Marking parties for marking written assessments: A spontaneous community of practice.

In programmes of assessment with both high and low-stakes assessments, the inclusion of open-ended long answer questions in the high-stakes examination can contribute to driving deeper learning among students. However, in larger institutions, this would generate a seemingly insurmountable marking workload. In this study, we use a focused ethnographic approach to explore how such a marking endeavour can be tackled efficiently and pragmatically. In marking parties, examiners come together to individually mark student papers. This study focuses on marking parties for two separate tasks assessing written clinical communication in medical school finals at Southampton, UK. Data collected included field notes from 21.3 h of marking parties, details of demographics and clinical and educational experience of examiners, examiners' written answers to an open-ended post-marking party questionnaire, an in-depth interview and details of the actual marks assigned during the marking parties. In a landscape of examiners who are busy clinicians and rarely interact with each other educationally, marking parties represent a spontaneous and sustainable community of practice, with functions extending beyond the mere marking of exams. These include benchmarking, learning, managing biases and exam development. Despite the intensity of the work, marking parties built camaraderie and were considered fun and motivating.

Composite Reliability of Workplace Based Assessment of International Medical Graduates.

This article was migrated. The article was marked as recommended. Introduction All developed countries depend on International Medical Graduates (IMGs) to complement their workforce. However, the assessment of their fitness to practice and acculturation into the new system can be challenging. To improve this, we introduced Workplace Based Assessment (WBA), using a programmatic philosophy. This paper reports the reliability of this new approach. Method Over the past 10 years, we have assessed over 250 IMGs, each cohort assessed over a 6-month period. We used Mini-Cex, Case Based Discussions (CBD) and Multi-Source Feedback (MSF) to assess them. We analysed the reliability of each tool and the composite reliability of 12 Mini-Cex, 5 CBDs and 12 MSF assessments in the tool kit. Results A reliability coefficient of 0.78 with a SEM of 0.19 was obtained for the sample of 236 IMGs. We found the MSF to be the most reliable tool. By adding one more MSF to the assessment on two occasions, we can reach a reliability of 0.8 and SEM of 0.18. Conclusions The current assessment methodology has acceptable reliability. By increasing the MSF, we can improve the reliability. The lessons from this study are generalisable to IMG assessment and other medical education programs.

The reliability of a portfolio of workplace-based assessments in anesthesia training.

PURPOSE: Competency-based anesthesia training programs require robust assessment of trainee performance and commonly combine different types of workplace-based assessment (WBA) covering multiple facets of practice. This study measured the reliability of WBAs in a large existing database and explored how they could be combined to optimize reliability for assessment decisions. METHODS: We used generalizability theory to measure the composite reliability of four different types of WBAs used by the Australian and New Zealand College of Anaesthetists: mini-Clinical Evaluation Exercise (mini-CEX), direct observation of procedural skills (DOPS), case-based discussion (CbD), and multi-source feedback (MSF). We then modified the number and weighting of WBA combinations to optimize reliability with fewer assessments. RESULTS: We analyzed 67,405 assessments from 1,837 trainees and 4,145 assessors. We assumed acceptable reliability for interim (intermediate stakes) and final (high stakes) decisions of 0.7 and 0.8, respectively. Depending on the combination of WBA types, 12 assessments allowed the 0.7 threshold to be reached where one assessment of any type has the same weighting, while 20 were required for reliability to reach 0.8. If the weighting of the assessments is optimized, acceptable reliability for interim and final decisions is possible with nine (e.g., two DOPS, three CbD, two mini-CEX, two MSF) and 15 (e.g., two DOPS, eight CbD, three mini-CEX, two MSF) assessments respectively. CONCLUSIONS: Reliability is an important factor to consider when designing assessments, and measuring composite reliability can allow the selection of a WBA portfolio with adequate reliability to provide evidence for defensible decisions on trainee progression.

RéSUMé: OBJECTIF: Les programmes de formation en anesthésie basés sur les compétences nécessitent de solides évaluations des performances des stagiaires et combinent habituellement des évaluations sur le lieu de travail (ÉLT) couvrant de nombreux aspects de la pratique. Cette étude a mesuré la fiabilité des ÉLT dans une grande base de données existante et a exploré comment elles pourraient être combinées pour accroître leur fiabilité pour des décisions sur les évaluations. MéTHODES: Nous avons utilisé la théorie de la généralisation pour mesurer un critère composite de fiabilité de quatre types d'ÉLT utilisés par les collèges d'anesthésiologistes d'Australie et de Nouvelle-Zélande : un exercice de mini-évaluation clinique (mini-CEX), l'observation directe des habiletés procédurales (DOPS), une discussion de cas (CbD) et une rétroaction de multiples sources (MSF). Nous avons alors modifié le nombre et la pondération des combinaisons d'ÉLT pour optimiser la fiabilité avec moins d'évaluations. RéSULTATS: Nous avons analysé 67 405 évaluations de 1 837 stagiaires et 4 145 assesseurs. Nous avons supposé une fiabilité acceptable pour les décisions intérimaires (enjeux intermédiaires) et définitives (enjeux élevés) à, respectivement, 0,7 et 0,8. Selon la combinaison des types d'ÉLT, 12 évaluations ont permis d'atteindre le seuil de 0,7 lorsqu'une évaluation de chaque type a le même poids, alors qu'il en a fallu 20 pour que la fiabilité atteigne 0,8. Si la pondération des évaluations est optimisée, la fiabilité acceptable pour les décisions intérimaires et finales est possible avec, respectivement, neuf évaluations (p. ex., deux DOPS, trois CbD, deux mini-CEX, deux MSF) et quinze évaluations (p. ex. deux DOPS, huit CbD, trois mini-CEX, deux MSF). CONCLUSIONS: La fiabilité est un facteur important dont il faut tenir compte quand on conçoit les évaluations et la mesure d'une fiabilité composite permet la sélection d'un éventail d'ÉLT avec une fiabilité adéquate pour l'obtention de données probantes et la défense de décisions sur les progrès des stagiaires.

