Subtyping of Performance Trajectory During Medical School, Medical Internship, and the First Year of Residency in Training Physicians: A Longitudinal Cohort Study.

BACKGROUND: Developmental trajectories of clinical skills in training physicians vary among tasks and show interindividual differences. This study examined the predictors of medical internship performance and residency entrance and found subtypes of performance trajectory in training physicians. METHODS: This retrospective cohort study involved 888 training physicians who completed a medical internship between 2015 and 2019. After the internship, 627 physicians applied for residency training between 2016 and 2020. Finally, 160 of them completed their first-year residency in internal medicine, surgery, pediatrics, and psychiatry departments between 2016 and 2020. Pearson's correlation coefficients of internship performance and first year-residency performance (n = 160) were calculated. Latent profile analysis identified performance trajectory subtypes according to medical school grade point average (GPA), internship performance, English proficiency, and residency selection procedures. Multivariate logistic regression models of residency acceptance (n = 627) and performance in the top 30%/lower 10% in the first year of residency were also constructed. RESULTS: Medical internship performance showed a significant positive correlation with the medical school GPA (r = 0.194) and the written score for the medical licensing examination (r = 0.125). Higher scores in the interview (adjusted odds ratio [aOR], 2.57) and written examination (aOR, 1.45) of residency selection procedures and higher medical internship performance (aOR, 1.19) were associated with a higher chance of residency acceptance. The latent profile analyses identified three training physician subgroups: average performance, consistently high performance (top 30%), and adaptation to changes (lowest 10%). Higher scores in the interview for residency selection (aOR, 1.35) and lower scores for medical internship performance (aOR, 0.79) were associated with a higher chance of performing in the top 30% or lowest 10% in the first year of residency, respectively. CONCLUSION: Performance in the interview and medical internship predicted being among the top 30% and lowest 10% of performers in the first year of residency training, respectively. Individualized educational programs to enhance the prospect of trainees becoming high-functioning physicians are needed.

A needs assessment for enhancing workplace-based assessment: a grounded theory study.

OBJECTIVES: Workplace-based assessment (WBA) has been vigorously criticized for not fulfilling its educational purpose by medical educators. A comprehensive exploration of stakeholders' needs regarding WBA is essential to optimize its implementation in clinical practice. METHOD: Three homogeneous focus groups were conducted with three groups of stakeholders: General Practitioner (GP) trainees, GP trainers, and GP tutors. Due to COVID-19 measures, we opted for an online asynchronous form to enable participation. An constructivist grounded theory approach was used to employ this study and allow the identification of stakeholders' needs for using WBA. RESULTS: Three core needs for WBA were identified in the analysis. Within GP Training, stakeholders found WBA essential, primarily, for establishing learning goals, secondarily, for assessment purposes, and, lastly, for providing or receiving feedback. CONCLUSION: All stakeholders perceive WBA as valuable when it fosters learning. The identified needs were notably influenced by agency, trust, availability, and mutual understanding. These were facilitating factors influencing needs for WBA. Embracing these insights can significantly illuminate the landscape of workplace learning culture for clinical educators and guide a successful implementation of WBA.

Co-designing Entrustable Professional Activities in General Practitioner's training: a participatory research study.

BACKGROUND: In medical education, Entrustable Professional Activities (EPAs) have been gaining momentum for the last decade. Such novel educational interventions necessitate accommodating competing needs, those of curriculum designers, and those of users in practice, in order to be successfully implemented. METHODS: We employed a participatory research design, engaging diverse stakeholders in designing an EPA framework. This iterative approach allowed for continuous refinement, shaping a comprehensive blueprint comprising 60 EPAs. Our approach involved two iterative cycles. In the first cycle, we utilized a modified-Delphi methodology with clinical competence committee (CCC) members, asking them whether each EPA should be included. In the second cycle, we used semi-structured interviews with General Practitioner (GP) trainers and trainees to explore their perceptions about the framework and refine it accordingly. RESULTS: During the first cycle, 14 CCC members agreed that all the 60 EPAs should be included in the framework. Regarding the formulation of each EPAs, 20 comments were given and 16 adaptations were made to enhance clarity. In the second cycle, the semi-structured interviews with trainers and trainees echoed the same findings, emphasizing the need of the EPA framework for improving workplace-based assessment, and its relevance to real-world clinical scenarios. However, trainees and trainers expressed concerns regarding implementation challenges, such as the large number of EPAs to be assessed, and perception of EPAs as potentially high-stakes. CONCLUSION: Accommodating competing stakeholders' needs during the design process can significantly enhance the EPA implementation. Recognizing users as experts in their own experiences empowers them, enabling a priori identification of implementation barriers and potential pitfalls. By embracing a collaborative approach, wherein diverse stakeholders contribute their unique viewpoints, we can only create effective educational interventions to complex assessment challenges.

