toronto, exploring their experiences with facilitators and barriers to EPA-based assessments in the first years of the CBME initiative. Residents were exposed to EPA-based feedback tools from early in residency. Themes were identified using constructivist grounded theory to develop a framework to understand the resident perception of EPA assessment and feedback initiatives. RESULTS: Residents' discussions reflected a growth mindset orientation, as they valued the idea of meaningful feedback through multiple low-stakes assessments. However, in practice, feedback seeking was onerous. While the quantity of feedback had increased, the quality had not; some residents felt it had worsened, by reducing it to a form-filling exercise. The assessments were felt to have increased daily workload with consequent disrupted workflow and to have blurred the lines between formative and summative assessment. CONCLUSIONS: Residents embraced the driving principles behind CBME, but their experience suggested that changes are needed for CBME in the study site program to meet its goals. Efforts may be needed to reconcile the tension between assessment and feedback and to effectively embed meaningful feedback into CBME learning environments.