Composite reliability of workplace-based assessment of international medical graduates.

OBJECTIVE: The fitness to practise of international medical graduates (IMGs) is usually evaluated with standardised assessment tests. The performance rather than the competency of practising doctors should, however, be assessed, for which reason workplace-based assessment (WBA) has gained increasing attention. Our aim was to assess the composite reliability of WBA instruments for assessing IMGs. DESIGN AND SETTING: Between June 2010 and April 2015, 142 IMGs were assessed by 99 calibrated assessors; each was assessed in the workplace over 6 months. The IMGs completed 970 case-based discussions (CBDs), 1741 mini-clinical examination exercises (mini-CEX), and 1020 multi-source feedback (MSF) assessments. PARTICIPANTS: 103 male and 39 female candidates from 28 countries (Africa, Asia, Europe, South America, South Pacific) in urban and rural hospitals of the Hunter New England Health region. MAIN OUTCOME MEASURES: The composite reliability across the three WBA tools, expressed as the standard error of measurement (SEM). RESULTS: In our WBA program, a combination of five CBD and 12 mini-CEX assessments achieved an SEM of 0.33, greater than the threshold 0.26 of a scale point. Adding six MSF results to the assessment package reduced the SEM to 0.24, which is adequately precise. CONCLUSIONS: Combining data from different WBA assessment instruments achieves acceptable reliability for assessing IMGs, provided that the panel of WBA assessment types are carefully selected and the assessors are calibrated.

Composite reliability of workplace-based assessment for international medical graduates.

OBJECTIVE: The fitness to practise of international medical graduates (IMGs) is usually evaluated with standardised assessment tests. Practising doctors should, however, be assessed on their performance rather than their competency, for which reason workplace-based assessment (WBA) has gained increasing attention. Our aim was to assess the composite reliability of WBA instruments for assessing the performance of IMGs. DESIGN AND SETTING: Between June 2010 and April 2015, 142 IMGs were assessed by 99 calibrated assessors; each cohort was assessed at their workplace over 6 months. The IMGs completed 970 case-based discussions (CBDs), 1741 Mini-Clinical Examination Exercises (mini-CEX) and 1020 multisource feedback (MSF) sessions. PARTICIPANTS: 103 male and 39 female candidates based in urban and rural hospitals of the Hunter New England Health region, from 28 countries (Africa, Asia, Europe, South America, South Pacific). MAIN OUTCOME MEASURES: The reliability of the three WBA tools; the composite reliability of the tools as a group. RESULTS: The composite reliability of our WBA toolbox program was good: the composite reliability coefficient for five CBDs and 12 mini-CEX was 0.895 (standard error of measurement, 0.138). When the six MSF results were included, the composite reliability coefficient was 0.899 (standard error of measurement, 0.125). CONCLUSIONS: WBA is a reliable method for assessing IMGs when multiple tools and assessors are used over a period of time. This form of assessment meets the criteria for "good assessment" (reliability ≥ 0.8) and can be applied in other settings.

The reliability of multisource feedback in competency-based assessment programs: the effects of multiple occasions and assessor groups.

PURPOSE: Residency programs around the world use multisource feedback (MSF) to evaluate learners' performance. Studies of the reliability of MSF show mixed results. This study aimed to identify the reliability of MSF as practiced across occasions with varying numbers of assessors from different professional groups (physicians and nonphysicians) and the effect on the reliability of the assessment for different competencies when completed by both groups. METHOD: The authors collected data from 2008 to 2012 from electronically completed MSF questionnaires. In total, 428 residents completed 586 MSF occasions, and 5,020 assessors provided feedback. The authors used generalizability theory to analyze the reliability of MSF for multiple occasions, different competencies, and varying numbers of assessors and assessor groups across multiple occasions. RESULTS: A reliability coefficient of 0.800 can be achieved with two MSF occasions completed by at least 10 assessors per group or with three MSF occasions completed by 5 assessors per group. Nonphysicians' scores for the "Scholar" and "Health advocate" competencies and physicians' scores for the "Health advocate" competency had a negative effect on the composite reliability. CONCLUSIONS: A feasible number of assessors per MSF occasion can reliably assess residents' performance. Scores from a single occasion should be interpreted cautiously. However, every occasion can provide valuable feedback for learning. This research confirms that the (unique) characteristics of different assessor groups should be considered when interpreting MSF results. Reliability seems to be influenced by the included assessor groups and competencies. These findings will enhance the utility of MSF during residency training.