The Ottawa resident observation form for nurses (O-RON): evaluation of an assessment tool's psychometric properties in different specialties.

BACKGROUND: Workplace-based assessment (WBA) used in post-graduate medical education relies on physician supervisors' feedback. However, in a training environment where supervisors are unavailable to assess certain aspects of a resident's performance, nurses are well-positioned to do so. The Ottawa Resident Observation Form for Nurses (O-RON) was developed to capture nurses' assessment of trainee performance and results have demonstrated strong evidence for validity in Orthopedic Surgery. However, different clinical settings may impact a tool's performance. This project studied the use of the O-RON in three different specialties at the University of Ottawa. METHODS: O-RON forms were distributed on Internal Medicine, General Surgery, and Obstetrical wards at the University of Ottawa over nine months. Validity evidence related to quantitative data was collected. Exit interviews with nurse managers were performed and content was thematically analyzed. RESULTS: 179 O-RONs were completed on 30 residents. With four forms per resident, the ORON's reliability was 0.82. Global judgement response and frequency of concerns was correlated (r = 0.627, P < 0.001). CONCLUSIONS: Consistent with the original study, the findings demonstrated strong evidence for validity. However, the number of forms collected was less than expected. Exit interviews identified factors impacting form completion, which included clinical workloads and interprofessional dynamics.

Perceptions and experiences of trainers and trainees of UK workplace-based assessment for general practice licensing: a mixed methods survey.

BACKGROUND: Workplace-Based Assessment (WPBA) forms a major component of the UK General Practitioner (GP) licensing, together with knowledge and clinical skills examination. WPBA includes Case-based Discussion, Consultation Observation Tool, Mini-Consultation Exercise, Multisource Feedback, Patient Satisfaction Questionnaire, Clinical Examination and Procedural Skills, Clinical Supervisor's Report, and Educational Supervisor Review. We aimed to investigate GP trainees' and trainers' perceptions and experiences of WPBA regarding validity and fairness. METHODS: We used a national online survey, with Likert-scaled and free-text responses, to a convenience sample of GP trainees and trainers, on perceptions and experiences of WPBA. Analysis included descriptive statistics, scale development, and regression models to investigate factors associated with attitudes towards WPBA, with thematic analysis of free text responses supported by NVivo 12. RESULTS: There were 2,088 responses from 1,176 trainees and 912 trainers. Both groups were generally positive towards WPBA, with trainers more positive or similar to trainees towards individual assessments. In a multivariable regression model, accounting for sex, ethnicity and country of primary medical qualification, trainees were significantly less positive (p < 0.001) while international medical graduates (IMGs) trained outside the European Economic Area (EEA) were significantly more (p < 0.001) positive towards WPBA. Qualitative analysis revealed varying concerns about validity and relevance, assessment burden, potential for bias, fairness to protected characteristics groups, gaps in assessment, and perceptions of individual assessments. DISCUSSION: Trainers' greater positivity towards elements of WPBA accords with their role as assessors. Despite concerns about bias, IMGs from outside the EEA were significantly more positive towards WPBA.

Evolution of the feedback conversation in anaesthesia education: a narrative review.

Over the past century, education has been a core component for improving patient safety. The initial focus was developing a curriculum and an assessment process. In recent decades, the value of work-based learning has come to the fore. Learning from work, or experiential learning, requires reflection, which is critically dependent on external feedback. Conceptions of feedback have moved from a transactional information transfer from the supervisor to the trainee to a learner-centred and collaborative process occurring in a complex socio-cultural environment. In this narrative review we describe the evolution of the feedback conversation, provide a model synthesising the core concepts of feedback, and offer some guidance for the development of effective feedback in anaesthesia education.

