Clinician educators' conceptions of assessment in medical education

In pursuing assessment excellence, clinician-educators who design and implement assessment are pivotal. The influence of their assessment practice in university-run licensure exams on student learning has direct implications for future patient care. While teaching practice has been shown to parallel conceptions of teaching, we know too little about conceptions of assessment in medical education to know if this is the case for assessment practice and conceptions of assessment. To explore clinician-educators' conceptions of assessment, a phenomenographic study was undertaken. Phenomenography explores conceptions, the qualitatively different ways of understanding a phenomenon. Data analysis identifies a range of hierarchically inclusive categories of understanding, from simple to more complex, and the dimensions that distinguish each category or conception. Thirty-one clerkship convenors in three diverse Southern settings were interviewed in three cycles of iterative data collection and analysis. Four conceptions of assessment were identified: passive operator, awakening enquirer, active owner and scholarly assessor. Six dimensions were elucidated to describe and distinguish each conception: purpose of assessment; temporal perspective; role and responsibility; accountability; reflexivity and emotional valence. Additionally, three characteristics that appeared to track the progressive nature of the conceptions were identified: professional identity, assessment literacy and self-efficacy. These conceptions encompass and extend previously described conceptions across different educational levels, disciplines and contexts, suggesting applicability to other settings. There is some evidence of a relationship between conceptions and practice, suggesting, together with the hierarchical nature of these conceptions, that targeting conceptions during faculty development may be an effective approach to enhance assessment practice.

Feedback during summative clinical assessments: Experiences of diagnostic radiography students at a higher education institution in South Africa

INTRODUCTION

Summative clinical assessments and feedback, conducted at clinical training sites, are vital for successfully preparing undergraduate diagnostic radiography students to become competent, skilled diagnostic radiographers. However, providing appropriate feedback in a clinical context is a complex matter, as studies show that students often feel intimidated by feedback and may only accept feedback selectively, so as to pass their assessment or course. This article reports on the experiences of radiography students regarding summative clinical assessment feedback.

METHODS

A qualitative, exploratory, descriptive, and contextual research design was used. Data were gathered from radiography students at one higher education institution in South Africa who were registered in year three and year four of a four-year professional Diagnostic Radiography degree. Five semi-structured focus group interviews were conducted, with 26 participants in total. Focus group interviews were audio recorded, transcribed verbatim and coded using Tesch's data analysis method.

RESULTS

Two principle themes emerged from the data analysis. Theme 1 unpacked whether radiography students viewed the assessor as an ally or foe. It was found that various assessor-related characteristics influenced radiography students receptivity towards feedback and this was related to how they viewed the assessor. Theme 2 concerned the radiography students' perceptions of the key elements influencing the nature of a feedback process. These elements were influenced primarily by the assessor, but the attitudes of radiography students towards the feedback process were also important.

CONCLUSION

Radiography students reported various positive experiences regarding assessor feedback during the summative clinical assessments. However, they were also dissatisfied with numerous aspects of how the assessors provided feedback often viewing the assessor as one who is a foe or who is opposed to their success. Subsequently the negative aspects of the feedback process hampered the learning experience of the participants.

IMPLICATIONS FOR PRACTICE

Awareness and the development of feedback skills for assessors and radiography students would be beneficial to the learning process. Radiography students, the radiography profession and ultimately the patients would benefit from the effects of effective feedback.

[Tips and tricks in court-Practical experience from a medical viewpoint]

When it comes to legal aspects and doctors have to go to court, most likely they will serve as an expert or regular witness or as a defendant in a civil litigation in case of recourse claims and only rarely as defendants in a criminal case. With the exception of expert testimonies by seasoned physicians, this is not usually an easy situation. This article addresses important aspects of the preparation for a trial and its procedures. If appropriately prepared, and if necessary represented by a good attorney, these sometimes emotionally stressful situations can be mastered quite well.

The effects of human factor related issues on assessors during the recruitment process for general and vascular surgery in the UK

INTRODUCTION

Healthcare professionals increasingly recognise how human factors (HF) can contribute to medical error. An understanding of HF is also important during other high stakes activities such as summative assessments or examinations. National organisations hosting such events need to be aware of potential fatigue, boredom and stress that can occur in interviewers during these often repetitive activities.

METHODS

A previously validated questionnaire based around the well known HF analysis and classification system (HFACS) was used to evaluate four factors (care and support, asking questions about the role as an interviewer, working within the rules and boundaries, and stress and pressure) at the 2018 UK general and vascular surgery trainee national selection process.

RESULTS

A total of 92 questionnaires were completed and analysed (48% response rate). After recoding for negative phrased questions, no significant differences were found between years of experience in the selection process and mean scores obtained for all four factor items. Interviewers had a positive experience during national selection with mean factor scores ranging from 3.84 to 3.98 (out of a maximum satisfaction score of 5).

CONCLUSIONS

Organisations need to plan carefully and recognise the human element to ensure that their interviewers are cared for during any high stakes assessment such as national selection. Our work suggests that a positive assessor experience will further help contribute to a reliable and fair recruitment process.

Cumulative cultural evolution: the role of teaching

In humans, cultural transmission occurs usually by cumulative inheritance, generating complex adaptive behavioral features. Cumulative culture requires key psychological processes (fundamentally imitation and teaching) that are absent or impoverished in non-human primates. In this paper we analyze the role that teaching has played in human cumulative cultural evolution. We assume that a system of cumulative culture generates increasingly adaptive behaviors, that are also more complex and difficult to imitate. Our thesis is that, as cultural traits become more complex, cumulative cultural transmission requires teaching to ensure accurate transmission from one generation to the next. In an increasingly complex cultural environment, we consider that individuals commit errors in imitation. We develop a model of cumulative cultural evolution in a changing environment and show that these errors hamper the process of cultural accumulation. We also show that a system of teaching between parents and offspring that increases the fidelity of imitation unblocks the accumulation and becomes adaptive whenever the gain in fitness compensates the cost of teaching.