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- Title
Opening the black box of clinical skills assessment via observation: a conceptual model.
- Authors
Kogan, Jennifer R; Conforti, Lisa; Bernabeo, Elizabeth; Iobst, William; Holmboe, Eric
- Abstract
Medical Education 2011: 45: 1048-1060 Objectives This study was intended to develop a conceptual framework of the factors impacting on faculty members' judgements and ratings of resident doctors (residents) after direct observation with patients. Methods In 2009, 44 general internal medicine faculty members responsible for out-patient resident teaching in 16 internal medicine residency programmes in a large urban area in the eastern USA watched four videotaped scenarios and two live scenarios of standardised residents engaged in clinical encounters with standardised patients. After each, faculty members rated the resident using a mini-clinical evaluation exercise and were individually interviewed using a semi-structured interview. Interviews were videotaped, transcribed and analysed using grounded theory methods. Results Four primary themes that provide insights into the variability of faculty assessments of residents' performance were identified: (i) the frames of reference used by faculty members when translating observations into judgements and ratings are variable; (ii) high levels of inference are used during the direct observation process; (iii) the methods by which judgements are synthesised into numerical ratings are variable, and (iv) factors external to resident performance influence ratings. From these themes, a conceptual model was developed to describe the process of observation, interpretation, synthesis and rating. Conclusions It is likely that multiple factors account for the variability in faculty ratings of residents. Understanding these factors informs potential new approaches to faculty development to improve the accuracy, reliability and utility of clinical skills assessment.
- Subjects
UNITED States; CLINICAL competence; COGNITION; CONCEPTUAL structures; CONTENT analysis; GROUNDED theory; HOSPITAL medical staff; INTERVIEWING; JUDGMENT (Psychology); RESEARCH methodology; MEDICAL school faculty; PHYSICIAN-patient relations; PSYCHOLOGY; RESEARCH funding; SIMULATED patients; RATING of students; TEACHER-student relationships; TEACHER attitudes; VIDEO recording; WORLD Wide Web; THEORY; DATA analysis; THEMATIC analysis; INTER-observer reliability; DATA analysis software; EVALUATION
- Publication
Medical Education, 2011, Vol 45, Issue 10, p1048
- ISSN
0308-0110
- Publication type
Article
- DOI
10.1111/j.1365-2923.2011.04025.x