Advancements in Surgical Performance Evaluation and Feedback.

PURPOSE OF REVIEW: How today's urology trainees acquire surgical skills has changed dramatically due to multiple forces placing strain on the graduate medical education mission. The development of workplace-based assessments that deliver feedback while capturing performance data has led to a paradigm shift toward individualized learning. RECENT FINDINGS: Delivering feedback that drives surgical skill development requires the educator to provide a meaningful assessment of the learner after an operative experience. Workplace-based assessment involves direct observation of routine clinical practice and has become a central component of competency-based medical education. Urology has the chance to fully embrace competency-based medical education, employing robust feedback mechanisms and workplace-based assessments. We must first define what it means to be a proficient urologist and design an assessment system that captures this collective sentiment. This can only be done through effective engagement and collaboration with stakeholders across our specialty.

Implicit versus explicit first impressions in performance-based assessment: will raters overcome their first impressions when learner performance changes?

First impressions can influence rater-based judgments but their contribution to rater bias is unclear. Research suggests raters can overcome first impressions in experimental exam contexts with explicit first impressions, but these findings may not generalize to a workplace context with implicit first impressions. The study had two aims. First, to assess if first impressions affect raters' judgments when workplace performance changes. Second, whether explicitly stating these impressions affects subsequent ratings compared to implicitly-formed first impressions. Physician raters viewed six videos where learner performance either changed (Strong to Weak or Weak to Strong) or remained consistent. Raters were assigned two groups. Group one (n = 23, Explicit) made a first impression global rating (FIGR), then scored learners using the Mini-CEX. Group two (n = 22, Implicit) scored learners at the end of the video solely with the Mini-CEX. For the Explicit group, in the Strong to Weak condition, the FIGR (M = 5.94) was higher than the Mini-CEX Global rating (GR) (M = 3.02, p < .001). In the Weak to Strong condition, the FIGR (M = 2.44) was lower than the Mini-CEX GR (M = 3.96 p < .001). There was no difference between the FIGR and the Mini-CEX GR in the consistent condition (M = 6.61, M = 6.65 respectively, p = .84). There were no statistically significant differences in any of the conditions when comparing both groups' Mini-CEX GR. Therefore, raters adjusted their judgments based on the learners' performances. Furthermore, raters who made their first impressions explicit showed similar rater bias to raters who followed a more naturalistic process.

"A whole other competence story": exploring faculty perspectives on the process of workplace-based assessment of entrustable professional activities.

The centrality of entrustable professional activities (EPAs) in competency-based medical education (CBME) is predicated on the assumption that low-stakes, high-frequency workplace-based assessments used in a programmatic approach will result in accurate and defensible judgments of competence. While there have been conversations in the literature regarding the potential of this approach, only recently has the conversation begun to explore the actual experiences of clinical faculty in this process. The purpose of this qualitative study was to explore the process of EPA assessment for faculty in everyday practice. We conducted 18 semi-structured interviews with Anesthesia faculty at a Canadian academic center. Participants were asked to describe how they engage in EPA assessment in daily practice and the factors they considered. Interviews were audio-recorded, transcribed, and analysed using the constant comparative method of grounded theory. Participants in this study perceived two sources of tension in the EPA assessment process that influenced their scoring on official forms: the potential constraints of the assessment forms and the potential consequences of their assessment outcome. This was particularly salient in circumstances of uncertainty regarding the learner's level of competence. Ultimately, EPA assessment in CBME may be experienced as higher-stakes by faculty than officially recognized due to these tensions, suggesting a layer of discomfort and burden in the process that may potentially interfere with the goal of assessment for learning. Acknowledging and understanding the nature of this burden and identifying strategies to mitigate it are critical to achieving the assessment goals of CBME.

Mobile technologies to support workplace-based assessment for entrustment decisions: Guidelines for programs and educators: AMEE Guide No. 154.

