An exploration of faculty perspectives on the in-training evaluation of residents.

PURPOSE: The in-training evaluation report (ITER) is the most widely used approach to the evaluation of residents' clinical performance. Participants' attitudes toward the process may influence how they approach the task of resident evaluation. Whereas residents find ITERs most valuable when they perceive their supervisors to be engaged in the process, faculty attitudes have not yet been explored. The authors studied faculty supervisors' experiences and perceptions of the ITER process to gain insight into the factors that influence faculty engagement. METHOD: Using a grounded theory approach, semistructured interviews were completed in 2008 with a purposive sample of 17 faculty involved in resident evaluation at one Canadian medical school. Constant comparative analysis for emergent themes was conducted. RESULTS: Three major themes emerged: (1) Faculty engagement was apparent, with a widely held view that ITERs were a worthwhile endeavor. (2) Fragmentation of the evaluation system compromised evaluators' ability to produce meaningful ITERs. Fragmentation appeared to be a system problem, elements of which included time constraints, inconsistency in approach to ITE, and lack of continuity between educational assignments. (3) Faculty found the challenge of giving negative feedback daunting and struggled to avoid harming residents. CONCLUSIONS: Faculty engagement in the ITER process may be compromised by both system and interpersonal challenges. These challenges may render ITERs less meaningful than faculty intend. Training programs must complement ITE with other tools to achieve robust systems of evaluation.

The sum of the parts detracts from the intended whole: competencies and in-training assessments.

OBJECTIVES: Despite the fact that Canadian residency programmes are required to assess trainees' performance within the context of the CanMEDS Roles Framework, there has been no inquiry into the potential relationship between residents' perceptions of the framework and their in-training assessments (ITA). Using data collected during the study of ITA, we explored residents' perceptions of these competencies. METHODS: From May 2006-07, a purposive sample of 20 resident doctors from internal medicine, paediatrics, and surgery were interviewed about their ITA experiences. Data collection and analysis proceeded in an iterative fashion consistent with grounded theory. In April 2008, a summary of recurrent themes was presented during a focus group interview of another five residents to afford further elaboration and refinement of thematic findings. RESULTS: The in-training assessment report (ITAR) was perceived as a primary source of residents' information on CanMEDS. Residents' familiarity with the set of competencies appeared to be quite limited and they possessed narrow definitions of the roles. Several trainees questioned the framework's relevance and some appeared confused about the overlapping nature of the roles. Although residents viewed the central Medical Expert role as the most relevant and important competency, they incorrectly perceived it as only involving the acquisition of medical and scientific knowledge. A visual rhetorical analysis of a typical ITAR suggests that the visual features found within this assessment tool may be misrepresenting the framework and the centrality of the Medical Expert role. CONCLUSIONS: Resident doctors' knowledge of CanMEDS was found to be limited. The visual structure of the ITAR appears to be a factor in residents' apparent distortion of the CanMEDS construct from its original holistic philosophy.

Rules of engagement: residents' perceptions of the in-training evaluation process.

BACKGROUND: In-training evaluation reports (ITERs) often fall short of their goals of promoting resident learning and development. Efforts to address this problem through faculty development and assessment-instrument modification have been disappointing. The authors explored residents' experiences and perceptions of the ITER process to gain insight into why the process succeeds or fails. METHOD: Using a grounded theory approach, semistructured interviews were conducted with 20 residents. Constant comparative analysis for emergent themes was conducted. RESULTS: All residents identified aspects of "engagement" in the ITER process as the dominant influence on the success of ITERs. Both external (evaluator-driven, such as evaluator credibility) and internal (resident-driven, such as self-assessment) influences on engagement were elaborated. When engagement was lacking, residents viewed the ITER process as inauthentic. CONCLUSIONS: Engagement is a critical factor to consider when seeking to improve ITER use. Our articulation of external and internal influences on engagement provides a starting point for targeted interventions.

Mission Statement Day: the impact on medical students of an early exercise in professionalism.

BACKGROUND: The development of professional attitudes in medical students is an important aspect of medical education. AIMS: This qualitative study describes medical students' experience of Mission Statement Day. METHOD: The study was conducted using focus groups and key informant interviews. Thematic analysis identified key words, phrases, and concepts. The data was condensed into major themes and key quotes were identified to illustrate each theme. RESULTS: The process of creating a Mission Statement was more important than the Mission Statement. Three themes were identified; the central role of patients, bonding and group formation, and student ownership and valuing of the Mission Statement. Patient involvement was critical to exploring the disease and illness experience, and to stimulating discussion about compassion and professional relationships. Role modelling by faculty highlighted the value placed on this experience by the medical school. The experience was memorable, prompting the medical students to reflect on their personal values and their decision to enter medical school. CONCLUSIONS: Creation of a Mission Statement is a powerful way to introduce students to their future professional role, identify their values, and begin to develop a sense of professional identity. This memorable experience could be expanded to help students continue their professional growth.