A New Tool To Give Hospitalists Feedback To Improve Interprofessional Teamwork And Advance Patient Care

Exploring the Impact of Workplace Satisfaction, Leadership, and Career Development on Employee Retention in Hospitals

Background and objectives This study examines hospital employees' perceptions of workplace satisfaction, communication, and professional development, providing insights into key factors affecting job satisfaction, retention, and the overall work environment. Methods A longitudinal survey design was employed to assess hospital employees' perceptions of workplace satisfaction, communication, and professional development at Bihor County Emergency Clinical Hospital. Data were collected over a four-year period (2019-2022) to capture evolving trends in employee attitudes and experiences. The total sample size includes 3,732 participants, who were asked to complete a questionnaire, with data stratified by year and analyzed for statistical significance using p-values. Results The survey results reveal strengths in infection control awareness and compliance, with 95% of employees understanding their responsibilities in preventing healthcare-associated infections. Positive interpersonal communication and collaboration were also highlighted, with 90.9% of employees reporting good relationships with colleagues. However, the survey also identified areas for improvement, particularly in career advancement opportunities, with only 41.8% of respondents believing the hospital had a structured promotion policy. Conclusions These findings suggest that while the hospital excels in certain aspects, addressing gaps in career development, resource management, leadership responsiveness, and training opportunities is essential for enhancing employee satisfaction, reducing turnover, and improving patient care outcomes. Recommendations include establishing merit-based promotion systems, improving infrastructure, and expanding professional development programs.

Comparative Analysis of Patient Satisfaction Surveys-A Crucial Role in Raising the Standard of Healthcare Services

(1) Background: The study aimed to assess the patients' perception of the quality of the medical staff's care, the hotel's services, and the hospital's overall impression as well as to determine the best rating scale through a comparative analysis of patient satisfaction questionnaires. (2) Methods: A retrospective study was performed based on satisfaction questionnaires addressed to the patients hospitalized in the Orthopedics and Traumatology departments of the County Clinical Emergency Hospital Oradea between 2015 and 2019. Three different types of questionnaires were used during the study period, with the number of questions varying between 30 (variant A) and 37 (variant C). The evaluation was done using the Likert scales with three, four, or five answer variables. (3) Results: The items that we found to be present in all three categories of surveys and for which at least two different questionnaire variants used the Likert scales with various answer variables were chosen. In terms of the treatment given by the medical staff, hotel services, and the overall perception of the hospital, the patients perceive a higher level of quality. (4) Conclusions: The level of patient overall satisfaction or general impression about the hospital is strongly dependent on the quality of medical care provided by the doctors and the specific hotel conditions of the hospital. The quality assessment using the Likert rating scale with five binary variables is more accurate.

Comparison of Patient Satisfaction in Inpatient Care Provided by Hospitalists and Nonhospitalists in South Korea

Background: A Korean hospitalist is a medical doctor in charge of inpatient care during hospital stays. The purpose of this study is to examine the patient satisfaction of hospitalist patients compared to non-hospitalist patients. Patient satisfaction is closely related to the outcome, quality, safety, and cost of care. Thus, seeking to achieve high patient satisfaction is essential in the inpatient care setting. Design, setting, and participants: This is a case-control study based on patient satisfaction survey by the Korean Health Insurance Review and Assessment Service. We measured patients’ satisfaction in physician accessibility, consultation and care service skills, and overall satisfaction through logistic regression analyses. A total of 3871 patients from 18 facilities responded to 18 questionnaires and had health insurance claim data. Results: Hospitalist patients presented higher satisfaction during the hospital stay compared to non-hospitalist patients. For example, as per accessibility, hospitalist patients could meet their attending physician more than twice a day (OR: 3.46, 95% CI: 2.82–4.24). Concerning consultation and care service skills, hospitalists’ explanations on the condition and care plans were easy to understand (OR: 2.33, 95% CI: 1.89–2.88). Moreover, overall satisfaction was significantly higher (β: 0.431, p < 0.0001). Subgroup analyses were conducted by medical division and region. Hospitalist patients in the surgical department and the rural area had greater patient satisfaction in all aspects of the survey than non-hospitalist patients. Conclusions: Hospitalists’ patients showed higher satisfaction during the hospital stay. Our study discovered that hospitalists could provide high-quality care as they provide onsite care continuously from admission to discharge.

