COVID-19 Pivoted Virtual Skills Teaching Model: Project ECHO Ontario Skin and Wound Care Boot Camp.

OBJECTIVE: To describe a virtual, competency-based skin and wound care (SWC) skills training model. The ECHO (Extension for Community Healthcare Outcomes) Ontario SWC pivoted from an in-person boot camp to a virtual format because of the COVID-19 pandemic. METHODS: An outcome-based program evaluation was conducted. Participants first watched guided commentary and videos of experts performing in nine SWC multiskills videos, then practiced and video-recorded themselves performing those skills; these recordings were assessed by facilitators. Data were collected using pre-post surveys and rubric-based assessments. Descriptive statistics and thematic analysis were applied to data analysis. RESULTS: Fifty-five healthcare professionals participated in the virtual boot camp, measured by the submission of at least one video. A total of 216 videos were submitted and 215 assessment rubrics were completed. Twenty-nine participants completed the pre-boot camp survey (53% response rate) and 26 responded to the post-boot camp survey (47% response rate). The strengths of the boot camp included the applicability of virtual learning to clinical settings, boot camp supplies, tool kits, and teaching strategies. The analysis of survey responses indicated that average proficiency scores were greater than 80% for three videos, 50% to 70% for three of the videos, and less than 50% for three of the videos. Participants received lower scores in local wound care and hand washing points of contact. The barriers of the boot camp included technical issues, time, level of knowledge required at times, and lack of equipment and access to interprofessional teams. CONCLUSIONS: This virtual ECHO SWC model expanded access to practical skills acquisition. The professional development model presented here is generalizable to other healthcare domains.

A Canadian survey of residency applicants' and interviewers' perceptions of the 2021 CaRMS R1 virtual interviews.

BACKGROUND: All Canadian Residency Matching Service (CaRMS) R1 interviews were conducted virtually for the first time in 2021. We explored the facilitators, barriers, and implications of the virtual interview process for the CaRMS R1 match and provide recommendations for improvement. METHODS: We conducted a cross-sectional survey study of CaRMS R1 residency applicants and interviewers across Canada in 2021. Surveys were distributed by email to the interviewers, and by email, social media, or newsletter to the applicants. Inductive thematic analysis was used for open-ended items. Recommendations were provided as frequencies to demonstrate strength. Close-ended items were described and compared across groups using Chi-Square Fisher's Exact tests. RESULTS: A total of 127 applicants and 400 interviewers, including 127 program directors, responded to the survey. 193/380 (50.8%) interviewers and 90/118 (76.3%) applicants preferred virtual over in-person interview formats. Facilitators of the virtual interview format included cost and time savings, ease of scheduling, reduced environmental impact, greater equity, less stress, greater reach and participation, and safety. Barriers of the virtual interview format included reduced informal conversations, limited ability for applicants to explore programs at different locations, limited ability for programs to assess applicants' interest, technological issues, concern for interview integrity, limited non-verbal communication, and reduced networking. The most helpful media for applicants to learn about residency programs were program websites, the CaRMS/AFMC websites, and recruitment videos. Additionally, panel interviews were preferred by applicants for their ability to showcase themselves and build connections with multiple interviewers. Respondents provided recommendations regarding: (1) dissemination of program information, (2) the use of technology, and (3) the virtual interview format. CONCLUSIONS: Perceptions of 2021 CaRMS R1 virtual interviews were favourable among applicants and interviewers. Recommendations from this study can help improve future iterations of virtual interviews.

Evaluation of a Virtual Team-Based Project Designed to Improve Chronic Wound Patient Care in Ontario, Canada.

OBJECTIVE: To evaluate the effectiveness of the Extension for Community Healthcare Outcomes Ontario Skin and Wound Care project, a virtual team-based endeavor designed to improve the care of patients with chronic wounds. METHODS: The study team conducted phone interviews with healthcare professionals (n = 8) regarding their patients (n = 10). The management recommendations were grouped, and the study participants questioned concerning the implementation of the recommendations. Interviews were recorded and transcribed, and the transcripts were analyzed for common themes. The Queen's University Research Ethics Board approved this study. RESULTS: Interviews documented improvement in 50% of patients; the other half of the patients did not improve because of patient- and healthcare-system barriers. Three of five nonhealing patients were nonadherent regarding compression, and only one of six suggested biopsies were carried out. The investigators noted three primary reasons for the lack of recommendation implementation: (1) could not obtain a diagnostic procedure, (2) lack of a diagnosis, and (3) patient was reluctant to make a lifestyle change. Major themes included problems in care coordination and suboptimal patient and provider education, along with other obstacles to management. CONCLUSIONS: Participants stated that the project provided a beneficial learning experience. The findings highlighted a lack of integrated and coordinated interprofessional chronic wound care.

