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Tools and Tips for Learner Assessment and Evaluation in the Emergency Department Heather Patterson PGY-4 April 28 2010.

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Presentation on theme: "Tools and Tips for Learner Assessment and Evaluation in the Emergency Department Heather Patterson PGY-4 April 28 2010."— Presentation transcript:

1 Tools and Tips for Learner Assessment and Evaluation in the Emergency Department Heather Patterson PGY-4 April 28 2010

2 Objectives 1.What should we be assessing? 2.What is the best method of assessment? 3.What factors influence assessment? 4.What are the tools available to evaluate learners? 5.Tips for delivering feedback.

3 Objectives 1.What should we be assessing? Brief review of CanMEDS 2.What is the best method of assessment? 3.What factors influence assessment? 4.What are the tools available to evaluate learners? 5.Tips for delivering feedback.

4 What should we assess?

5 Objectives 1.What should we be assessing? 2.What is the best method of assessment in the ED? Direct Observation 3.What factors influence assessment? 4.What are the tools available to evaluate learners? 5.Tips for delivering feedback.

6 Direct Observation Why bother? –Sherbino et al 2008 –Hobgood et al 2008 –Cydulka 1996 What counts?

7 Direct Observation Challenges –Hawthorne effect –ED flow and pt care –Teaching responsibilities

8 Direct Observation Formalized direct observation program –Pittsburg EM residency program Dorfsman et al 2009 How did they evaluate resident performance? –Standardized direct observation tool (SDOT) Shayne et al 2002 and 2006, La Manita et al 2002 – Reliable?? – Valid??

9 Direct Observation Take home: –Best method for the assessment of true behaviour –It may be worthwhile to do some behind the curtain assessments to minimize the Hawthorne effect –Can be used to guide feedback and to give more representative evaluations –Opportunity exists for development of reliable and valid checklist tools to assess resident performance in the ED

10 Objectives 1.What should we be assessing? 2.What is the best method of assessment? 3.What factors influence assessment? Pitfalls of learner assessment 4.What are the tools available to evaluate learners? 5.Tips for delivering feedback.

11 Evaluation vs Feedback Evaluation : –Formal assessment of how the learner has performed.

12 Evaluation vs Feedback Feedback : –Designed to make a learner aware and accepting of strengths and weaknesses and to help guide future learning

13 Pitfalls of assessment Hawk vs. Dove –Know your tendencies for how you evaluate –Acknowledge your subjective expectations for a particular domain of assessment Cydulka et al 1996 A practical guide for medical teachers. Dent 2005

14 Pitfalls of assessment Halo vs millstone effect –Well documented and accepted as a source of bias in learner evaluation A practical guide for medical teachers. Dent 2005

15 Pitfalls of assessment Leniency bias –Bandiera et al 2008

16 Pitfalls of assessment Leniency bias and range restriction –Jouriles et al 2002 No evaluation of lowest score despite previously identified problems

17 Pitfalls of assessment Possible reasons for leniency bias and range restriction –Dudek et al 2005 Lack of documentation of specific events Lack of knowledge about what to document Anticipation of an appeal process Lack of remediation options –Jouriles et al 2002 Avoidance of negative interactions Fear of negative teaching evaluation Worry about time commitments to justify evaluation Worry about time requirements and potential responsibility for remediation –Gray et al 1996 Weakness inherent to ITER as an evaluation tool Lack of training on proper use of ITER or other assessment tools used

18 Pitfalls of assessment Take home points : –Be aware of your pre-existing perceptions about the learner –Be aware of your biases –Don t be afraid to give a representative evaluation

19 Objectives 1.What should we be assessing? 2.What is the best method of assessment? 3.What factors influence assessment? 4.What are the tools available to evaluate learners? ITER Encounter Cards 360 degree feedback Checklists 5.Tips for Delivering Feedback

20 ITER/Global Rating Forms

21 Pros : –Ease of administration –Allows for longitudinal assessments Sherbino et al 2008 Cons : –Bias introduced into evaluation Recall Halo/millstone Leniency and range restriction –Sherbino et al 2008 –Practical guide for medical teachers Dent 2005 –Gray et al 1996

22 ITER/Global Rating Forms Cons (cont): –Poor reliability –Poor discrimination between constructs or behaviours Donnon et al - not yet published Silber et al 2004 Take home : –Residents: Deliver ITERs earlier to minimize recall bias. Tell staff you are sending them. –Staff: Be objective as possible and include written comments. Be aware of bias

23 Daily Encounter Cards

24 Pros –Less recall bias –Can be structured to facilitate CanMEDS roles evaluation Bandiera et al 2008 Cons –Leniency bias –Recall bias –Needs further reliability and validity assessment Kim et al 2005 Paukert et al 2002 Brennan et al 1997

25 Multisource Feedback (MSF) Pros –? More representative assessment of teamwork, leadership, communication, collaboration and professionalism Sherbino et al 2008 –?Stimulus for positive change Lockyer 2003 Cons –No true MSF post-graduate medical education research Rodgers et al 2002 –Numbers required achieve reliability Wood et al 2006

