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Perceived Effects of Innovations in Postgraduate Medical Education: A Q Study Focusing on Workplace-Based Assessment

Fokkema, Joanne P.I. MD; Scheele, Fedde MD, PhD; Westerman, Michiel MD, PhD; van Exel, Job PhD; Scherpbier, Albert J.J.A. MD, PhD; van der Vleuten, Cees P.M. PhD; Dörr, P. Joep MD, PhD; Teunissen, Pim W. MD, PhD

doi: 10.1097/ACM.0000000000000394
Research Reports

Purpose Anticipating users’ perceptions of the effects an innovation will have in daily practice prior to implementation may lead to a more optimal innovation process. In this study, the authors aimed to identify the kinds of perceptions that exist concerning the effects of workplace-based assessment (WBA), an innovation that is widely used in medical education, among its users.

Method In 2012, the authors used Q methodology to ascertain the principal user perceptions of effects of WBA in practice. Participating obstetrics–gynecology residents and attending physicians (including residency program directors) at six hospitals in the Netherlands performed individual Q sorts to rank 36 statements concerning WBA and WBA tools according to their level of agreement. The authors conducted by-person factor analysis to uncover patterns in the rankings of the statements. They used the statistical results and participant comments about their sorts to interpret and describe distinct perceptions.

Results The analysis of 65 Q sorts (completed by 22 residents and 43 attendings) identified five distinct user perceptions regarding the effects of WBA in practice, which the authors labeled enthusiasm, compliance, effort, neutrality, and skepticism. These perceptions were characterized by differences in views on three main issues: the intended goals of the innovation, its applicability (ease of applying it to practice), and its actual impact.

Conclusions User perceptions of the effects of innovations in medical education can be typified and should be anticipated. This study’s insights into five principal user perceptions can support the design and implementation of innovations in medical education.

Dr. Fokkema is a physician and PhD student, St. Lucas Andreas Hospital, Amsterdam, the Netherlands.

Dr. Scheele is professor, VU University Medical Center, Amsterdam, the Netherlands, and a gynecologist and residency program director, St. Lucas Andreas Hospital, Amsterdam, the Netherlands.

Dr. Westerman is a researcher, School of Medical Sciences, VU University Medical Center, Amsterdam, the Netherlands, and a resident in internal medicine, St. Lucas Andreas Hospital, Amsterdam, the Netherlands.

Dr. van Exel is associate professor, Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.

Dr. Scherpbier is professor and dean, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.

Dr. van der Vleuten is professor, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.

Dr. Dörr, deceased, was professor, Department of Education and Teaching, Leiden University Medical Center, Leiden, the Netherlands, and a gynecologist, Medical Centre Haaglanden, Den Haag, the Netherlands.

Dr. Teunissen is a resident in obstetrics–gynecology, VU University Medical Center, Amsterdam, the Netherlands, and associate professor, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: The study was approved by the ethical review board of the Dutch Society of Medical Education (NVMO-ERB; file number 183).

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A219.

Correspondence should be addressed to Dr. Fokkema, St. Lucas Andreas Hospital, Department of Education, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands; telephone: (+31) 627056411; e-mail: joanne.fokkema@gmail.com.

© 2014 by the Association of American Medical Colleges