[en] Purpose: Clinical supervisors hesitate to report learner weaknesses, a widely documented phenomenon referred to as "failure to fail." They also struggle to discuss weaknesses with learners themselves. Their reluctance to report and discuss learner weaknesses threatens the validity of assessment-of-learning decisions and the effectiveness of assessment for learning. Personal and interpersonal factors have been found to act as barriers to reporting learners' difficulties, but the precise role of the resident-supervisor relationship remains underexplored, specifically in the emergency setting. This study aims to better understand if and how factors related to the resident-supervisor relationship are involved in assessment of and for learning in the emergency setting. Methods: We conducted a qualitative study, using semistructured interviews of 15 clinical supervisors in emergency medicine departments affiliated with our institution. Transcripts were independently coded by three members of the team using an iterative mixed deductive-inductive thematic analysis approach. The team then synthesized the coding and discussed analysis following guidelines for thematic analysis. Results: Participating emergency medicine supervisors valued resident-supervisor relationships built on collaboration and trust and believed that such relationships support learning. They described how these relationships influenced assessment of and for learning and how in turn assessment influenced the relationship. Almost all profiles of resident-supervisor relationships in our study could hinder the disclosing of resident weaknesses, through a variety of mechanisms. To protect residents and themselves from the discomfort of disclosing weaknesses and to avoid deteriorating the resident-supervisor relationship, many downplayed or even masked residents' difficulties. Supervisors who described themselves as able to provide negative assessment of and for learning often adopted a more distant or professional stance.
Research Center/Unit :
Soins primaires et Santé - ULiège
Disciplines :
Education & instruction
Author, co-author :
Laurin, Suzanne; Department of Family Medicine and Emergency Medicine, Université de Montréal, Montréal, Canada ; Centre for Applied Health Sciences Education, Université de Montréal, Montréal, Canada
Castonguay, Véronique; Department of Family Medicine and Emergency Medicine, Université de Montréal, Montréal, Canada ; Centre for Applied Health Sciences Education, Université de Montréal, Montréal, Canada
Dory, Valérie ; Université de Liège - ULiège > Département des sciences cliniques > Médecine générale
Cusson, Lise; Department of Family Medicine and Emergency Medicine, Université de Montréal, Montréal, Canada ; Department of General Practice, Université de Liège, Liège, Belgium
Luc Côté, |; Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada
Language :
English
Title :
"They were very very nice but just not very good": The interplay between resident-supervisor relationships and assessment in the emergency setting
Epstein RM. Assessment in medical education. N Engl J Med. 2007;356(4):387-396.
Norcini J, Anderson B, Bollela V, et al. Criteria for good assessment: consensus statement and recommendations from the Ottawa 2010 conference. Med Teach. 2011;33(3):206-214.
Cilliers F, Schuwirth L, Adendorff H, Herman N, Van der Vleuten C. The mechanism of impact of summative assessment on medical students' learning. Adv Health Sci Educ. 2010;15(5):695-715.
Hattie J, Timperley H. The power of feedback. Rev Educ Res. 2007;77(1):81-112.
Holmboe ES, Sherbino J, Long DM, Swing SR, Frank JR. The role of assessment in competency-based medical education. Med Teach. 2010;32(8):676-682.
Bok H, Teunissen P, Favier R, et al. Programmatic assessment of competency-based workplace learning: when theory meets practice. BMC Med Educ. 2013;13(1):123.
Bindal T, Wall D, Goodyear HM. Trainee doctors' views on workplace-based assessments: are they just a tick box exercise? Med Teach. 2011;33(11):919-927.
Barrett A, Galvin R, Scherpbier AJJA, Teunissen PW, O'Shaughnessy A, Horgan M. Is the learning value of workplace-based assessment being realized? A qualitative study of trainer and trainee perceptions and experiences. Postgrad Med J. 2017;93(1097):138-142.
Yepes-Rios M, Dudek N, Duboyce R, Curtis J, Allard RJ, Varpio L. The failure to fail underperforming trainees in health professions education: a BEME systematic review: BEME guide No. 42. Med Teach. 2016;38:1-8.
Cleland JA, Knight LV, Rees CE, Tracey S, Bond CM. Is it me or is it them? Factors that influence the passing of underperforming students. Med Educ. 2008;42(8):800-809.
Luhanga F, Yonge OJ, Myrick F. “Failure to assign failing grades”: issues with grading the unsafe student. Int J Nurs Educ Scholarsh. 2008;5(1):000010220215489231366.
Bush HM, Schreiber RS, Oliver SJ. Failing to fail: clinicians' experience of assessing underperforming dental students. Eur J Dent Educ. 2013;17(4):198-207.
Dudek NL, Marks MB, Regehr G. Failure to fail: the perspectives of clinical supervisors. Acad Med. 2005;80(10 Suppl):S84-S87.
Dehon E, Jones J, Puskarich M, Sandifer JP, Sikes K. Use of emergency medicine milestones as items on end-of-shift evaluations results in overestimates of residents' proficiency level. J Grad Med Educ. 2015;7(2):192-196.
