当反不被视为反时:监管机构授权同行评审的挑战
Kori A LaDonna1, Lindsay Cowley2, Lesley Ananny3
1K.A. LaDonna is associate professor, Department of Innovation in Medical Education and Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; ORCID: http://orcid.org/0000-0003-4738-0146.
概括
医生反计划面临一个悖论:非威胁性反往往被忽视,而威胁性反阻碍了改进. 对于高绩效的医生来说,feedforward可能比传统的反更有效,以改善实践.
科学领域:
- 医学教育 医学教育
- 医生的表现 医生的表现
- 提高质量 提高质量
背景情况:
- 有效的医生表现依赖于通过反识别和解决缺陷.
- 医生往往无法获得有意义的指导来改善.
- 监管机构委托同行促进的实践增强计划,以确保质量.
研究的目的:
- 探索医生参与监管授权的同行评审计划中的反.
- 了解强制性医生绩效评估的感知价值和挑战.
主要方法:
- 采访了来自不同专业和职业阶段的30名医生 (审查员和被审查者).
- 采访成绩单的分析,使用3阶段编码过程,由构造主义的基础理论.
- 在监管机构授权的项目中探索同行评审的经验.
主要成果:
- 医生对强制性同行评审价值的看法是混合的,由于监管监督,医生经常存在焦虑.
- 审查者采用了与R2C2反和指导模型一致的策略,以优化互动.
- 反往往侧重于微小的调整 ("调整"),而不是实质性的绩效变化,限制感知到的学习价值.
结论:
- 存在一种悖论,即忽略了非威胁性反,但威胁性反对于改进来说是不理想的.
- 对于可能表现良好的医生来说,通过feedforward管理期望可能会比反更有效地提高实践改进.
- 调和形成性反意图和感知总结性风险之间的紧张关系对于有效的医生发展至关重要.
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