Dual purposes by design: exploring alignment between residents' and academic advisors' documents in a longitudinal...

Area of Science:

• Medical Education
• Competency-Based Medical Education (CBME)

Background:

• Longitudinal academic advising (AA) and coaching are vital in CBME for resident reflection on assessment data.
• Dual-purposing resident reflection documents for formative and summative assessments poses challenges.

Purpose of the Study:

• To analyze resident self-reflections and AA reports over two years in CBME.
• To understand resident reflection content, alignment with AA reports, and changes over time.

Main Methods:

• Inductive thematic analysis of 109 resident self-reflections and 105 AA reports from 21 resident-AA dyads.
• Analysis of written comments over a two-year period in an internal medicine residency program.

Main Results:

• Residents initially focused on autonomy and improvement, shifting towards performance metrics like Entrustable Professional Activities (EPAs) and exams.
• AAs focused more on performance measures, while residents' reflections evolved to align with AA priorities, emphasizing quantity over learning for EPAs.
• A divergence was observed between resident self-reflection themes and AA report content.

Conclusions:

• The dual-purpose use of reflective documents in CBME may blur formative and summative intents, potentially hindering resident growth.
• Re-evaluation of reflective document utilization and structure is needed in CBME programs.
• Further research should explore optimal methods for using documentation to support resident development.