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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_112_библиотеки_им_акад_М_И_Перельмана
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difficulty in “giving” a grade is contaminated by their
acceptance of “subjective-objective” distinctions, and by an
intuitive, clinical fear of inadequate sampling of the student’s
abilities. The teacher may see each observation of a trainee
with a patient as not just evaluation but grading with
premature or incomplete data.
While reasonable questions remain regarding reliability,
validity, and the ability to discriminate among different
aspects of clinical competence, most notably “soft areas”
such as humanism, attitudes, professionalism, and judgment,
recent research supports the use of synthetic and
developmental scales such as RIME, Milestones, and
entrustment over older types of scales. However, despite the
improved operating characteristics of these scales, such as
improved acceptance by faculty and reliability, they alone do
not “fix” lingering problems around other elements of
validity and accuracy. It is crucial to remember that the
actual assessment instrument is the individual using the
evaluation form, not the form itself. Teacher training in
assessment is crucial to the effective use of even the newer
rating scales. While the optimal approach to rater training in
medical education remains to be defined, a growing body of
research
57
and the general principles discussed throughout
this chapter and in Chapter 5 are an excellent and evidencebased place to begin.
Annotated Bibliography
1. Rekman J, Gofton W, Dudek N, Gofton T, Hamstra SJ.
Entrustability scales: outlining their usefulness for
https://t.me/med1917
competency-based clinical assessment. Acad Med. 2016
Feb;91(2):186-190. doi:10.1097/ACM.0000000000001045. As
the abstract nicely summarizes, the paper “outlines how
‘entrustability scales’ may help bridge the gap between the
assessment judgments of clinical supervisors and WBA
instruments. Entrustment-based assessment evaluates
trainees against what they will actually do when
independent; thus ‘entrustability scales’—defined as
behaviorally anchored ordinal scales based on progression to
competence—reflect a judgment that has clinical meaning for
assessors. Rather than asking raters to assess trainees against
abstract scales, entrustability scales provide raters with an
assessment measure structured around the way evaluators
already make day-to-day clinical entrustment decisions,
which results in increased reliability.”.
2. Pangaro, LN. Evaluating professional growth: a new
vocabulary and other innovations for improving the
descriptive evaluation of students. Acad Med. 1999
Nov;74(11):1203-1207. doi:10.1097/00001888-199911000-00012.
a. This article provides additional background and detail
about the RIME framework. This is a very useful paper to
give to all faculty involved in evaluating trainees in any
setting.
3. Battistone MJ, Milne C, Sande MA, Pangaro LN, Hemmer
PA, Shomaker TS. The feasibility and acceptability of
implementing formal evaluation sessions and using
descriptive vocabulary to assess student performance on a
clinical clerkship. Teach Learn Med. 2002 Winter;14(1):5-10.
doi:10.1207/S15328015TLM1401_3
.
https://t.me/med1917
4. Hemmer P, Hawkins R, Jackson J, Pangaro L. Assessing
how well three evaluation methods detect deficiencies in
medical students' professionalism in two settings of an
internal medicine clerkship. Acad Med. 2000 Feb;75(2):167-
173. doi:10.1097/00001888-200002000-00016.
5. Hemmer PA, Pangaro L. Using formal evaluation sessions
for case-based faculty development during clinical
clerkships. Acad Med. 2000 Dec;75(12):1216-1221.
doi:10.1097/00001888-200012000-00021. These three articles
provide valuable data and insight into the value of using
formal evaluation sessions to enhance the evaluation process
and improve the consistency of the evaluation process by
providing ongoing, longitudinal faculty development. The
fourth article provides specific guidance on how to use
evaluation sessions for ongoing faculty development. This is
a very important concept: the need to embed faculty
development into ongoing educational activities and to move
away from using only the workshop approach to faculty
development.
6. Pangaro L, ten Cate O. Frameworks for learner assessment
in medicine (Theories in Medical Education series). Med
Teach. 2013;35:524-537. This AMEE Guide from the
Association for Medical Education in Europe reviews the
premises underlying common frameworks used in
educational assessment.
7. Gingerich A, Kogan J, Yeates P, Govaerts M, Holmboe E.
Seeing the ‘black box’ differently: assessor cognition from
three research perspectives. Med Educ. 2014
Nov;48(11):1055-1068. doi:10.1111/medu.12546. This article
https://t.me/med1917
explores the process of rater cognition through three
perspectives: (1) the assessor as trainable—assessors vary
because they do not apply assessment criteria correctly, use
varied and at times frames of reference that are not evidence
based, and make unjustified inferences; (2) the assessor as
fallible—variations arise as a result of fundamental
limitations in human cognition that mean assessors are
readily and haphazardly influenced by their immediate
context, and (3) the assessor as meaningfully idiosyncratic—
experts are capable of making sense of highly complex and
nuanced scenarios through inference and contextual
sensitivity, which suggests assessor differences may
represent legitimate experience-based interpretations.
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