Developing Faculty Developers: An Underexplored Realm in Professional Development.

ABSTRACT: As faculty developers enter the field and grow in their roles, how do they keep up with ongoing changes and ensure that their knowledge remains relevant and up-to-date? In contrast to most of the studies which focused on the needs of faculty members, we focus on the needs of those who fulfill the needs of others. We highlight the knowledge gap and lack of adaptation of the field to consider the issue of professional development of faculty developers more broadly by studying how they identify their knowledge gaps and what approaches they use to address those gaps. The discussion of this problem sheds light on the professional development of faculty developers and offers several implications for practice and research. Our own piece of the solution indicates that faculty developers follow a multimodal approach to the development of their knowledge, including formal and informal approaches to addressing perceived gaps. Within this multimodal approach, our results suggest that the professional growth and learning of faculty developers is best characterized as a social practice. Based on our research, it would seem worthwhile for those in the field to become more intentional about the professional development of faculty developers and harness aspects of social learning in that process to better reflect faculty developers' learning habits. We also recommend applying these aspects more broadly to, in turn, enhance the development of educational knowledge and educational practices for the faculty members these educators support.

Using Administrative Data in Primary Care to Evaluate the Effectiveness of a Continuing Professional Development Program Focused on the Management of Patients Living With Obesity.

INTRODUCTION: There are guidelines for referral to medical and/or surgical weight loss interventions (MSWLI) in Ontario; however, only about one-third of eligible patients in our region are being referred for consideration of MSWLI. METHODS: A planning committee, including a registered dietician, psychiatrist, endocrinologist, bariatric surgeon, family physician, and educationalists, developed an interdisciplinary continuing professional development (CPD) program focused on practical approaches to the management of patients living with obesity. The Kirkpatrick model was used to evaluate the educational outcomes of the CPD program specifically focusing on Level-2, -3, and -4 outcomes based on self-reported questionnaire and health administrative data. RESULTS: Eighteen primary care providers from the CPD program agreed to participate in this study, and 16 primary care providers (89%) completed the postintervention questionnaire and granted us access to their MSWLI referral data; 94% of study participants reported changes to their knowledge, comfort, and confidence (Level 2), as well as expected change in their future behaviour (Level 3) following the CPD program. However, there was no change in Kirkpatrick Level-4 outcomes, despite more than 90% of participants indicating that they will be making changes to their practice after the program. DISCUSSION: The CPD program in our study was overwhelmingly well received and participants reported knowledge (Level 2) and behavioural (Level 3) changes following participation; however, there was no detectable change in their clinical practice (Level 4). The methodology described in our proof-of-concept study can be modified and adopted to evaluate Level-4 outcomes in other studies of effectiveness of CPD interventions.

Professional Development in Health Sciences: Scoping Review on Equity, Diversity, Inclusion, Indigeneity, and Accessibility Interventions.

INTRODUCTION: Equity, diversity, inclusion, indigeneity, and accessibility (EDIIA) are critical considerations in the formation of professional development (PD) programs for health care workers. Improving EDIIA competency in health care serves to enhance patient health, staff confidence and well-being, delivery of care, and the broader health care system. There is a gap in the literature as to the efficacy of EDIIA-based PD programs and their individual components. The present article will review available quantitative data pertaining to EDIIA-based PD programs for health care workers as well as their effectiveness. METHOD: A scoping review of articles published in the EBSCOhost, MEDLINE, PubMed, EMBASE, and CINAHL databases was performed. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS: A total of 14,316 references were identified with 361 reaching full-text review. A final 36 articles were included in the scoping review with 6552 total participants (72.9% women; 26.9% men; 0.2% nonbinary). EDIIA-based PD interventions were developed around the topics of culture (n = 22), gender (n = 11), sexual orientation (n = 9), indigeneity (n = 6), race (n = 6), ableism (n = 1), and ageism (n = 1). DISCUSSION: Despite an increased interest in developing EDIIA-based PD curricula for health care workers, there are glaring disparities in the quality of care received by marginalized and equity-seeking populations. The present scoping review delineated key features which were associated with increased quantitative efficacy of EDIIA-based PD training programs. Future work should focus on large-scale implementation and evaluation of these interventions across health care sectors and levels of training.

