Assessment and feedback methods in competency-based medical education.

Graduate and continuing medical education programs have transitioned to a competency-based medical education model, in which abilities necessary for the practice of medicine, called competencies, are defined as learning outcomes. Each competency contains milestones that describe stages of development from novice to master and provide criteria for assessing learners along this continuum. Assessments in competency-based medical education are formative and are intended to assist learners in achieving the next stage in mastery rather than render a final evaluation. Although written examinations are typically used to evaluate learners, assessments measuring the performance of skills, such as direct observation or patient registries, provide stronger evidence of achievement of learning outcomes. Once assessments identify strengths and areas of improvement in a learner, effective feedback is critical in assisting their professional development. Feedback should be routine, timely, nonthreatening, specific, and encourage self-assessment. The "ask-tell-ask" feedback method follows this framework by asking for the learner's self-assessment first, telling the observer's own assessment next, and then finally asking for the learner's questions and action plan to address the issues raised. Effective assessment and feedback in competency-based medical education assists learners in their continued professional development and aims to provide evidence of their impact on the health status of patients and communities.

Performance of Eosinophil Cationic Protein as a Biomarker in Asthmatic Children.

BACKGROUND: Although blood eosinophils are a frequently used marker of type 2 inflammation in children with asthma, their sensitivity is relatively poor. Additional markers of type 2 inflammation are needed. OBJECTIVE: We hypothesized that plasma concentrations of eosinophil cationic protein (ECP), a marker of eosinophil activation, would be useful for detection of type 2 inflammation and would predict poorer asthma outcomes over 1 year. METHODS: Children and adolescents 6 through 17 years (N = 256) with confirmed asthma completed a baseline visit and a follow-up visit at 12 months. A subset also underwent systemic corticosteroid responsiveness testing with intramuscular triamcinolone. Outcome measures at 12 months included uncontrolled asthma, lung function, and asthma exacerbations treated with systemic corticosteroids. RESULTS: Plasma ECP concentrations ranged from 0.03 to 413.61 ng/mL (median, 6.95 ng/mL) and were consistently associated with other markers of type 2 inflammation. At baseline, children in the highest ECP tertile had poorer asthma control, more airflow limitation, and more exacerbations, but also had greater symptom improvement with intramuscular triamcinolone. At 12 months, associations between the highest ECP tertile and exacerbations, but not lung function or asthma control, persisted after covariate adjustment. However, the sensitivity of ECP was modest and was not markedly different from that of blood eosinophil counts. CONCLUSION: Plasma ECP concentrations may be a useful marker of type 2 inflammation in children and may help identify those children at highest risk for recurrent exacerbations who could benefit from corticosteroid treatment. However, additional markers may be needed to improve sensitivity for outcome detection.