Hospital staffing patterns and safety culture perceptions: The mediating role of perceived teamwork and perceived handoffs

BACKGROUND

As hospitals are under increasing pressure to improve quality and safety, safety culture has become a focal issue for high-risk organizations, including hospitals. Prior research has examined how structural characteristics directly impact safety culture. However, and based on Donabedian's structure-process-outcome quality model, there is a need to understand the processes that intermediate the relationship between structural characteristics and safety culture perceptions.

PURPOSE

The processes by which registered nurse (RN) and hospitalist staffing may affect safety culture perceptions were examined in this study. Specifically, this study investigates the processes of perceived teamwork across units and perceived handoffs.

METHODOLOGY

Data sources for this research included Hospital Survey on Patient Safety Culture from the Agency for Healthcare Research and Quality, the American Hospital Association's Annual Survey Data, the American Hospital Association Information Technology supplement, and the Area Health Resource File. Two separate mediation models for each process were used. Propensity weights were assigned to each hospital in the sample ( N = 207) to adjust for potential nonresponse bias of hospitals that did not assess employee's safety culture perceptions.

RESULTS

Results suggest that RN staffing influences safety culture perceptions, but hospitalist staffing does not. In addition, RN staffing has an indirect effect on safety culture perceptions through better processes.

PRACTICE IMPLICATIONS

Our study sheds light on how staffing affects safety culture perceptions. Specifically, our findings suggest that positive perceptions of teamwork across units and handoffs are integral in the relationship between RN staffing and safety culture perceptions. Hospital managers should, therefore, invest resources in staff recruitment and retention. In addition, a targeted focus on perceived teamwork and handoffs may allow hospital managers to improve safety culture perceptions.

Unlocking medical leadership’s potential: a multilevel virtuous circle?

Background and aimMedical leadership (ML) has been introduced in many countries, promising to support healthcare services improvement and help further system reform through effective leadership behaviours. Despite some evidence of its success, such lofty promises remain unfulfilled.

MethodCouched in extant international literature, this paper provides a conceptual framework to analyse ML’s potential in the context of healthcare’s complex, multifaceted setting.

ResultsWe identify four interrelated levels of analysis, or domains, that influence ML’s potential to transform healthcare delivery. These are the healthcare ecosystem domain, the professional domain, the organisational domain and the individual doctor domain. We discuss the tensions between the various actors working in and across these domains and argue that greater multilevel and multistakeholder collaborative working in healthcare is necessary to reprofessionalise and transform healthcare ecosystems.

Development of a national medical leadership competency framework: the Dutch approach

BACKGROUND

The concept of medical leadership (ML) can enhance physicians' inclusion in efforts for higher quality healthcare. Despite ML's spiking popularity, only a few countries have built a national taxonomy to facilitate ML competency education and training. In this paper we discuss the development of the Dutch ML competency framework with two objectives: to account for the framework's making and to complement to known approaches of developing such frameworks.

METHODS

We designed a research approach and analyzed data from multiple sources based on Grounded Theory. Facilitated by the Royal Dutch Medical Association, a group of 14 volunteer researchers met over a period of 2.5 years to perform: 1) literature review; 2) individual interviews; 3) focus groups; 4) online surveys; 5) international framework comparison; and 6) comprehensive data synthesis.

RESULTS

The developmental processes that led to the framework provided a taxonomic depiction of ML in Dutch perspective. It can be seen as a canonical 'knowledge artefact' created by a community of practice and comprises of a contemporary definition of ML and 12 domains, each entailing four distinct ML competencies.

CONCLUSIONS

This paper demonstrates how a new language for ML can be created in a healthcare system. The success of our approach to capture insights, expectations and demands relating leadership by Dutch physicians depended on close involvement of the Dutch national medical associations and a nationally active community of practice; voluntary work of diverse researchers and medical practitioners and an appropriate research design that used multiple methods and strategies to circumvent reverberation of established opinions and conventionalisms.

IMPLICATIONS

The experiences reported here may provide inspiration and guidance for those anticipating similar work in other countries to develop a tailored approach to create a ML framework.

