Michel Donoff

Involving users in the refinement of the competency-based achievement system: An innovative approach to competency-based assessment

Background: Competency-based assessment innovations are being implemented to address concerns about the effectiveness of traditional approaches to medical training and the assessment of competence. Aim: Integrating intended users’ perspectives during the piloting and refinement process of an innovation is necessary to ensure the innovation meets users’ needs. Failure to do so results in no opportunity for users to influence the innovation, nor for developers to assess why an innovation works or does not work in different contexts. Methods: A qualitative participatory action research approach was used. Sixteen first-year residents participated in three focus groups and two interviews during piloting. Verbatim transcripts were analyzed individually and then across all transcripts using a constant comparison approach. Results: The analysis revealed three key characteristics related to the impact on the residents’ acceptance of the innovation as being a worthwhile investment of time and effort: access to frequent, timely, and specific feedback from preceptors. Findings were used to refine the innovation further. Conclusion: This study highlights the necessary conditions for assessing the success of implementation of educational innovations. Reciprocal communication between users and developers is vital. This reflects the approaches recommended in the Ottawa Consensus Statement on research in assessment published in Medical Teacher in March 2011.

Family physician practice visits arising from the Alberta Physician Achievement Review

BackgroundLicensed physicians in Alberta are required to participate in the Physician Achievement Review (PAR) program every 5 years, comprising multi-source feedback questionnaires with confidential feedback, and practice visits for a minority of physicians. We wished to identify and classify issues requiring change or improvement from the family practice visits, and the responses to advice.MethodsRetrospective analysis of narrative practice visit reports data using a mixed methods design to study records of visits to 51 family physicians and general practitioners who participated in PAR during the period 2010 to 2011, and whose ratings in one or more major assessment domains were significantly lower than their peer group.ResultsReports from visits to the practices of family physicians and general practitioners confirmed opportunities for change and improvement, with two main groupings – practice environment and physician performance. For 40/51 physicians (78%) suggested actions were discussed with physicians and changes were confirmed. Areas of particular concern included problems arising from practice isolation and diagnostic conclusions being reached with incomplete clinical evidence.ConclusionThis study provides additional evidence for the construct validity of a regulatory authority educational program in which multi-source performance feedback identifies areas for practice quality improvement, and change is encouraged by supplementary contact for selected physicians.

Superior vena cava syndrome and telangiectasia in a man with lymphoma

The case: A 30-year-old man presented with shortness of breath 5 days after returning from a Hawaiian vacation. He reported a 2-week history of progressive difficulty breathing and pain between his shoulder blades, especially when in a supine position. The patient had been previously well, and he