26 Multisource Feedback (MSF) Take home: –Input from allied health professionals, collegues, and patients may contribute to a more complete assessment of resident competencies if done appropriately –Caution: introduction of bias, ?reliability if only a few comments

27 Checklists

28 Pros –No recall bias, +/- reduced leniency bias –Over 55 published tools for use during direct observation of clinical behaviour Kogan et al 2009 Cons –Evaluates specific behaviours NOT global performance ACGME toolbox of assessment methods 2000 –Extensive process to develop a reliable, valid tool Cooper et al 2010 –Requires direct observation without interference Dorfsman et al 2009 Shayne et al 2006

29 Checklists Take home points: –Good for specific behavioural assessment ie leadership –Extensive process to develop a tool –Significant research potential in this area

30 Objectives 1.What should we be assessing? 2.What is the best method of assessment? 3.What factors influence assessment? 4.What are the tools available to evaluate learners? 5.Tips for Delivering Feedback

31 Types of Feedback Brief Formal Major

32 Tips for Effective Feedback Timing and location Feedback on your performance Learner self assessment

33 Tips for Effective Feedback Feedback content

34 Take Home Messages Direct observation represents the highest fidelity measurement of true behaviour Feedback and evaluation are different processes and have different goals Be aware of your biases and limitations of the evaluation tools –Hawk vs Dove –Halo vs Millstone effect –Recall bias –Leniency and range restriction Feedback should be specific and identify modifiable behaviours

35 References (1) Dorfsman ML, Wolfson AB. Direct observation of residents in the emergency department: a structured educational program. Acad.Emerg.Med. 2009 Apr;16(4):343-351. (2) Sherbino J, Bandiera G, Frank JR. Assessing competence in emergency medicine trainees: an overview of effective methodologies. CJEM, Can.j.emerg.med.care. 2008 Jul;10(4):365-371. (3) Hobgood CD, Riviello RJ, Jouriles N, Hamilton G. Assessment of Communication and Interpersonal Skills Competencies. Acad.Emerg.Med. 2002;9(11):1257-1269. (4) Jouriles NJ, Emerman CL, Cydulka RK. Direct observation for assessing emergency medicine core competencies: interpersonal skills. Acad.Emerg.Med. 2002 Nov;9(11):1338-1341. (5) Kogan JR, Holmboe ES, Hauer KE. Tools for direct observation and assessment of clinical skills of medical trainees: a systematic review. JAMA 2009 Sep 23;302(12):1316-1326. (6) Andersen PO, Jensen MK, Lippert A, Ostergaard D, Klausen TW. 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Acad.Med. 2001 Oct;76(10):1053-1055. (16) Morgan PJ, Cleave-Hogg D, DeSousa S, Tarshis J. High-fidelity patient simulation: validation of performance checklists. Br.J.Anaesth. 2004 Mar;92(3):388-392. (17) Wright MC, Phillips-Bute BG, Petrusa ER, Griffin KL, Hobbs GW, Taekman JM. Assessing teamwork in medical education and practice: relating behavioural teamwork ratings and clinical performance. Med.Teach. 2009 Jan;31(1):30-38. (18) Jefferies A, Simmons B, Tabak D, McIlroy JH, Lee KS, Roukema H, et al. Using an objective structured clinical examination (OSCE) to assess multiple physician competencies in postgraduate training. Med.Teach. 2007 Mar;29(2-3):183-191. (19) Cydulka RK, Emerman CL, Jouriles NJ. Evaluation of Resident Performance and Intensive Bedside Teaching during Direct Observation. Acad.Emerg.Med. 1996;3(4):345-351. (20) Shayne P, Heilpern K, Ander D, Palmer-Smith V, Emory University Department of Emergency Medicine Education,Committee. 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A randomized-controlled study of encounter cards to improve oral case presentation skills of medical students. Journal of General Internal Medicine 2005 Aug;20(8):743-747. (26) Brennan BG, Norman GR. Use of encounter cards for evaluation of residents in obstetrics. Academic Medicine 1997 Oct;72(10 Suppl 1):S43-4. (27) Dudek NL, Marks MB, Regehr G. Failure to fail: the perspectives of clinical supervisors. Acad.Med. 2005 Oct;80(10 Suppl):S84-7. (28) Frank JR, Danoff D. The CanMEDS initiative: implementing an outcomes-based framework of physician competencies. Med.Teach. 2007 Sep;29(7):642-647. (29) Zibrowski EM, Singh SI, Goldszmidt MA, Watling CJ, Kenyon CF, Schulz V, et al. The sum of the parts detracts from the intended whole: competencies and in-training assessments. Med.Educ. 2009 Aug;43(8):741-748. (30) Epstein RM. Assessment in medical education. N.Engl.J.Med. 2007 Jan 25;356(4):387-396. (31) Gray JD. Global rating scales in residency education. Acad.Med. 1996 Jan;71(1 Suppl):S55-63.

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