Competitive Advantage of MBA for Physician Executives: A Systematic Literature Review

In response to systemic challenges facing the US healthcare system, many medical students, residents and practicing physicians are pursuing a Master in Business Administration (MBA) degree. The value of such proposition remains poorly defined. The aim of this review is to analyze current literature pertaining to the added value of MBA training for physician executives (PEs). We hypothesized that physicians who supplement their clinical expertise with business education gain a significant competitive advantage. A detailed literature search of four electronic databases (PubMed, SCOPUS, Embase and ERIC) was performed. Included were studies published between Jan 2000 and June 2017, focusing specifically on PEs. Among 1580 non-duplicative titles, we identified 23 relevant articles. Attributes which were found to add value to one's competitiveness as PE were recorded. A quality index score was assigned to each article in order to minimize bias. Results were tabulated by attributes and by publication. We found that competitive domains deemed to be most important for PEs in the context of MBA training were leadership (n = 17), career advancement opportunities (n = 12), understanding of financial aspects of medicine (n = 9) and team-building skills (n = 10). Among other prominent factors associated with the desire to engage in an MBA were higher compensation, awareness of public health issues/strategy, increased negotiation skills and enhanced work-life balance. Of interest, the learning of strategies for reducing malpractice litigation was less important than the other drivers. This comprehensive systemic review supports our hypothesis that a business degree confers a competitive advantage for PEs. Physician executives equipped with an MBA degree appear to be better equipped to face the challenge of the dynamically evolving healthcare landscape. This information may be beneficial to medical schools designing or implementing combined dual-degree curricula.

A Qualitative Analysis of Narrative Preclerkship Assessment Data to Evaluate Teamwork Skills

Construct: Students entering the health professions require competency in teamwork. Background: Although many teamwork curricula and assessments exist, studies have not demonstrated robust longitudinal assessment of preclerkship students' teamwork skills and attitudes. Assessment portfolios may serve to fill this gap, but it is unknown how narrative comments within portfolios describe student teamwork behaviors. Approach: We performed a qualitative analysis of narrative data in 15 assessment portfolios. Student portfolios were randomly selected from 3 groups stratified by quantitative ratings of teamwork performance gathered from small-group and clinical preceptor assessment forms. Narrative data included peer and faculty feedback from these same forms. Data were coded for teamwork-related behaviors using a constant comparative approach combined with an identification of the valence of the coded statements as either "positive observation" or "suggestion for improvement." Results: Eight codes related to teamwork emerged: attitude and demeanor, information facilitation, leadership, preparation and dependability, professionalism, team orientation, values team member contributions, and nonspecific teamwork comments. The frequency of codes and valence varied across the 3 performance groups, with students in the low-performing group receiving more suggestions for improvement across all teamwork codes. Conclusions: Narrative data from assessment portfolios included specific descriptions of teamwork behavior, with important contributions provided by both faculty and peers. A variety of teamwork domains were represented. Such feedback as collected in an assessment portfolio can be used for longitudinal assessment of preclerkship student teamwork skills and attitudes.

Reducing Interdisciplinary Communication Failures Through Secure Text Messaging: A Quality Improvement Project

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Introduction:

Interdisciplinary communication failures contribute to medical mistakes and adverse events. At our institution, provider communication previously occurred through unidirectional pager systems. We utilized quality improvement methodology to (1) implement a secure text messaging system for providers on a pediatric ward and (2) evaluate its impact on communication failures. We aimed to reduce potential communication failures between providers by > 25% within 1 month.

Methods:

Implementation of secure text messaging occurred via Plan-Do-Study-Act cycles focused on education, feedback, and electronic health record interventions. We collected pager data before implementation and both pager and secure text messaging data after intervention. Potential communication failures were identified a priori through manual review of the messaging data to capture lack of closed-loop communication. A run chart was used to track daily potential communication failures and total communication volumes.

Results:

Before implementation of secure text messaging, the median daily potential communication failure rate was 5.5%. Usage of secure text messaging increased after implementation, representing 3.5 of 7.2 communications per patient-day. Paging communications decreased from 4.2 to 3.7 per patient-day. Potential communication failures decreased to a median daily rate of 2.2%, representing a 59% reduction in communication failures.

Conclusion:

Implementation of secure text messaging using quality improvement methods resulted in a significant reduction in potential communication failures between residents and nurses. Future interventions will be aimed at maintaining and augmenting providers’ use of secure text messaging to ensure the potential for communication failure remains low.

Performance Measures for Health Care Teams: A Review

Interest in effective health care teamwork has advanced in recent years. To ensure these teams are performing effectively, valid and reliable measurement is necessary. This review identifies and organizes information about measures of health care team performance by addressing the following objectives: (a) identify existing measures of health care team performance ( k = 70), (b) summarize validity evidence (i.e., construct and content validity), (c) summarize reliability information (i.e., interrater/interobserver reliability and internal consistency), (d) summarize information pertaining to the use and implementation of the measures (i.e., generalizability, instrument type, and clarity of language), and (e) identify the teamwork content included in the measures. These findings can aid researchers and practitioners in selecting a measure that is appropriate for a specific context. This review also illuminates areas where future research is needed by identifying types of reliability, validity, and teamwork content that have been largely unaddressed.