With the rise of competency-based medical education and workplace-based assessment (WBA) since the turn of the century, much has been written about methods of assessment. Direct observation and other sources of information have become standard in many clinical programs. Entrustable professional activities (EPAs) have also become a central focus of assessment in the clinical workplace. Paper and pencil (one of the earliest mobile technologies!) to document observations have become almost obsolete with the advent of digital technology. Typically, clinical supervisors are asked to document assessment ratings using forms on computers. However, accessing these forms can be cumbersome and is not easily integrated into existing clinical workflows. With a call for more frequent documentation, this practice is hardly sustainable, and mobile technology is quickly becoming indispensable. Documentation of learner performance at the point of care merges WBA with patient care and WBA increasingly uses smartphone applications for this purpose.This AMEE Guide was developed to support institutions and programs who wish to use mobile technology to implement EPA-based assessment and, more generally, any type of workplace-based assessment. It covers backgrounds of WBA, EPAs and entrustment decision-making, provides guidance for choosing or developing mobile technology, discusses challenges and describes best practices.

Fitness-for-purpose of the CanMEDS competencies for workplace-based assessment in General Practitioner's Training: a Delphi study.

BACKGROUND: In view of the exponential use of the CanMEDS framework along with the lack of rigorous evidence about its applicability in workplace-based medical trainings, further exploring is necessary before accepting the framework as accurate and reliable competency outcomes for postgraduate medical trainings. Therefore, this study investigated whether the CanMEDS key competencies could be used, first, as outcome measures for assessing trainees' competence in the workplace, and second, as consistent outcome measures across different training settings and phases in a postgraduate General Practitioner's (GP) Training. METHODS: In a three-round web-based Delphi study, a panel of experts (n = 25-43) was asked to rate on a 5-point Likert scale whether the CanMEDS key competencies were feasible for workplace-based assessment, and whether they could be consistently assessed across different training settings and phases. Comments on each CanMEDS key competency were encouraged. Descriptive statistics of the ratings were calculated, while content analysis was used to analyse panellists' comments. RESULTS: Out of twenty-seven CanMEDS key competencies, consensus was not reached on six competencies for feasibility of assessment in the workplace, and on eleven for consistency of assessment across training settings and phases. Regarding feasibility, three out of four key competencies under the role "Leader", one out of two competencies under the role "Health Advocate", one out of four competencies under the role "Scholar", and one out of four competencies under the role "Professional" were deemed as not feasible for assessment in a workplace setting. Regarding consistency, consensus was not achieved for one out of five competencies under "Medical Expert", two out of five competencies under "Communicator",one out of three competencies under "Collaborator", one out of two under "Health Advocate", one out of four competencies under "Scholar", one out of four competencies under "Professional". No competency under the role "Leader" was deemed to be consistently assessed across training settings and phases. CONCLUSIONS: The findings indicate a mismatch between the initial intent of the CanMEDS framework and its applicability in the context of workplace-based assessment. Although the CanMEDS framework could offer starting points, further contextualization of the framework is required before implementing in workplace-based postgraduate medical trainings.

"We just don't have the resources": Supervisor perspectives on introducing workplace-based assessments into medical specialist training in South Africa.

BACKGROUND: South Africa (SA) is on the brink of implementing workplace-based assessments (WBA) in all medical specialist training programmes in the country. Despite the fact that competency-based medical education (CBME) has been in place for about two decades, WBA offers new and interesting challenges. The literature indicates that WBA has resource, regulatory, educational and social complexities. Implementing WBA would therefore require a careful approach to this complex challenge. To date, insufficient exploration of WBA practices, experiences, perceptions, and aspirations in healthcare have been undertaken in South Africa or Africa. The aim of this study was to identify factors that could impact WBA implementation from the perspectives of medical specialist educators. The outcomes being reported are themes derived from reported potential barriers and enablers to WBA implementation in the SA context. METHODS: This paper reports on the qualitative data generated from a mixed methods study that employed a parallel convergent design, utilising a self-administered online questionnaire to collect data from participants. Data was analysed thematically and inductively. RESULTS: The themes that emerged were: Structural readiness for WBA; staff capacity to implement WBA; quality assurance; and the social dynamics of WBA. CONCLUSIONS: Participants demonstrated impressive levels of insight into their respective working environments, producing an extensive list of barriers and enablers. Despite significant structural and social barriers, this cohort perceives the impending implementation of WBA to be a positive development in registrar training in South Africa. We make recommendations for future research, and to the medical specialist educational leaders in SA.

Exam prediction and the general Practice Registrar Competency Assessment Grid (GPR-CAG).