Practices, knowledge, and attitudes about lithium treatment: Results of online surveys completed by clinicians and lithium-treated patients.

BACKGROUND: Lithium remains the gold-standard medication for acute and prophylactic treatment of bipolar disorder. Understanding clinicians' practices and patients' experiences, knowledge and attitudes about lithium may improve its clinical use. METHODS: Online anonymous surveys collected information about clinician's practices and level of confidence in managing lithium and patients' experiences with lithium treatment and information received about benefits and side effects. Knowledge and attitudes regarding lithium were assessed with the Lithium Knowledge Test (LKT) and the Lithium Attitudes Questionnaire (LAQ). RESULTS: Among 201 clinicians, 64.2% endorsed often treating patients with lithium and reported high levels of confidence in assessing and managing lithium. Practices concerning clinical indications, drug titration, and serum levels were guideline-concordant, but compliance with monitoring recommendations was less frequent. Practitioners were interested in receiving more education about lithium. The patients' survey recruited 219 participants with 70.3% being current lithium users. Most patients (68%) found lithium helpful and 71% reported experiencing any kind of side effect. Most responders did not receive information about side effects or other benefits of lithium. Patients with higher scores on the LKT were more likely to have positive attitudes about lithium. LIMITATIONS: Cross-sectional design with predominantly English-speaking participants from Brazil and North America. CONCLUSIONS: There is a discrepancy between guidelines, clinician confidence and knowledge of lithium use and practice. A deeper understanding of how to monitor, prevent and manage long-term side effects and which patients are most likely to benefit from lithium may narrow the gap between knowledge and use.

Internal medicine residents' and program directors' perception of virtual interviews during COVID-19: a national survey.

Purpose: Due to the coronavirus disease 2019 pandemic, all Canadian Resident Matching Service interviews for internal medicine subspecialty programs were conducted virtually for the first time. This study explored the perceptions and experiences of internal medicine residents, subspecialty medicine program directors, and interviewers during virtual interviews. Methods: We invited all Canadian third-year IM residents, subspecialty program directors, and interviewers who participated in the 2020 medical subspecialty medicine interviews to complete a branching survey with a section for residents and one for program directors and interviewers. We distributed the anonymous survey after the submission of the rank order lists, to not affect residency match outcomes. Qualitative data were open-coded thematically and quantitative data were cleaned and then statistically analyzed using descriptive statistics and Analysis of Variance tests. Results: 62 residents, 59 program directors, and 113 interviewers responded to the survey with representation from almost all Canadian medical faculties and medical subspecialties. Strengths of virtual interviews included reduced cost, stress, pandemic infection risk, and carbon footprint. Weaknesses of virtual interviews included decreased ability to connect personally and informally, and inability to tour medical facilities and cities. A majority of both resident respondents (59.6%) and program directors/interviewer respondents (54.6%) supported conducting interviews virtually in the future. Conclusions: This study showed that the majority of both sampled residents and program directors/interviewers would prefer to conduct medicine subspecialty match interviews virtually in the future, and provides suggestions on how to improve the virtual interviews for the next iteration.