Indicators and Measurement Tools for Health Systems Integration: A Knowledge Synthesis

Background:

Despite far reaching support for integrated care, conceptualizing and measuring integrated care remains challenging. This knowledge synthesis aimed to identify indicator domains and tools to measure progress towards integrated care.

Methods:

We used an established framework and a Delphi survey with integration experts to identify relevant measurement domains. For each domain, we searched and reviewed the literature for relevant tools.

Findings:

From 7,133 abstracts, we retrieved 114 unique tools. We found many quality tools to measure care coordination, patient engagement and team effectiveness/performance. In contrast, there were few tools in the domains of performance measurement and information systems, alignment of organizational goals and resource allocation. The search yielded 12 tools that measure overall integration or three or more indicator domains.

Discussion:

Our findings highlight a continued gap in tools to measure foundational components that support integrated care. In the absence of such targeted tools, “overall integration” tools may be useful for a broad assessment of the overall state of a system.

Conclusions:

Continued progress towards integrated care depends on our ability to evaluate the success of strategies across different levels and context. This study has identified 114 tools that measure integrated care across 16 domains, supporting efforts towards a unified measurement framework.

Integrative Review of Technology to Support Communication With Parents of Infants in the NICU

OBJECTIVE

To synthesize findings from the published literature on the use of technology in the NICU to improve communications and interactions among health care providers, parents, and infants.

DATA SOURCES

Electronic databases including Ovid MEDLINE, CINAHL, Web of Science, and Google Scholar were searched for related research published through May 2016. The reference lists of all studies were reviewed, and a hand search of key journals was also conducted to locate eligible studies.

STUDY SELECTION

Eleven studies (five quantitative, two qualitative, and four mixed methods) were identified that met the inclusion criteria. Only studies published in English were included.

DATA EXTRACTION

Whittemore and Knafl's methodology for conducting integrative reviews was used to guide data extraction, analysis, and synthesis. Data were extracted and organized according to the following headings: author, year, and location; study purpose and design; sample size and demographics; technology used; study findings; and limitations.

DATA SYNTHESIS

Various technologies were used, including videoconferencing, videophone, and commercially available modalities such as Skype, FaceTime, AngelEye, and NICView Webcams. In the 11 studies, three main outcomes were evaluated: parents' perception of technology use, health care providers' perceptions of technology use, and objective outcomes, such as parental anxiety or stress or infant length of stay. Overall, parents and health care providers perceived the varied interventions quite favorably, although a few significant differences were found for the objective measures.

CONCLUSION

Several interventions have been tested to improve communications and promote interactions among NICU health care team members, parents, and infants. Although initial findings are positive, research in this area is quite limited, and the reviewed studies had several limitations. There is a significant need for further rigorous research to be conducted with diverse samples.

How hospitalists work to pull healthcare teams together

Purpose

– The purpose of this paper is to document everyday practices by which hospitalist physicians negotiate barriers to effective teamwork.

Design/methodology/approach

– Ethnographic observation with a sample of hospitalists chosen to represent a range of hospital and practice types.

Findings

– Hospitals rely on effective, interprofessional teamwork but typically do not support it. Hospitalist physicians must bridge the internal boundaries within their hospitals to coordinate their patients’ care, but they face challenges – scattered patients, fragmented information, uncoordinated teams, and unreliable processes – that can impact the timeliness and safety of care. Hospitalists largely rely on personal presence and memory to deal with these challenges. Some invent low-tech supports for teamwork, but these are typically neither tested nor shared with others. Formal support for teamwork, primarily case management rounds, is applied unevenly and may not be respected by all team members.

Research limitations/implications

– The findings are drawn from observation over a limited period of time with a small, purposefully chosen sample of physicians and hospitals.

Practical implications

– Hospitals must recognize the issues hospitalists and other providers face, evaluate and disseminate supports for teamwork, and make interprofessional teamwork a core feature of hospital design and evaluation.

Originality/value

– The authors show the nuances of how hospitalists struggle to practice teamwork in a challenging context, and how the approaches they take (relying on memory and personal presence) do not address, and may actually contribute to, the system-level problems they face.

