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Daily encounter cards facilitate competency-based feedback while leniency bias persists

Published online by Cambridge University Press:  21 May 2015

Glen Bandiera  and
David Lendrum
Glen Bandiera*
Affiliation:
Department of Medicine and the Wilson Centre for Research in Education, University of Toronto, Toronto, Ont. Department of Emergency Medicine, St. Michael's Hospital, Toronto, Ont.
David Lendrum
Affiliation:
University of Toronto FRCP(EM) Residency Program, Toronto, Ont.
*
St. Michael's Hospital, 1-056 Bond Wing, 30 Bond St., Toronto ON M5B 1W8; bandierag@smh.toronto.on.ca

Abstract

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Objective:

We sought to determine if a novel competency-based daily encounter card (DEC) that was designed to minimize leniency bias and maximize independent competency assessments could address the limitations of existing feedback mechanisms when applied to an emergency medicine rotation.

Methods:

Learners in 2 tertiary academic emergency departments (EDs) presented a DEC to their teachers after each shift. DECs included dichotomous categorical rating scales (i.e., “needs attention” or “area of strength”) for each of the 7 CanMEDS roles or competencies and an overall global rating scale. Teachers were instructed to choose which of the 7 competencies they wished to evaluate on each shift. Results were analyzed using both staff and resident as the units of analysis.

Results:

Fifty-four learners submitted a total of 801 DECs that were then completed by 43 different teachers over 28 months. Teachers' patterns of selecting CanMEDS competencies to assess did not differ between the 2 sites. Teachers selected an average of 3 roles per DEC (range 0–7). Only 1.3% were rated as “needs further attention.” The frequency with which each competency was selected ranged from 25% (Health Advocate) to 85% (Medical Expert).

Conclusion:

Teachers chose to direct feedback toward a breadth of competencies. They provided feedback on all 7 CanMEDS roles in the ED, yet demonstrated a marked leniency bias.

Résumé

RÉSUMÉObjectif:

Nous avons cherché à déterminer si le nouveau concept de fiche de rencontre quotidienne (FRQ), axée sur les compétences et conçue pour réduire au minimum le biais d'évaluation et maximiser l'évaluation indépendante des compétences, pourrait remédier aux limites des mécanismes de rétroaction existants appliqués à une rotation en médecine d'urgence.

Méthodes:

Les apprenants dans deux services d'urgence de soins tertiaires à vocation universitaire ont présenté une FRQ à leurs enseignants après chaque quart de travail. Les fiches comportaient, d'une part, des échelles d'évaluation à variables catégorielles dichotomiques (c.-à-d. « attention à apporter » ou « point fort ») pour chacune des sept compétences CanMEDS et, d'autre part, une échelle d'évaluation générale. On a demandé aux enseignants de choisir une de ces sept compétences et de l'évaluer pendant chaque période de travail. Puis, les résultats ont été analysés, les enseignants et les résidents constituant les unités d'analyse.

Résultats:

Sur une période de 28 mois, 54 apprenants ont soumis 801 FRQ, qui ont été remplies par 43 enseignants. Le schéma selon lequel les enseignants ont choisi les compétences CanMEDS à évaluer était similaire dans les deux services d'urgence. Les enseignants ont choisi en moyenne trois rôles par FRQ (gamme de 0 à 7). La note « attention à apporter » n'a été accordée que sur seulement 1,3 % des fiches. La fréquence selon laquelle chaque compétence a été sélectionnée variait de 25 % (promoteur de la santé) à 85 % (expert médical).

Conclusion:

Les enseignants ont choisi de donner de la rétroaction à l'égard d'une variété de compétences. Ils ont fourni des commentaires sur chacune des sept compétences CanMEDS dans un service d'urgence et ont par ailleurs fait montre d'indulgence marquée dans leur évaluation.

Keywords

medical educationdaily encounter cardsfeedbackevaluationpractice-based assessment
Type
Education • Enseignement
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 1 , January 2008 , pp. 44 - 50
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

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