Exploring the nature of interprofessional collaboration and family member involvement in an intensive care context.

Little is known about the nature of interprofessional collaboration on intensive care units (ICUs), despite its recognition as a key component of patient safety and quality improvement initiatives. This comparative ethnographic study addresses this gap in knowledge and explores the different factors that influence collaborative work in the ICU. It aims to develop an empirically grounded team diagnostic tool, and associated interventions to strengthen team-based care and patient family involvement. This iterative study is comprised of three phases: a scoping review, a multi-site ethnographic study in eight ICUs over 2 years; and the development of a diagnostic tool and associated interprofessional intervention-development. This study's multi-site design and the richness and breadth of its data maximize its potential to improve clinical outcomes through an enhanced understanding of interprofessional dynamics and how patient family members in ICU settings are best included in care processes. Our research dissemination strategy, as well as the diagnostic tool and associated educational interventions developed from this study will help transfer the study's findings to other settings.

Tensions in informed self-assessment: how the desire for feedback and reticence to collect and use it can conflict.

PURPOSE: Informed self-assessment describes the set of processes through which individuals use external and internal data to generate an appraisal of their own abilities. The purpose of this project was to explore the tensions described by learners and professionals when informing their self-assessments of clinical performance. METHOD: This 2008 qualitative study was guided by principles of grounded theory. Eight programs in five countries across undergraduate, postgraduate, and continuing medical education were purposively sampled. Seventeen focus groups were held (134 participants). Detailed analyses were conducted iteratively to understand themes and relationships. RESULTS: Participants experienced multiple tensions in informed self-assessment. Three categories of tensions emerged: within people (e.g., wanting feedback, yet fearing disconfirming feedback), between people (e.g., providing genuine feedback yet wanting to preserve relationships), and in the learning/practice environment (e.g., engaging in authentic self-assessment activities versus "playing the evaluation game"). Tensions were ongoing, contextual, and dynamic; they prevailed across participant groups, infusing all components of informed self-assessment. They also were present in varied contexts and at all levels of learners and practicing physicians. CONCLUSIONS: Multiple tensions, requiring ongoing negotiation and renegotiation, are inherent in informed self-assessment. Tensions are both intraindividual and interindividual and they are culturally situated, reflecting both professional and institutional influences. Social learning theories (social cognitive theory) and sociocultural theories of learning (situated learning and communities of practice) may inform our understanding and interpretation of the study findings. The findings suggest that educational interventions should be directed at individual, collective, and institutional cultural levels. Implications for practice are presented.

Features of assessment learners use to make informed self-assessments of clinical performance.

CONTEXT: Conceptualisations of self-assessment are changing as its role in professional development comes to be viewed more broadly as needing to be both externally and internally informed through activities that enable access to and the interpretation and integration of data from external sources. Education programmes use various activities to promote learners' reflection and self-direction, yet we know little about how effective these activities are in 'informing' learners' self-assessments. OBJECTIVES: This study aimed to increase understanding of the specific ways in which undergraduate and postgraduate learners used learning and assessment activities to inform self-assessments of their clinical performance. METHODS: We conducted an international qualitative study using focus groups and drawing on principles of grounded theory. We recruited volunteer participants from three undergraduate and two postgraduate programmes using structured self-assessment activities (e.g. portfolios). We asked learners to describe their perceptions of and experiences with formal and informal activities intended to inform self-assessment. We conducted analysis as a team using a constant comparative process. RESULTS: Eighty-five learners (53 undergraduate, 32 postgraduate) participated in 10 focus groups. Two main findings emerged. Firstly, the perceived effectiveness of formal and informal assessment activities in informing self-assessment appeared to be both person- and context-specific. No curricular activities were considered to be generally effective or ineffective. However, the availability of high-quality performance data and standards was thought to increase the effectiveness of an activity in informing self-assessment. Secondly, the fostering and informing of self-assessment was believed to require credible and engaged supervisors. CONCLUSIONS: Several contextual and personal conditions consistently influenced learners' perceptions of the extent to which assessment activities were useful in informing self-assessments of performance. Although learners are not guaranteed to be accurate in their perceptions of which factors influence their efforts to improve performance, their perceptions must be taken into account; assessment strategies that are perceived as providing untrustworthy information can be anticipated to have negligible impact.

The processes and dimensions of informed self-assessment: a conceptual model.

PURPOSE: To determine how learners and physicians engaged in various structured interventions to inform self-assessment, how they perceived and used self-assessment in clinical learning and practice, and the components and processes comprising informed self-assessment and factors that influence these. METHOD: This was a qualitative study guided by principles of grounded theory. Using purposive sampling, eight programs were selected in Canada, the United States, the United Kingdom, the Netherlands, and Belgium, representing low, medium, and high degrees of structure/rigor in self-assessment activities. In 2008, 17 focus groups were conducted with 134 participants (53 undergraduate learners, 32 postgraduate learners, 49 physicians). Focus-group transcripts were analyzed interactively and iteratively by the research team to identify themes and compare and confirm findings. RESULTS: Informed self-assessment appeared as a flexible, dynamic process of accessing, interpreting, and responding to varied external and internal data. It was characterized by multiple tensions arising from complex interactions among competing internal and external data and multiple influencing conditions. The complex process was evident across the continuum of medical education and practice. A conceptual model of informed self-assessment emerged. CONCLUSIONS: Central challenges to informing self-assessment are the dynamic interrelationships and underlying tensions among the components comprising self-assessment. Realizing this increases understanding of why self-assessment accuracy seems frequently unreliable. Findings suggest the need for attention to the varied influencing conditions and inherent tensions to progress in understanding self-assessment, how it is informed, and its role in self-directed learning and professional self-regulation. Informed self-assessment is a multidimensional, complex construct requiring further research.