BACKGROUND: In GP training, identifying early predictors of poor summative examination performance can be challenging. We aimed to establish whether external clinical teaching visit (ECTV) performance, measured using a validated instrument (GP Registrar Competency Assessment Grid, GPR-CAG) is predictive of Royal Australian College of General Practitioners (RACGP) Fellowship examination performance. METHODS: A retrospective cohort study including GP registrars in New South Wales/Australian Capital Territory with ECTV data recorded during their first training term (GPT1), between 2014 and 2018, who attempted at least one Fellowship examination. Independent variables of interest included the four GPR-CAG factors assessed in GPT1 ('patient-centredness/caring', 'formulating hypotheses/management plans', 'professional responsibilities', 'physical examination skills'). Outcomes of interest included individual scores of the three summative examinations (Applied Knowledge Test (AKT); Key Feature Problem (KFP); and the Objective Structured Clinical Examination (OSCE)) and overall Pass/Fail status. Univariable and multivariable regression analyses were performed. RESULTS: Univariably, there were statistically significant associations (p < 0.01) between all four GPR-CAG factors and all four summative examination outcomes, except for 'formulating hypotheses/management plans' and OSCE score (p = 0.07). On multivariable analysis, each factor was significantly associated (p < 0.05) with at least one exam outcome, and 'physical examination skills' was significantly associated (p < 0.05) with all four exam outcomes. DISCUSSION: ECTV performance, via GPR-CAG scores, is predictive of RACGP Fellowship exam performance. The univariable findings highlight the pragmatic utility of ECTVs in flagging registrars who are at-risk of poor exam performance, facilitating early intervention. The multivariable associations of GPR-CAG scores and examination performance suggest that these scores provide predictive ability beyond that of other known predictors.

Validity Evidence for a Novel, Comprehensive Bag-Mask Ventilation Assessment Tool.

OBJECTIVE: To develop a comprehensive competency assessment tool for pediatric bag-mask ventilation (pBMV) and demonstrate multidimensional validity evidence for this tool. STUDY DESIGN: A novel pBMV assessment tool was developed consisting of 3 components: a 22-item-based checklist (trichotomized response), global rating scale (GRS, 5-point), and entrustment assessment (4-point). Participants' performance in a realistic simulation scenario was video-recorded and assessed by blinded raters. Multidimensional validity evidence for procedural assessment, including evidence for content, response-process, internal structure, and relation to other variables, was assessed. The scores of each scale were compared with training level. Item-based checklist scores also were correlated with GRS and entrustment scores. RESULTS: Fifty-eight participants (9 medical students, 10 pediatric residents, 18 critical care/neonatology fellows, 21 critical care/neonatology attendings) were evaluated. The pBMV tool was supported by high internal consistency (Cronbach α = 0.867). Inter-rater reliability for the item-based checklist component was acceptable (r = 0.65, P < .0001). The item-based checklist scores differentiated between medical students and other providers (P < .0001), but not by other trainee level. GRS and entrustment scores significantly differentiated between training levels (P < .001). Correlation between skill item-based checklist and GRS was r = 0.489 (P = .0001) and between item-based checklist and entrustment score was r = 0.52 (P < .001). This moderate correlation suggested each component measures pBMV skills differently. The GRS and entrustment scores demonstrated moderate inter-rater reliability (0.42 and 0.46). CONCLUSIONS: We established evidence of multidimensional validity for a novel entrustment-based pBMV competence assessment tool, incorporating global and entrustment-based assessments. This comprehensive tool can provide learner feedback and aid in entrustment decisions as learners progress through training.

Desire paths for workplace assessment in postgraduate anaesthesia training: analysing informal processes to inform assessment redesign.

