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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2823_Библиотеки_им_академика_М_И_Перельмана
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Strengths and Best Applications
Weaknesses and Challenges
Available Technologies
Practical Suggestions for Use Now and Future Directions
Conclusion
Acknowledgment
Disclosure
References
14 Feedback and Coaching
Introduction
Evolution of Feedback and Introduction of Coaching in Medical
Education
Recent Cultural Shifts and Strategies Supporting Innovation in
Feedback and Coaching
Philosophy and Skills of Coaching in Education
Theoretical Framework Positioning Feedback and Coaching as
Central Activities in Clinical Teaching and Learning
Individual and System Factors Influencing Effective Feedback and
Coaching
Practical Strategies for Engaging in Effective Feedback and
Coaching Conversations and for Changing the Feedback Culture
Practical Exercises
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Conclusion
Acknowledgments
Annotated Bibliography
References
15 Portfolios
Introduction
Strengths Unique to Portfolios as Assessments
Use of the Portfolio in Medical Education
Constructing a Comprehensive Portfolio
Implementation
Reliability and Validity in Portfolio Assessment: Challenges and
Opportunities
Conclusion
Annotated Bibliography
References
16 Group Process in Assessment
Introduction
Purpose of Group Decision-Making
Group Decision-Making in Medical Education
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Key Concepts in Group Decision-Making
Establishing the Group
Group Procedures
Learner Role Related to Group Decision-Making Within a Program
of Assessment
Continuous Improvement in Group Process
Conclusion
Annotated Bibliography
References
17 A Programmatic Approach to Identifying and Supporting the
Struggling Learner
Introduction
Background: Setting the Stage and Definitions
Barriers to Recognition and Remediation of the Struggling Learner
Scope of the Problem: Prevalence of Struggling Learners
Assessment and Remediation of the Struggling Learner
Legal Principles
Outside the United States
Challenges for the Future
Conclusion
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References
18 Program Evaluation
Introduction
Evaluation Purposes
Overview of Evaluation Models
Program Evaluation Models
Constructing an Evaluation Program
Design and Methods
Reporting and Feedback
Conclusion
Annotated Bibliography
References
Appendix
Index
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Video Contents
5 Direct Observation
5-1 Medical interviewing Level 1
5-2 Medical interviewing Level 2
5-3 Medical interviewing Level 3
5-4 Physical examination Level 1
5-5 Physical examination Level 2
5-6 Physical examination Level 3
5-7 Counseling Level 1
5-8 Counseling Level 2
5-9 Counseling Level 3
5-10 Conducting an Observation by Faculty
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1
Assessment in the Era of
Outcomes-Based Education
Eric S. Holmboe, MD, Olle ten Cate, PhD, Steven J. Durning,
MD, PhD
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Chapter Outline
The Rise of Outcomes-Based Medical Education
Competency-Based Medical Education
A Brief History of Assessment in Medical
Education
Drivers of Change in Assessment
Accountability and Quality Assurance
Quality Improvement Movement
Technology
Psychometrics
Qualitative Assessment and Group Process
Framework for Assessment
Dimension 1: Competencies
Dimension 2: Levels and Types of Assessment
Dimension 3: Assessment of Progression
Criteria for Choosing an Assessment Method
Elements of Effective Faculty Development
Overview of Assessment Methods
Emerging Directions in Assessment
Competency Milestones
Entrustable Professional Activities
Combining Competency Milestones and EPAs
EPAs – Competencies – Skills
EPAs Across the Continuum and Nested EPAs
Entrustment Decision-Making as an Assessment
Approach
Distinguish Three Benchmarks or Frames of
Reference for Assessment
Frame the Assessment as a Developmental
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Entrustment Decision
Entrustment Decisions Require the Acceptance of
Risks
Align Scales With Supervision Recommendation
Distinguish Ad Hoc Entrustment Decisions From
Summative Entrustment Decisions
Use Multiple Sources of Information to Support
Entrustment Decisions
Entrustment Is an Approach to Assessment
Requiring a Prospective Outlook
Systems of Assessment
Conclusion
Acknowledgments
References
The Rise of Outcomes-Based
Medical Education
Despite major biomedical and technical advances, medical
care across the globe continues to suffer from pernicious
quality and safety gaps that result in substantial harm and
ineffective care for too many patients each year. The COVID19 pandemic only exacerbated this situation, further exposing
serious problems in healthcare equity and the care of
vulnerable populations. It is estimated that over 20 million
people had died from COVID-19 worldwide by the end of
2022.
1–3
The Institute of Medicine (now called the National
Academy of Medicine, NAM) published a seminal report on
the serious quality and safety issues in healthcare and
codified the six aims of quality: care that is effective, efficient,
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safe, patient centered, timely, and equitable.
4–6
More recently,
the Quadruple Aim of quality in patient experience (defined
by the six aims), health of a population, cost stewardship,
and wellness of the healthcare workforce has become the
overarching driving framework for the US and other
healthcare systems.
6
,7
Some are calling for healthcare equity
to be its own aim.
8
Data from multiple sources, such as the Organisation for
Economic Co-operation and Development (OECD), the
World Health Organization (WHO), and the Commonwealth
Fund, demonstrate persistent problems in morbidity and
mortality that are amenable to better and safer healthcare
delivery.
9–11
While a number of factors contribute to this state
of affairs, many medical educators and policymakers accept
the premise that the medical education enterprise bears some
responsibility through insufficient preparation of trainees for
21st-century practice.12 In conjunction with these concerns
about healthcare quality and safety has been the growing
focus on the outcomes of education. Specifically, educators are
now most concerned with the abilities of a graduate rather
than whether a trainee simply completes a prescribed
educational program.
13,14
These and other factors have led to
the global spread of outcomes-based medical education using
competencies as a foundational outcomes framework for
educational programs, or competency-based medical
education (CBME).
15–18
In 1978, McGaghie and colleagues described a rationale for
an approach to health professions education founded on the
acquisition of defined competencies using mastery-based
learning principles. “The intended output of a competencybased programme,” they wrote, “is a health professional who
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can practise medicine at a defined level of proficiency, in
accord with local conditions, to meet local needs.”
15
Educational leaders and policymakers worldwide produced
multiple reports lamenting that medical education systems
were not producing physicians with the abilities needed to
meet the complexities of modern practice, leading to the
realization that reforms in undergraduate, graduate, and
continuing medical education were urgently needed. In the
United States, reviews call attention to the inadequate
preparation of our graduates to practice effectively in our
evolving healthcare system, especially around transitions
from undergraduate medical education (UME; i.e., medical
school) to graduate or postgraduate medical education (GME
or PGME) training, to clinical practice.
19–21
These findings and other factors ultimately led to the
development of competency frameworks in several countries
as part of initiatives to implement CBME to achieve better
educational and clinical care outcomes. The first iteration of
the CanMEDS Roles by the Royal College of Physicians and
Surgeons of Canada (RCPSC) was produced in 1996.
22,23
Recognizing similar needs and issues, the Accreditation
Council of Graduate Medical Education (ACGME), the
American Board of Medical Specialties (ABMS), the National
Academy of Medicine (NAM), the General Medical Council
of the United Kingdom, the Royal Australasian College of
Surgeons, the Dutch College of Medical Specialties, and other
national professional entities produced competency
frameworks.
23–27
Two key features of these competency
frameworks stand out. One is a redefinition of the doctor to
include many more important and relevant abilities and
constructs beyond medical knowledge and technical skill that
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