Assessing interprofessional teamwork: pilot test of a new assessment module for practicing physicians

INTRODUCTION

Teamwork is a basic component of all health care, and substantial research links the quality of teamwork to safety and quality of care. The TEAM (Teamwork Effectiveness Assessment Module) is a new Web-based teamwork assessment module for practicing hospital physicians. The module combines self-assessment, multisource feedback from members of other professions and specialties with whom the physician exercises teamwork, and a structured review of those data with a peer to develop an improvement plan.

METHODS

We conducted a pilot test of this module with hospitalist physicians to evaluate the feasibility and usefulness of the module in practice, focusing on these specific questions: Would physicians in hospitals of different types and sizes be able to use the module; would the providers identified as raters respond to the request for feedback; would the physicians be able to identify one or more "trusted peers" to help analyze the feedback; and how would physicians experience the module process overall?

RESULTS

20 of 25 physicians who initially volunteered for the pilot completed all steps of the TEAM, including identifying interprofessional teammates, soliciting feedback from their team, and identifying a peer to help review data. Module users described the feedback they received as helpful and actionable, and indicated this was information they would not have otherwise received.

CONCLUSIONS

The results suggest that a module combining self-assessment, multisource feedback, and a guided process for interpreting these data can provide help practicing hospital physicians to understand and potentially improve their interprofessional teamwork skills and behaviors.

Perceptions of interprofessional teamwork in low-acuity settings: a qualitative analysis

CONTEXT

Working effectively in interprofessional teams is a core competency for all health care professionals, yet there is a paucity of instruments with which to assess the associated skills. Published medical teamwork skills assessment tools focus primarily on high-acuity situations, such as cardiopulmonary arrests and crisis events in operating rooms, and may not generalise to non-high-acuity environments, such as in-patient wards and out-patient clinics.

OBJECTIVE

We undertook the current study to explore the constructs underlying interprofessional teamwork in non-high-acuity settings and team members' perspectives of essential teamwork attributes.

METHODS

We used an ethnographic approach to study four interprofessional teams in two different low-acuity settings: women's HIV (human immunodeficiency virus) clinics and in-patient paediatric wards. Over a period of 17 months, we collected qualitative data through direct observations, focus groups and individual interviews. We analysed the data using qualitative thematic analysis, following an iterative process: data from our observations (20 hours in total) informed the focus group guide and focus group data informed the interview guide. To enhance the integrity of our analysis, we triangulated data sources and verified themes through member checking.

RESULTS

We conducted seven focus groups and 27 individual interviews with a total of 39 study participants representing eight professions. Participants emphasised shared leadership and collaborative decision making, mutual respect, recognition of one's own and others' limitations and strengths, and the need to nurture relationships. Team members also discussed tensions around hierarchy and questioned whether doctor leadership is appropriate for interprofessional teams. Our findings indicate that there are differences in teamwork between low-acuity and high-acuity settings, and also provide insights into potential barriers to effective interprofessional teamwork.

CONCLUSIONS

Our study delineates essential elements of teamwork in low-acuity settings, including desirable attributes of team members, thus laying the foundation for the development of an individual teamwork skills assessment tool.

An academic hospitalist model to improve healthcare worker communication and learner education: results from a quasi-experimental study at a Veterans Affairs medical center

BACKGROUND

Although hospitalists may improve efficiency and quality of inpatient care, their effect on healthcare-worker communication and education has been less well-studied.

OBJECTIVE

To test various approaches to improving healthcare-worker communication and learner education within the context of a newly designed academic hospital medicine program.

DESIGN

Before-and-after design with concurrent control group.

SETTING

A Midwestern Veterans Affairs medical center.

INTERVENTION

Multimodal systems redesign of 1 of 4 medical teams (Gold team) that included clinical modifications (change in rounding structure, with inclusion of nurses, a Clinical Care Coordinator, and a pharmacist) and educational interventions (providing explicit expectations of learners and providing a reading list for both learners and attending physicians).

MEASUREMENTS

Number of admissions, length of stay, readmissions, house officer and medical student ratings of attendings' teaching, medical student internal medicine National Board of Medical Examiners Subject Examination ("shelf" exam) scores, and clinical staff surveys.

