Trainees’ perspectives of assessment messages: a narrative systematic review

Scarff, Catherine E; Bearman, Margaret; Chiavaroli, Neville; Trumble, Steve

doi:10.1111/medu.13775

Cited by 12 publications

(11 citation statements)

References 51 publications

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“…Workplace-based assessment offers trainees an opportunity for guidance and supervisors the opportunity to judge the trainees' clinical practice. However, many trainees do not see workplacebased assessments as an opportunity to learn but rather a hurdle to be passed [1][2][3] and may alter their practice specifically for these assessments. 4,5 One reason for this inauthenticity may be lack of trust in their supervisor.…”

Section: Discussionmentioning

confidence: 99%

How Trainees Come to Trust Supervisors in Workplace-Based Assessment: A Grounded Theory Study

Castanelli¹,

Weller²,

Molloy³

et al. 2022

Academic Medicine

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Purpose In competency-based medical education, workplace-based assessment provides trainees with an opportunity for guidance and supervisors the opportunity to judge the trainees’ clinical practice. Learning from assessment is enhanced when trainees reveal their thinking and are open to critique, which requires trust in the assessor. If supervisors knew more about how trainees come to trust them in workplace-based assessment, they could better engender trainee trust and improve trainees’ learning experience. Method From August 2018 to September 2019, semistructured interviews were conducted with 17 postgraduate anesthesia trainees across Australia and New Zealand. The transcripts were analyzed using constructivist grounded theory methods sensitized by a sociocultural view of learning informed by Wenger’s communities of practice theory. Results Participants described a continuum from a necessary initial trust to an experience-informed dynamic trust . Trainees assumed initial trust in supervisors based on accreditation, reputation, and a perceived obligation of trustworthiness inherent in the supervisor’s role. With experience and time, trainees’ trust evolved based on supervisor actions. Deeper levels of trainee trust arose in response to perceived supervisor investment and allowed trainees to devote more emotional and cognitive resources to patient care and learning rather than impression management. Across the continuum from initial trust to experience-informed trust, trainees made rapid trust judgments that were not preceded by conscious deliberation; instead, they represented a learned “feel for the game.” Conclusions While other factors are involved, our results indicate that the trainee behavior observed in workplace-based assessment is a product of supervisor invitation. Supervisor trustworthiness and investment in trainee development invite trainees to work and present in authentic ways in workplace-based assessment. This authentic engagement, where learners “show themselves” to supervisors and take risks, creates assessment for learning.

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Section: Discussionmentioning

confidence: 99%

How Trainees Come to Trust Supervisors in Workplace-Based Assessment: A Grounded Theory Study

Castanelli¹,

Weller²,

Molloy³

et al. 2022

Academic Medicine

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“…In their systematic review of trainee's perspectives of assessment messages, Scarff et al 34 outline environmental and assessor‐related factors that affect perspectives on feedback, including available time for feedback, enthusiasm for feedback, engagement with the learner, and honesty. This study builds on these findings, demonstrating the interaction between these characteristics with trust, relationship‐building, and their effect on resident mindset, which residents associated with their front stage performances.…”

Section: Discussionmentioning

confidence: 99%

“…This study builds on these findings, demonstrating the interaction between these characteristics with trust, relationship‐building, and their effect on resident mindset, which residents associated with their front stage performances. In their discussion, Scarff posits that learners are polarised into two groups with regards to their interaction with assessment and feedback: learning goal‐oriented vs performance goal‐oriented 34 —these link directly to growth vs fixed mindset. While they describe them as intrinsic characteristics of the learner, we have shown that these characteristics are fluid, even within the individual learner, and are affected by context and relationship within the clinical learning environment.…”