Objectif: En raison de la pandémie du coronavirus 2019, toutes les entrevues du Service canadien de jumelage des résidents pour les programmes de sur-spécialités en médecine interne ont été menées virtuellement pour une première fois. Cette étude a exploré les perceptions et les expériences des résidents en médecine interne, des directeurs de programmes de médecine de sur-spécialités et des intervieweurs à l'égard des entrevues virtuelles. Méthodes: Nous avons invité tous les résidents canadiens de troisième année en médecine interne, les directeurs de programmes de sur-spécialités et les intervieweurs qui ont participé aux entrevues de médecine de sur-spécialités de 2020 à répondre à un sondage à branchement conditionnel comportant une section pour les résidents et une autre section pour les directeurs de programmes et les intervieweurs. Nous avons distribué le sondage anonyme après la soumission des listes de classement, afin de ne pas affecter les résultats du jumelage des résidents. Les données qualitatives ont fait l'objet d'un codage thématique et les données quantitatives ont été épurées, puis analysées statistiquement à l'aide de statistiques descriptives et de tests d'analyse de la variance. Résultats: Au total, 62 résidents, 59 directeurs de programmes et 113 intervieweurs, ont complété le sondage avec une représentation de presque toutes les facultés de médecine et de toutes les sur-spécialités médicales au Canada. Les avantages des entrevues virtuelles comportaient la réduction des coûts, du stress, du risque d'infection pandémique et de l'empreinte carbone. Les inconvénients des entrevues virtuelles incluaient la possibilité restreinte d'établir des contacts personnels et informels ainsi que l'impossibilité de visiter les installations médicales et les villes. La majorité des résidents (59,6 %) et des directeurs de programme/intervieweurs (54,6 %) supportent l'utilisation d'entretiens virtuels dans le futur. Conclusions: Cette étude a montré que la majorité des résidents et des directeurs de programme/intervieweurs de l'échantillon préféreraient désormais mener les entretiens pour le jumelage de sur-spécialités virtuellement. Elle propose également des suggestions sur la façon d'améliorer les entretiens virtuels pour la prochaine itération.

Environmental factors impacting the motivation to innovate: a systematic review.

The environments where innovation occurs are often as varied as the areas of endeavors that aspiring innovators could pursue. This systematic review followed the guidelines of the Campbell Collaboration and PRISMA to consolidate the findings of 74 studies into the Expectancy-Value-Cost motivation theoretical framework as a means of usefully isolating for decision-makers the environmental factors that impact the motivation to innovate. The results of this review reveal that additional study of interdisciplinary samples is needed to gather deep narrative and case-driven data that considers the experiences of innovators in addition to organizations. Leaders, including decision-makers, teachers, and supervisors, can set a precedent for their learners and workers to use their past experiences and to feel safe to take intelligent risks and make reasonable mistakes in pursuit of innovating. Ensuring that project teams have a mix of experiences and backgrounds can make for more productive collaborations. Proactively addressing costs can increase workplaces' psychological safety and stability, which enables workers and learners to better focus on the endeavors at hand. The articles' evaluation illustrates that conversation about innovation promotion is dominated by business, which reduces the opportunity to learn from other innovation-driven disciplines or take truly interdisciplinary approaches.

Reimagining Bias: Making Strange With Disclosure.

ABSTRACT: Academic presentations in health professions continuing professional development (CPD) often begin with a declaration of real or potential conflicts utilizing a three-slide template or a similar standardized display. These declarations are required in some constituencies. The three-slide template and similar protocols exist to assure learners that the content that follows has been screened, is notionally bias free, and without financial or other influence that might negatively affect health provider behavior. We suggest that there is a potential problem with this type of process that typically focusses in on a narrow definition of conflict of interest. There is the possibility that it does little to confront the issue that bias is a much larger concept and that many forms of bias beyond financial conflict of interest can have devastating effects on patient care and the health of communities. In this article, we hope to open a dialogue around this issue by "making the familiar strange," by asking education organizers and providers to question these standard disclosures. We argue that other forms of bias, arising from the perspectives of the presenter, can also potentially change provider behavior. Implicit biases, for example, affect relationships with patients and can lead to negative health outcomes. We propose that CPD reimagine the process of disclosure of conflicts of interest. We seek to expand reflection on, and disclosure of, perspectives and biases that could affect CPD learners as one dimension of harnessing the power of education to decrease structural inequities.

Systematic review support received and needed by researchers: a survey of libraries supporting Ontario medical schools.