RESULTS

Length of stay was reduced by about 0.3 days on all teams after the initiative began (P = 0.004), with no significant differences between Gold and non-Gold teams. The majority of physicians (83%) and nurses (68%) felt that including nurses during rounds improved healthcare-worker communication; significantly more nurses were satisfied with communication with the Gold team than with the other teams (71% vs 53%; P = 0.02). Gold attendings generally received higher teaching scores compared with non-Gold attendings, and third-year medical students on the Gold team scored significantly higher on the shelf exam compared with non-Gold team students (84 vs 82; P = 0.006).

CONCLUSIONS

Academic hospitalists working within a systems redesign intervention were able to improve healthcare-worker communication and enhance learner education without increasing patient length of stay or readmission rates.

Disengaged: a qualitative study of communication and collaboration between physicians and other professions on general internal medicine wards

BACKGROUND

Poor interprofessional communication in hospital is deemed to cause significant patient harm. Although recognition of this issue is growing, protocols are being implemented to solve this problem without empirical research on the interprofessional communication interactions that directly underpin patient care. We report here the first large qualitative study of directly-observed talk amongst professions in general internal medicine wards, describing the content and usual conversation partners, with the aim of understanding the mechanisms by which current patterns of interprofessional communications may impact on patient care.

METHODS

Qualitative study with 155 hours of data-collection, including observation and one-on-one shadowing, ethnographic and semi-structured interviews with physicians, nurses, and allied health professionals in the General Internal Medicine (GIM) wards of two urban teaching hospitals in Canada. Data were coded and analysed thematically with a focus on collaborative interactions between health professionals in both interprofessional and intraprofessional contexts.

RESULTS

Physicians in GIM wards communicated with other professions mainly in structured rounds. Physicians' communications were terse, consisting of reports, requests for information, or patient-related orders. Non-physician observations were often overlooked and interprofessional discussion was rare. Intraprofessional interactions among allied health professions, and between nursing, as well as interprofessional interactions between nursing and allied health were frequent and deliberative in character, but very few such discussions involved physicians, whose deliberative interactions were almost entirely with other physicians.

CONCLUSION

Without interprofessional problem identification and discussion, physician decisions take place in isolation. While this might be suited to protocol-driven care for patients whose conditions were simple and courses predictable, it may fail complex patients in GIM who often need tailored, interprofessional decisions on their care.Interpersonal communication training to increase interprofessional deliberation may improve efficiency, patient-centredness and outcomes of care in hospitals. Also, electronic communications tools which reduce cognitive burden and facilitate the sharing of clinical observations and orders could help physicians to engage more in non-medical deliberation. Such interventions should take into account real-world power differentials between physicians and other health professions.

Specialty board certification in the United States: issues and evidence

BACKGROUND

The American Board of Medical Specialties (ABMS) certification and maintenance of certification (MOC) programs strive to provide the public with guidance about a physician's competence. This study summarizes the literature on the effectiveness of these programs.

METHOD

A literature search was conducted for studies published between 1986 and April 2013 and limited to ABMS certification. A modified version of Kirkpatrick's 4 levels of program evaluation included the reaction of stakeholders to certification, the extent to which physicians are encouraged to improve, the relationship between performance in the programs and nonclinical external measures of physician competence, and the relationship of performance in the programs with clinical quality measures.

RESULTS

Patients' and hospitals' value of board certification and physician participation in MOC are high. Physicians are conflicted as to whether the effort involved is worth its value. Self-reported evidence shows improvement in knowledge, practice infrastructure, communication with patients and peers, and clinical care. Certification performance is generally related to nonclinical external measures such as types of training, practice characteristics, demographics, and disciplinary actions. In general, physicians who are board certified provide better patient care, albeit the results have modest effect sizes and are not unequivocal.

CONCLUSIONS

Certification boards should continuously try to improve their programs in response to feedback from stakeholders, changes in the way physicians practice, as well as the growth in the fields of measurement and technology. Keeping pace with these changes in a responsible and evidence-based way is important.

Realizing the promise and importance of performance-based assessment

Work-based assessment (WBA) is the assessment of trainees and physicians across the educational continuum of day-to-day competencies and practices in authentic, clinical environments. What distinguishes WBA from other assessment modalities is that it enables the evaluation of performance in context. In this perspective, we describe the growing importance, relevance, and evolution of WBA as it relates to competency-based medical education, supervision, and entrustment. Although a systematic review is beyond the purview of this perspective, we highlight specific methods and needed shifts to WBA that (a) consider patient outcomes, (b) use nonphysician assessors, and (c) assess the care provided to populations of patients. We briefly describe strategies for the effective implementation of WBA and identify outstanding research questions related to its use.