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Presentation Description
Thun How Ong1,2
Jason Chang1,2, Sok Hong Goh1, Limin Wijaya1,2, Ling Zhu1,2 and Deanna Lee1,2
1 Duke-NUS Graduate Medical School
2 Singhealth
Jason Chang1,2, Sok Hong Goh1, Limin Wijaya1,2, Ling Zhu1,2 and Deanna Lee1,2
1 Duke-NUS Graduate Medical School
2 Singhealth
Background
A perennial issue with workplace based assessment (WBA) is failure to identify students or trainees who are not meeting standards (Yepes-Rios et al., 2016). Frame of reference training can help align faculty expectations and improve grading consistency (Cook et al., 2009). However, there may be other reasons why faculty fail to flag such students (Kogan et al., 2011).
A perennial issue with workplace based assessment (WBA) is failure to identify students or trainees who are not meeting standards (Yepes-Rios et al., 2016). Frame of reference training can help align faculty expectations and improve grading consistency (Cook et al., 2009). However, there may be other reasons why faculty fail to flag such students (Kogan et al., 2011).
Methods
Clinical faculty who were performing mini-CEX for students were asked to consider a student they had previously assessed who was not meeting standards. The current form asks faculty to assess if students need further development, meet expectations, or exceed expectations for their level of training. They were asked how they thought they and their peers would have graded the student.
Results
28/140 faculty who had just completed a mini-CEX for the students answered the survey. 22/28 indicated they thought they were assessing students well or very well. A large proportion thought they themselves (46.2%) or their peers ( 42.3%) of faculty would have graded the weak student as meet expectations.
Discussion
A large proportion of our faculty passed students in their mini-CEX even though they internally assessed that the students had not met expectations, and expected that many fellow faculty would also do so. Despite this dichotomy, faculty perceived that they were assessing students well.Thissuggeststhat gradinggiven may nottrulyreflecttheobservedassessmentandthere may be cultural norms influencing failure to fail.
Conclusion and take-home message
Faculty may be unwilling to mark out students who are performing poorly even though they are able to identify the poor performance. Faculty training needs to go beyond frame of reference training to educate faculty on the intent and implications of the assessment and to address a cultural reluctance to “fail” students.
References (maximum three)
Cook, D. A., Dupras, D. M., Beckman, T. J., Thomas, K. G., & Pankratz, V. S. (2009, Jan). Effect of rater training on reliability and accuracy of mini-CEX scores: a randomized, controlled trial. J Gen Intern Med, 24(1), 74-79. https://doi.org/10.1007/s11606-008-0842-3
Kogan, J. R., Conforti, L., Bernabeo, E., Lobst, W., & Holmboe, E. (2011, Oct). Opening the black box of clinical skills assessment via observation: a conceptual model. Med Educ, 45(10), 1048-1060. https://doi.org/10.1111/j.1365-2923.2011.04025.x
Yepes-Rios, M., Dudek, N., Duboyce, R., Curtis, J., Allard, R. J., & Varpio, L. (2016, Nov). The failure to fail underperforming trainees in health professions education: A BEME systematic review: BEME Guide No. 42. Medical Teacher, 38(11), 1092-1099. https://doi.org/10.1080/0142159x.2016.1215414