Introduction: Finding efficient ways to meet the growing demand for library systematic review support is imperative for facilitating the production of high-quality research. The objectives of this study were threefold: 1) to ascertain the systematic review support provided by health sciences libraries at Ontario medical schools and their affiliated hospitals, 2) to determine the perceived educational needs by researchers at these institutions, and 3) to assess the potential usefulness of freely available, online educational modules for researchers that discuss all stages of the systematic review process. Methods: We conducted a cross-sectional survey in June and July of 2020. Data was analyzed and presented using median and interquartile range (IQR) for continuous measures, and in proportions for categorical measures. Results: 13 of 19 libraries invited provided usable data. Most libraries spent more time supporting systematic reviews via collaboration and participation than by providing educational support. The perceived needs of library users were contrary to the perceived gaps in researcher support provided by the library/institution. All libraries reported they would find freely available, online educational modules useful for training researchers. Discussion: The next steps for our inter-professional research team will be to develop freely available, online education modules that introduce researchers to all stages of the systematic review process. These modules cannot replace the value that direct support from librarians, biostatisticians or methodology experts can provide, however, they may offer a more efficient way for libraries to familiarize researchers and trainees with best practices and universally accepted reporting guidelines for performing a high-quality review.

Leader strategies for motivating innovation in individuals: a systematic review.

Innovation is a topic of intense interest and is seen as key to confronting the vast majority of issues facing humanity. To consolidate the knowledge about approaches promoting innovation, this study conducted a systematic review integrating an all-database (n = 375) search through EBSCOhost completed on April 6th, 2019 in addition to search engine use. Three hundred three studies were full-text reviewed yielding 82 final studies eligible for the inclusion in findings extraction. The findings were synthesized and then organized into the Expectancy-value-cost (EVC) motivation framework to isolate promotive and hindering factors. It is clear that there is an unbalanced primacy in the innovation literature in favor of business and corporate settings with very little representation from the arts or social justice sectors. There is also a common trend of using surveys of individuals in organizations within a single discipline, while interviews are rare. The paucity of studying costs of innovation in the literature is symptomatic of the primarily positive psychology approach taken by studies, rather than a framework like EVC which also considers detractive factors like costs. Numerous studies provide support for the notion that more internal motivations like intrinsic (e.g., interest) and attainment (e.g., importance, fulfillment) were more influential than external motivators like rewards as targets of strategies. Leaders should focus, whenever possible, on topics that engaged curiosity, interest, and satisfaction and, if they choose to use rewards, should focus their strategies to give related rewards; otherwise, they risk sundering the internal motivation to innovate for already interested workers.

Developing Academic Advisors and Competence Committees members: A community approach to developing CBME faculty leaders.

INTRODUCTION: Implementing competency-based medical education (CBME) at the institutional level poses many challenges including having to rapidly enable faculty to be facilitators and champions of a new curriculum which utilizes feedback, coaching, and models of programmatic assessment. This study presents the necessary competencies required for Academic Advisors (AA) and Competence Committee (CC) members, as identified in the literature and as perceived by faculty members at Queen's University. METHODS: This study integrated a review of available literature (n=26) yielding competencies that were reviewed by the authors followed by an external review consisting of CBME experts (n=5). These approved competencies were used in a cross-sectional community consultation survey distributed one year before (n=83) and one year after transitioning to CBME (n=144). FINDINGS: Our newly identified competencies are a useful template for other institutions. Academic Advisor competencies focused on mentoring and coaching, whereas Competence Committee member's competencies focused on integrating assessments and institutional policies. Competency discrepancies between stakeholder groups existing before the transition had disappeared in the post-implementation sample. CONCLUSIONS: We found value in taking an active community-based approach to developing and validating faculty leader competencies sooner rather than later when transitioning to CBME. The evolution of Competence Committees members and Academic Advisors requires the investment of specialized professional development and the sustained engagement of a collaborative community with shared concerns.