BACKGROUND: In postgraduate specialist training, workplace assessments are expected to provide the information required for decisions on trainee progression. Research suggests that meeting this expectation can be difficult in practice, which has led to the development of informal processes, or 'shadow systems' of assessment. Rather than rejecting these informal approaches to workplace assessment, we propose borrowing from sociology the concept of 'desire paths' to legitimise and strengthen these well-trodden approaches. We asked what information about trainees is currently used or desired by those charged with making decisions on trainee progression, and how is it obtained? METHODS: We undertook a qualitative study with thematic analysis of semi-structured interviews of supervisors of training across Australia and New Zealand. RESULTS: From 21 interviews, we identified four interrelated themes, the first being the local context of training sites. The other three themes represent dilemmas in the desire for authentic and representative information about the trainee: 1) how the process of gathering and documenting information can filter, transform, or limit the original message; 2) deciding when possible trainee deviation from performance norms warrants a closer look; and 3) how transparent vs covert information gathering affects the information supervisors will provide, and how control over assessment is distributed between trainee and supervisor. CONCLUSION: From these themes, we propose a set of design principles for future workplace assessment. Understanding the reasons desire paths exist can inform future assessment redesign, and may address the current disjunct between the formal workplace assessment system and what happens in practice.

Validity evidence for the Anesthesia Clinical Encounter Assessment (ACEA) tool to support competency-based medical education.

BACKGROUND: Workplace-based assessment (WBA) is key to a competency-based assessment strategy. Concomitantly with our programme's launch of competency-based medical education, we developed an entrustment-based WBA, the Anesthesia Clinical Encounter Assessment (ACEA), to assess readiness for independent practice of competencies essential to perioperative patient care. This study aimed to examine validity evidence of the ACEA during postgraduate anaesthesiology training. METHODS: The ACEA comprises an eight-item global rating scale (GRS), an overall independence rating, an eight-item checklist, and case details. ACEA data were extracted for University of Toronto anaesthesia residents from July 2017 to January 2020 from the programme's online assessment portal. Validity evidence was generated following Messick's validity framework, including response process, internal structure, relations with other variables, and consequences. RESULTS: We analysed 8664 assessments for 137 residents completed by 342 assessors. From generalisability analysis, 10 independent observations (two assessments each from five assessors) were sufficient to achieve a reliability threshold of ≥0.70 for in-training assessments. A composite GRS score of 3.65/5 provided optimal sensitivity (93.6%) and specificity (90.8%) for determining entrustment on receiver operator characteristic curve analysis. Test-retest reliability was high (intraclass correlation coefficient [ICC2,1]=0.81) for matched assessments within 14 days of each other. Composite GRS scores differed significantly between residents based on their training level (P<0.0001) and correlated highly with overall independence (0.91, P<0.001). The internal consistency of the GRS (α=0.96) was excellent. CONCLUSIONS: This study supports the validity of the ACEA for assessing the competence of residents performing perioperative care and supports its use in competency-based anaesthesiology training.

A mobile application to facilitate implementation of programmatic assessment in anaesthesia training.

BACKGROUND: Programmatic assessment is a concept to support learning through continuously providing information about learner progress to trainees and supervisors. Central to the concept are multiple low-stakes workplace-based assessments and meaningful feedback opportunities. Mobile technology may facilitate frequent and concise workplace-based assessments and trigger meaningful feedback. We designed a mobile application (app) for real-time use at the workplace utilising the concept of entrustable professional activities. As the primary outcome, we analysed completion times and as the secondary outcome the quality of documented learning goals. METHODS: The prEPAred app requests trainees and supervisors to rate level of supervision of a professional activity directly after completion. Subsequently, ratings are compared, and supervisors may provide feedback via the app. We tested the app in five anaesthesiology departments at major teaching hospitals, analysing completion times, agreement on ratings, and quality of documented learning goals. RESULTS: We recorded 1518 assessments from 159 trainees and 89 supervisors. Median time for level of supervision rating was 56 (inter-quartile range: 39-85) s for trainees and 17 (11-30) s for supervisors. Learning goals via the app were documented in 767 cases (50.5%). Median feedback time was 2 min, 31 s (confidence interval [CI]: 1 min, 20 s to 5 min, 20 s). In 443 (29%) cases, a specific learning goal was documented. A post hoc analysis revealed that the odds of documenting learning goals increased if trainees rated the level of supervision higher than their supervisors (odds ratio 1.39; CI: 1.03-1.87). CONCLUSIONS: The prEPAred mobile app enabled frequent and concise documentation of workplace-based assessments. Disagreement in level of supervision rating stimulated documentation of specific learning goals indicating more meaningful feedback. Thus, the tool could advance workplace-based assessments towards programmatic assessment.

Is the rating result reliable? A new approach to respond to a medical trainee's concerns about the reliability of Mini-CEX assessment.

