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Area of Science:

  • Medical Education
  • Competency-Based Medical Education (CBME)
  • Assessment in Healthcare

Background:

  • Competency-based medical education (CBME) models rely heavily on assessing entrustable professional activities (EPAs).
  • However, direct comparisons of rater entrustment decisions for the same EPA across different assessment settings (workplace vs. simulation) are lacking.
  • This gap hinders a comprehensive understanding of assessment validity and reliability.

Purpose of the Study:

  • To explore and compare rater entrustment decision-making processes for EPAs in both workplace-based and simulation-based assessment settings.
  • To identify factors influencing rater judgments and potential discrepancies between settings.

Main Methods:

  • An interview-based study employing constructivist grounded theory.
  • Gastroenterology faculty (raters) assessed trainee endoscopic polypectomy performance using EPAs in workplace and simulation settings.
  • Semi-structured interviews were conducted post-assessment to explore the rationale behind entrustment decisions.

Main Results:

  • Raters demonstrated varied interpretations and justifications for entrustment decisions.
  • Personal caveats, such as authenticity and observing multiple performances, influenced "comfortable" entrustment decisions.
  • Tensions arose between formative and summative assessment purposes.
  • Simulation offered formative assessment freedom but constrained summative entrustment decisions.

Conclusions:

  • Variability in defining and making entrustment decisions can lead to inconsistencies in EPA assessment aggregation across settings.
  • CBME programs must address rater idiosyncrasies and ensure clear definitions and purposes for assessments.
  • Integrating workplace and simulation-based assessments requires careful design to meet rater criteria for confident entrustment decisions.