CONTEXTE: La mise en œuvre d'une formation médicale fondée sur les compétences (FMFC) au niveau institutionnel pose de nombreux défis, y compris de devoir permettre au corps professoral de devenir rapidement des facilitateurs et des champions d'un nouveau cursus qui fait appel à la rétroaction, à l'accompagnement et à l'évaluation programmatique. Cette étude présente les compétences nécessaires requises pour les conseillers pédagogiques(CP) et les membres des comités des compétences (CC), tel qu'identifié dans la littérature et comme perçues par le corps professoral à l'Université Queen. MÉTHODES: Cette étude a intégré une recension des écrits disponibles (n = 26) identifiantdes compétences, qui ont été évaluéespar les auteurs, suivie d'une évaluation externe composée d'experts de la FMFC (n = 5). Ces compétences approuvées ont été utilisées dans une consultation communautaire transversale distribuée une année avant(n = 83) et une année après la transition vers la FMFC (n = 144). RÉSULTATS: Nos compétences nouvellement déterminées représentent un modèle utile pour d'autres institutions. Les compétences d'un conseiller pédagogiquesont axées sur le mentorat et l'accompagnement, alors que les compétences des membres des comités des compétences sont axées sur l'intégration des évaluations et des politiques institutionnelles. Les divergences dans les compétences entre les parties prenantes existants avant la transition avaient disparu dans l'échantillon qui a suivi la mise en œuvre. CONCLUSIONS: Nous avons jugé utile d'adopter une approche active fondée sur lacommunauté pour élaborer et valider les compétences du corps professoral en position de leadership plus tôt que tard dans la transition vers la FMFC. L'évolution des membres des comités de compétences et des conseillers pédagogiquesnécessite un investissement dans un développement professoral spécialisé et un engagement soutenu d'une communauté collaborative qui présente des préoccupations communes.

Aligning Requirements of Training and Assessment in Radiation Treatment Planning in the Era of Competency-Based Medical Education.

PURPOSE: Radiation treatment planning (RTP) is a unique skill that requires interdisciplinary collaboration among radiation oncologists (ROs), dosimetrists, and medical physicists (MP) to train and assess residents. With the adoption of competency-based medical education (CBME) in Canada, it is essential residency program curricula focuses on developing competencies in RTP to facilitate entrustment. Our study investigates how radiation oncology team members' perspectives on RTP education align with requirements of the CBME approach, and its implications for improving residency training. METHODS AND MATERIALS: This qualitative research study took place in the Department of Oncology at a midsize academic institution. Through convenience sampling, focus groups were conducted with radiation oncologists (n = 11), dosimetrists (n = 7), medical physicists (n = 7), and residents (n = 7). Thematic design was adopted to analyze the transcripts through open coding resulting in 3 overarching themes. RESULTS: The results identified existing strengths and weaknesses of the residency program and future opportunities to redesign the curriculum and assessment process within a CBME model. Three overarching themes emerged from the analysis: (1) the strengths of RTP in the CBME environment; (2) challenges of RTP in CBME; and (3) opportunities for change. Stakeholders were optimistic CBME will help enrich resident learning with the increased frequency and quality of competency-based assessments. Participants suggested building a library of cases and developing computer-based learning resources to provide a safe environment to develop skills in contouring, dosimetry, and plan evaluation, in accordance with CBME training. CONCLUSIONS: This study identified future opportunities to redesign the RTP curriculum and assessment process within a CBME model. The need for innovative teaching and learning strategies, including case libraries, computer-based learning, and quality assessments, were highlighted in designing an innovative RTP planning curriculum.

Assessing the quality of feedback to general internal medicine residents in a competency-based environment.

CONSTRUCT: Competency Based Medical Education (CBME) is designed to use workplace-based assessment (WBA) tools to provide observed assessment and feedback on resident competence. Moreover, WBAs are expected to provide evidence beyond that of more traditional mid- or end-of-rotation assessments [e.g., In Training Evaluation Reports (ITERs)]. In this study, we investigated the quality of feedback in General Internal Medicine (GIM), by comparing WBA and ITER assessment tools. BACKGROUND: WBAs are hypothesized to improve written and numerical feedback to support the development and documentation of competence. In this study, we investigated residents' and preceptors' perceptions of WBA validity, usability, and reliability and the extent to which WBAs differentiate residents' performance when compared to ITERs. APPROACH: We used a mixed methods approach over a three-year period, including perspectives gathered from focus groups, interviews, along with numerical and narrative comparisons between WBA and ITERs in one GIM program. RESULTS: Our quantitative analysis of feedback from seven residents' clinical assessments showed that overall rates of actionable feedback, for both ITERs and WBAs, were low (26%), with only 9% of the total providing an improvement strategy. The provision of quality feedback was not significantly different between tools; although WBAs provided more actionable feedback, ITERs provided more strategies. We found that residents and preceptors indicated the narrative component of feedback was more constructive and effective than numerical scores. Both groups perceived the focus on specific workplace-based feedback was more effective than ITERs. CONCLUSIONS: Participants in this study viewed narrative, actionable, and specific feedback as essential, and an overall preference was found for written feedback over numerical assessments. However, our quantitative analyses showed that specific actionable feedback was rarely documented, despite finding an emphasis from both residents and preceptors of its importance for developing competency. Neither formative WBAs nor summative ITERs clearly provided better feedback, and both may still have a role in overall resident evaluation. Participant views differed in roles and responsibilities, with residents stating that preceptors should be responsible for initiating assessments and vice-versa. These results reveal an incongruence between resident and preceptor perceptions and practice around giving feedback and emphasize opportunities for programs adopting and implementing CBME to address how best to support residents and frontline clinical teachers.