PURPOSE: Whether the rating result of mini-clinical evaluation exercise (Mini-CEX) for rating clinical skills is reliable is of a medical trainee's great concerns. The objectives of this study were to analyze the test-retest reliability, interrater reliability and internal consistency reliability of Mini-CEX. METHODS: Three clinical scenarios, each played by a standardized patient and resident, were developed and videotaped. A group of assessors were recruited to rate the resident's clinical skills using Mini-CEX with a nine-point grading scale in each videotaped clinical scenario. Each assessor was required: (1) to watch the videotaped clinical scenarios a sequential order; (2) to rate each medical trainee's clinical skills in each clinical scenario for two rating sessions, and there must be a minimum three-week interval between the first and the second Mini-CEX rating session. RESULTS: A total of 38 assessors participated in this study. This study showed that: (1) an assessor carried out similar rating reuslts under the same clinical performance based on an acceptable test-retest reliability (Pearson's correlation coefficients = 0.24-0.76, P value=<0.01-0.14); (2) assessors gave similar rating results to a medical trainee's clinical performance based on a good interrater reliability (intra-class correlation coefficient = 0.57-0.83, P value=<0.01-0.03); and (3) the items reflected unidimensionally a construct-a medical trainee's clinical skills based on an excellent internal consistency reliability (Cronbach's alpha = 0.92-0.97). CONCLUSION: This study convincingly showed that Mini-CEX is a reliable assessment tool for rating clinical skills, and can be widely used to assess medical trainees' clinical skills.

Measuring interprofessional education and collaborative practice competencies: a content validity study of the Jefferson Teamwork Observation Guide®.

Collaborative practice (CP) is integral in meeting the Quadruple Aim of healthcare, with effective team-based practice linked to improving all four components. Evidence of the validity of tools measuring collaborative practice competencies is lacking in educational and practice settings. The Jefferson Teamwork Observation Guide® (JTOG®), a real-time, 360-degree competency-based assessment tool administered via mobile app, provides formative feedback to learners in educational settings and helps practitioners develop and refine team-based behaviors in clinical settings. This study examines content validity evidence in terms of the linkage of JTOG items with the four Interprofessional Education Collaborative (IPEC) core competencies, along with two additional domains of leadership and patient-centeredness. Results provide content validity evidence to support use of the JTOG in interprofessional collaborative practice (IPCP) settings. The Teams and Teamwork competency was linked with every item, which is consistent with JTOG as a measure of teamwork. Aligning with the 2016 IPEC update, the JTOG items are all intercorrelated and together represent coverage across all competency areas. While items were typically linked to multiple competencies, each item only had one primary linkage. Analyses revealed that there is sufficient evidence of content validity relative to the intended IPCP competencies, and the JTOG tool is promising in its role to fill a gap in extant literature to measure collaborative practice behaviors.

An innovative interprofessional dental clinical learning environment using entrustable professional activities.

INTRODUCTION: Changes in society, new public demands for dental care and contemporary educational insights have influenced dental education worldwide and demand a renewed perspective. Following this perspective, an innovative interprofessional dental Master curriculum was developed at Radboud University Nijmegen in the Netherlands. EDUCATIONAL PRINCIPLES: The curriculum is based on five contemporary educational principles and the core of the curriculum consists of a Student Run Dental Clinic that is fully run by students under professional supervision. THE NEW CURRICULUM: In the Student Run Dental Clinic, Master dental students and Bachelor oral hygiene students are responsible for the care of approximately 750 patients. The students work within the same clinic for 3 years and patients receive oral health care from the same students over a long period. The clinic is a longitudinal cross-disciplinary clinic with different dental subdisciplines. Entrustable professional activities (also known as EPAs), to our knowledge not yet widely used in dental education, were introduced to facilitate learning and assessment. Fourteen EPAs have been developed to stimulate interprofessional education and learning. Of these, five EPAs are identical for the dental and oral hygiene curriculum, leading to extended interprofessional education and learning in the Student Run Dental Clinic. DISCUSSION: Preliminary results show that EPAs are generally well received by supervisors and students. CONCLUSION: To monitor and investigate the exact effect of the interventions and underlying mechanisms, a research programme on interprofessional learning, practice-based learning and EPAs and entrustment in dental education was recently set up.