Essential activity 2 Lydia and Abi by

Assessment in the clinical setting complicates the notion of objectivity

lbarry211 — 2024-04-04 19:09:45 UTC

LB - I found this paragraph of the resource really interesting. When I initially read the introduction, I felt passionate that objectivity is vital. Vital to ensuring patient safety and vital to ensuring fairness between student capabilities and the tasks they are entrusted with. However, I agree with the authors that the 'moment-by-moment, ad hoc entrustment decisions' are rightly so subjective and context specific. Gut feeling and intuition really do play a major role in making such decisions. However, this makes me feel very uneasy - if we can't record or document why or how the students are ready to practice, should we let them? Is objective evidence really required to be entrusted with clinical tasks? I most certainly agree with the authors that it is necessary to guide further training or determine readiness for certification. I use my intuition and make these decisions every day, but despite this I still feel uneasy because often I cannot verbalise my intuition.

The authors later discuss learners questioning the objective truth and how clinicians should receive support on how to explain entrustment decisions to learners. However, the authors do not discuss what support or guidance should be given and the statement doesn't feel tangible? This is something that I would like to delve into further and would have appreciated more information on

Adaptability

lbarry211 — 2024-04-04 19:38:32 UTC

LB - I agree with the authors that adaptability to the context is an important feature of a skilful practitioner (or student veterinary nurse (SVN) in my case). I often experience SVNs seeking the 'correct way' to act and the subsequent frustration when finding this way does not work, all of the time. The authors suggest that the learners are not prepared for the variability in interpretations of their behaviour. I agree with this, and wonder why? Why are they not prepared? The authors suggest a contrast between an assessment process with one best way could be a contributing factor. I would like to discuss this with the SVNs and delve into this deeper with them, as I assume it will be more multi-faceted.

However, my main 'yes' moment when reading this section was that the trainees need to be given the feedback that their behaviour or actions were or could be interpreted in different ways. Feedback will be vital for developing situational awareness and continuing to improve knowledge and skills for a variety of patients. In this case, subjectivity is very important and most certainly should be embraced. It's lead to me to wonder how often the SVNs in my workplace are given this feedback and if so, what manner is this feedback provided in?

Defensibility

ataylor7_20 — 2024-04-05 19:38:44 UTC

Abi - One area that really stood out for me from this paper was defensibility. My instant gut reaction (and this paper has told me to follow my gut!!), was 'how can I defend my grades to students if I don't have objective data to back it up?!'. Standardized checklists, rubrics and documenting objective observations are how I have got through challenging entrustment decisions previously, with students that are either about to pass/fail my rotation - or in extreme cases - potentially be dismissed from the program based on the grade. The paper suggests that an instructors subjective experience is the only true defensible proposition; to just say something like 'I'm not comfortable with you performing this procedure'. How would this prevent a student from claiming bias (implicit or explicit) against them by the instructor? I feel like with the increases of threatened (or actual) litigation against institutions reported in human medical education by potentially failing students, this puts a lot more pressure on individual instructors to defend their position. I have been fortunate, that with a growing faculty, we've been able to have multiple instructors interact with a student during our primary care rotation, leading to potentially more robust multi-source feedback. But there are still many services that still only have a single instructor on clinics at a time. I'm not sure instructors need more stress at this time!

Quick paper overview (for anyone reading this conversation)

ataylor7_20 — 2024-04-05 19:52:03 UTC

What I think the paper is trying to say:

Abi - This paper questions objectivity and whether any assessments - particularly WBA - can ever really be objective, given that our 'objective measures' are usually just negotiated compromises/consensus between clinician experts who all think differently. It suggests embracing subjectivity and redesigning our assessments to encompass this.

Take aways/What now?

ataylor7_20 — 2024-04-05 20:03:34 UTC

My take aways:

Abi - Essentially, this paper blew my mind and my reflective essay will comprise the process of working through putting the pieces back together!! The theory has really challenged how I think about objectivity, which - based on prior CE, education meetings and research that I have read - I have strived for in all my assessments. But I feel like I need to reflect carefully and consider how the balance or objectivity vs. subjectivity should play out in varying types of assessments. For example, I'm not sure that hands on surgical skills technique assessment should be very subjective, but when we put the skills together into procedures or patient management assessment, subjectivity should perhaps play a wider role. How do we implement this? Perhaps in OSCEs, we could re-implement the GRS (...that I've worked so hard to remove!!). Although this is not without multi-factorial challenges. For more complex assessments, my reading is really pushing me towards figuring out ways to implement more effective feedback as well as training for both the assessor and student in working through feedback conversations (both giving and accepting).

What ideas do you have on this Lydia?