Ann Lee¹
Anoushka Jere¹, Lihani du Plessis¹, Pascal Van Gerven², Sylvia Heeneman² and Shelley Ross¹
1 University of Alberta
2 Maastricht University

The transition to competency-based medical education (CBME) has included a focus on best practices in feedback and assessment of learner competence.1 Continuity of supervision (CoS) has been suggested as one of these best practices, but the evidence comes primarily from undergraduate (UG) longitudinal integrated clerkships.2 At the postgraduate level (PG), there are differences in supervisory relationships that may affect assessment.3 We explored faculty and resident perceptions of CoS on feedback and assessment. Researching CoS at the PGME level will help improve assessment practices essential to medical education. 

Summary of Work 

We conducted 22 semi-structured interviews involving faculty and residents in a family medicine postgraduate program. Transcripts were analyzed iteratively using constructivist grounded theory methodology. 

Interviewees indicated CoS allows faculty to observe development over time and provide iterative feedback and assessment. Both faculty and residents described more confidence in the usefulness of assessments because they are: a) based on more evidence; b) more tailored to each resident, and; c) given in the context of a relationship where trust has developed. Interviewees, however, also warned of risks of CoS including lack of assessment variety and risk of assessment bias particularly when a trusting faculty-resident relationship has not developed. 

These results suggest CoS provides faculty with the ability to assess residents through a developmental lens to make feedback and assessment more useful for residents and faculty. 

Findings from this study highlight the importance of understanding the impact of different CoS relationships on feedback and assessment during residency, which, in turn, influence learning and decision-making. 

Where CoS exists, feedback and assessment are perceived to be more useful, and to occur through a developmental lens. However, care should be taken to design a workplace-based assessment approach that increases variety of assessments and reduce potential risks of CoS. 

References (maximum three) 

1. Holmboe, Eric S. MD1; Osman, Nora Y. MD2; Murphy, Christina M.3; Kogan, Jennifer R. MD4. The Urgency of Now: Rethinking and Improving Assessment Practices in Medical Education Programs. Academic Medicine 98(8S):p S37-S49, August 2023. | DOI: 10.1097/ACM.0000000000005251 

1. Mazotti L, O'Brien B, Tong L, Hauer KE. Perceptions of evaluation in longitudinal versus traditional clerkships. Med Educ. 2011 May;45(5):464-70. doi: 10.1111/j.1365- 2923.2010.03904.x. PMID: 21486322. 

1. Lee AS, Ross S. Continuity of supervision: Does it mean what we think it means? Med Educ. 2021 Apr;55(4):448-454. doi: 10.1111/medu.14378. Epub 2020 Sep 25. PMID: 32929800.