RIME Oral Abstracts
Assessing resident competency in emergency department (ED) settings requires observing a substantial number of work-based skills and tasks. The McMaster Modular Assessment Program (McMAP) is a novel, workplace-based assessment (WBA) system that uses task-specific and global low-stakes assessments of resident performance. The evaluation of a WBA program three years after implementation is described.
We used a qualitative approach, conducting focus groups with resident physicians in all five postgraduate years (N = 26) who used McMAP as part of McMaster University’s emergency medicine residency program. Responses were triangulated using a follow-up written survey. Data were analyzed using theory-based thematic analysis. An audit trail was reviewed to ensure that all themes were captured.
Residents identified elements of McMAP that were perceived as supporting or inhibiting learning. Residents shared their opinions on the feasibility of completing daily WBAs, perceptions and utilization of rating scales, and the value of structured feedback (written and verbal) from faculty.
Of great interest was the emergent culture around feedback that is evolving. The residents’ focus groups have suggested to us that there is an emergent culture around learning and feedback that is occurring to meet the demands of the rich, programmatic WBA system we have implemented.
Residents commented extensively on the evolving and improving feedback culture that has been created within our system. Residents noted that McMAP prompted teaching and feedback on topics and areas not previously discussed between faculty–resident dyads. They also noted that at times, much more feedback is given than actually written in the comments, suggesting a high level of formative feedback that is occurring outside of our formal assessment systems. Residents infer that this may be due to variable levels of comfort on the side of the faculty members to act as assessors; although they have much advice to share, they might not be comfortable with using this information in an official assessment capacity.
A programmatic approach to WBAs can foster opportunities for feedback, although barriers must still be overcome in order to fully realize the potential of a continuous WBA system. Professional culture change is required to implement and routinely use WBAs over time. Barriers, such as familiarity with assessment system logistics, faculty member discomfort with providing feedback, and empowering residents to ask faculty for direct observations and assessments, must be addressed to realize the potential of a programmatic WBA system.