Section: Discussionmentioning

confidence: 99%

Resident impression management within feedback conversations: A qualitative study

et al. 2020

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Introduction Medical education is moving to conceptualise feedback as a bidirectional learning conversation. Within this conversation, learners experience a tension between assessment and feedback. That perceived tension affects learners’ outward performances. In this study, we aimed to characterise residents’ experiences with this tension and its effect on learner authenticity within feedback conversations. Methods In this constructivist grounded theory study, the authors were informed by Goffman's theory of impression management. During data analysis, Dweck's theory of mindset was adopted. The authors conducted semi‐structured interviews with 15 internal medicine residents. Data collection and analysis were conducted iteratively, using constant comparison to identify themes coinciding with impression management and mindset, ultimately developing a theoretical model to help explain residents’ responses to tensions within feedback conversations. Results Residents constantly felt ‘scrutinized’, and this affected their engagement in feedback conversations. They staged a performance within those conversations, linked to their underlying mindset: growth or fixed. Growth mindset was characterised by a focus on development as a physician and was associated with asking questions and seeking opportunities for growth. Fixed mindset was characterised by a focus on achieving a favourable evaluation and was associated with a hesitation to ask questions when faced with uncertainty and admit opportunities for growth, because they were concerned about impression management. Context influenced mindset and impression management. Residents adopted a fixed mindset and managed impressions when they perceived the permanence or consequences of evaluations within feedback. Residents adopted a growth mindset when they trusted the supervisor. Discussion Residents assess the context of feedback conversations, altering the authenticity of their behaviours. Context, including the perceptions of formal assessment and relationships with supervisors, affected residents’ mindset and impression management. Providing space for relationship‐building and clarifying the purpose and structure of assessment may be helpful in supporting effective learning conversations in graduate medical education.

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“…Moreover, recent reviews highlight person al and environmental factors influencing the way trainees perceive the developmental value of assessment, self-motivation also being reported as an important driver of feedback seeking. 17 18 This is a possible reason explaining why previous attempts for gathering such information 8 were felt as incomplete and unreliable. By using a qualitative approach, we were able to combine and report in-depth views of several individuals from different positions and countries.…”

Section: Discussionmentioning

confidence: 99%

Strategies for the assessment of competences during rheumatology training across Europe: results of a qualitative study

et al. 2020

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ObjectivesTo gain insight into current methods and practices for the assessment of competences during rheumatology training, and to explore the underlying priorities and rationales for competence assessment.MethodsWe used a qualitative approach through online focus groups (FGs) of rheumatology trainers and trainees, separately. The study included five countries—Denmark, the Netherlands, Slovenia, Spain and the United Kingdom. A summary of current practices of assessment of competences was developed, modified and validated by the FGs based on an independent response to a questionnaire. A prioritising method (9 Diamond technique) was then used to identify and justify key assessment priorities.ResultsOverall, 26 participants (12 trainers, 14 trainees) participated in nine online FGs (2 per country, Slovenia 1 joint), totalling 12 hours of online discussion. Strong nationally (the Netherlands, UK) or institutionally (Spain, Slovenia, Denmark) standardised approaches were described. Most groups identified providing frequent formative feedback to trainees for developmental purposes as the highest priority. Most discussions identified a need for improvement, particularly in developing streamlined approaches to portfolios that remain close to clinical practice, protecting time for quality observation and feedback, and adopting systematic approaches to incorporating teamwork and professionalism into assessment systems.ConclusionThis paper presents a clearer picture of the current practice on the assessment of competences in rheumatology in five European countries and the underlying rationale of trainers’ and trainees’ priorities. This work will inform EULAR Points-to-Consider for the assessment of competences in rheumatology training across Europe.

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Trainees’ perspectives of assessment messages: a narrative systematic review

Cited by 12 publications

References 51 publications

How Trainees Come to Trust Supervisors in Workplace-Based Assessment: A Grounded Theory Study

How Trainees Come to Trust Supervisors in Workplace-Based Assessment: A Grounded Theory Study

Resident impression management within feedback conversations: A qualitative study

Strategies for the assessment of competences during rheumatology training across Europe: results of a qualitative study

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