ÉLABORATION: La formation médicale par compétences (CBME) est conçue pour utiliser les outils d'évaluation en milieu de travail (WBA) afin de fournir une évaluation formative et une rétroaction basés sur l'observationde la compétence des résidents. De plus, les WBA doivent fournir une preuve plus exacte que les évaluations traditionnelles à mi-cycle et en fin de cycle [p. ex. rapports d'évaluation en cours de formation (ITER)]. Dans cette étude, nous avons examiné la qualité de la rétroaction en médecine interne générale (GIM) en comparant les outils d'évaluation WBA et ITER. CONTEXTE: Les WBA sont pressentis pour être associés à une meilleure rétroaction narrative ou sur échelle quantitative pour appuyer le développement et la documentation de la compétence. Dans cette étude, nous avons examiné les perceptions des résidents et des superviseurs quant à la validité, l'utilité et la fiabilité de la WBA, et la façon dont les WBA différencient les performances des résidents par rapport aux ITER. APPROCHE: Nous avons utilisé une approche de méthodes mixtes sur une période de trois ans, notamment des perspectives recueillies auprès de groupes de discussion, des entrevues, et également des comparaisons numériques et narratives entre les WBA et les ITER liés à un programme de médecine interne générale. RÉSULTATS: Notre analyse quantitative de rétroaction basée sur sept évaluations cliniques de résidents démontre que les taux globaux de rétroaction pertinente, pour les ITER et les WBA, étaient bas (26 %), et que seulement 9 % de ces deux types d'évaluation suggéraient une stratégie d'amélioration. La qualité de la rétroaction n'était pas très différente entre les outils; les WBA ont fourni plus de rétroaction pertinente, mais les ITER ont fourni plus de stratégies. Selon nos observations, les résidents et les superviseurs ont indiqué que la partie narrative de la rétroaction était plus constructive et efficace que les évaluations par échelles quantitative. Les deux groupes ont estimé que l'accent mis sur la rétroaction en milieu de travail était plus efficace que les ITER. CONCLUSIONS: Les participants à cette étude ont estimé que les rétroactions narratives, pertinentes et spécifiques sont essentielles, et nous avons observé une préférence générale pour la rétroaction narrative plutôt que pour l'évaluation avec échelle quantitative. Cependant, nos analyses quantitatives ont démontré que la rétroaction pertinente spécifique était rarement documentée, bien que les résidents et les superviseurs insistent sur son importance quant au développement des compétences. Ni les WBA formatives ni les ITER sommatifs n'ont clairement fourni de meilleures rétroactions et les deux pourraient toujours avoir un rôle dans l'évaluation globale des résidents. Les opinions des résidents divergent de celles des superviseurs quant aux rôles et les responsabilités : les résidents affirment que les précepteurs ont la responsabilité d'initier les évaluations, et vice versa. Ces résultats révèlent une discordance entre les perceptions et les pratiques des résidents et des superviseurs quant aux rétroactions à apporter. Ils mettent également l'accent sur les opportunités pouraux les programmes qui adoptent et implantent la formation médicale par compétences pour trouver la meilleure façon d'appuyer les résidents et les enseignants cliniques sur le terrain.