Fazio SB, Torre DM, DeFer TM. Grading practices and distributions across internal medicine clerkships. Teach Learn Med. 2016;28(3):286-292.
Ginsburg S, Regehr G, Lingard L, Eva KW. Reading between the lines: faculty interpretations of narrative evaluation comments. Med Educ. 2015;49(3):296-306.
Rosen S, Tesser A. On reluctance to communicate undesirable information: the MUM effect. Sociometry. 1970;33(3):253-263.
Scarff CE, Bearman M, Chiavaroli N, Trumble S. Keeping mum in clinical supervision: private thoughts and public judgements. Med Educ. 2019;53(2):133-142.
McQueen SA, Petrisor B, Bhandari M, Fahim C, McKinnon V, Sonnadara RR. Examining the barriers to meaningful assessment and feedback in medical training. Am J Surg. 2016;211(2):464-475.
Watling CJ, Kenyon CF, Schulz V, Goldszmidt MA, Zibrowski E, Lingard L. An exploration of faculty perspectives on the in-training evaluation of residents. Acad Med. 2010;85(7):1157-1162.
Michael Shanahan E, van der Vleuten C, Schuwirth L. Conflict between clinician teachers and their students: the clinician perspective. Adv Health Sci Educ. 2020;25(2):401-414.
Van Melle E, Frank JR, Holmboe ES, Dagnone D, Stockley D, Sherbino J. A core components framework for evaluating implementation of competency-based medical education programs. Acad Med. 2019;94(7):1002-1009.
Szulewski A, Braund H, Dagnone DJ, et al. The assessment burden in competency-based medical education: how programs are adapting. Acad Med. 2023;98(11):1261-1267.
Laurin S, Côté L, Cusson L, Korany L, Jolicoeur A, Fernandez N. Les facteurs et enjeux relationnels lors de l'évaluation des résidents en médecine familiale. Pédagogie Médicale. 2022;23(1):7-16.
Rees CE, Knight LV, Cleland JA. Medical educators’ metaphoric talk about their assessment relationships with students: ‘you don't want to sort of be the one who sticks the knife in them’. Assess Eval High Educ. 2009;34(4):455-467.
Donoff MG. Field notes: assisting achievement and documenting competence. Can Fam Physician. 2009;55(12):1260.
Hennink M, Kaiser BN. Sample sizes for saturation in qualitative research: a systematic review of empirical tests. Soc Sci Med. 2022;292:114523.
Denzin N. The Research Act: A Theoretical Introduction to Sociological Methods. 2nd ed. Routledge; 1978.
Carter N, Bryant-Lukosius D, DiCenso A, Blythe J, Neville AJ. The use of triangulation in qualitative research. Oncol Nurs Forum. 2014;41(5):545-547.
Fereday J, Muir-Cochrane E. Demonstrating rigor using thematic analysis: a hybrid approach of inductive and deductive coding and theme development. Int J Qual Methods. 2006;5(1):80-92.
Braun V, Clarke V. Thematic analysis. In: Cooper H, Camic PM, Long DL, Panter AT, Rindskopf SKJ, eds. APA Handbook of Research Methods in Psychology. Vol. 2. Research Designs: Quantitative, Qualitative, Neuropsychological, and Biological. Vol 2. American Psychological Association; 2012.
Kiger ME, Varpio L. Thematic analysis of qualitative data: AMEE guide No. 131. Med Teach. 2020;42(8):846-854.
Scarff CE, Bearman M, Chiavaroli N, Trumble S. Assessor discomfort and failure to fail in clinical performance assessments. BMC Med Educ. 2023;23(1):901.
Telio S, Ajjawi R, Regehr G. The “educational alliance” as a framework for reconceptualizing feedback in medical education. Acad Med. 2015;90(5):609-614.
Telio S, Regehr G, Ajjawi R. Feedback and the educational alliance: examining credibility judgements and their consequences. Med Educ. 2016;50(9):933-942.
Karpenko V, Gidycz CA. The supervisory relationship and the process of evaluation: recommendations for supervisors. Clin Superv. 2012;31(2):138-158.
Schut S, Heeneman S, Bierer B, Driessen E, van Tartwijk J, van der Vleuten C. Between trust and control: teachers' assessment conceptualisations and relationships within programmatic assessment. Med Educ. 2020;54(6):491-583.
CMPA Good Practices Guidance—Professionalism and Ethics: Boundaries. The Canadian Medical Protective Association 2021. Accessed January 29, 2024. https://www.cmpa-acpm.ca/en/education-events/good-practices/professionalism-ethics-and-wellness/boundaries
Professional versus Social Relationships. College of Nurses of Ontario. Accessed January 29, 2024. https://www.cno.org/en/learn-about-standards-guidelines/educational-tools/ask-practice/social-versus-professional-relationships/
Kuper A, Lingard L, Levinson W. Critically appraising qualitative research. BMJ. 2008;337:a1035.
Côté L, Breton E, Boucher D, Déry É, Roux J-F. The educational alliance in clinical supervision: a qualitative study in health sciences. Med Educ. 2017;18(4):161-170.
