A realist evaluation of prospective entrustment decisions in paediatric residency clinical competency committees.

IF 4.9 1区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES Medical Education Pub Date : 2024-09-05 DOI:10.1111/medu.15530
Daniel J Schumacher, Abigail Martini, Catherine Michelson, David A Turner, Ariel S Winn, Benjamin Kinnear
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Abstract

Purpose: Making entrustment decisions (granting more responsibility, advancement and graduation) are important actions in medical training that pose risks to trainees and patients if not done well. A previous realist synthesis of the existing literature revealed that clinical competency committees (CCCs) do not typically make deliberate entrustment decisions, instead defaulting to the promotion and graduation of trainees in the absence of red flags. This study sought further understanding of these areas through empirical data.

Methods: The authors conducted a realist inquiry to better understand how CCC prospective entrustment decision-making is carried out in paediatric residency programs. They conducted four CCC meeting observations and 18 interviews with CCC members at eight sites in an effort to confirm, disconfirm, and elaborate an existing theory that was based on a literature synthesis.

Results: The literature-based theory held up well against the empiric data collected in this study. Therefore, the authors did not modify that theory and instead developed three new demi-regularities (recurring patterns in data when conducting realist work) that add detail and nuance to their previous understanding of this model. These new demi-regularities focus on (i) expounding on how deliberate actions of CCCs focus more on resident development than on resident entrustment; (ii) elucidating that effortful work is not only about reconciling a paucity of data or incongruent data but also working hard to 'do the right thing' for residents; and (iii) describing how programs consider bias, equity and fairness, with a wide range of intentionality from being reactive to being proactive.

Conclusion: This study offers evidence of deliberate CCC efforts to support resident development. Moving forward, a similar focus should be more consistently placed on equitable entrustment and advancement decisions to balance both of these foundational goals.

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对儿科住院医师临床能力委员会的前瞻性委托决策进行现实主义评估。
目的:委托决策(授予更多责任、晋升和毕业)是医学培训中的重要行动,如果做不好,会给受训者和患者带来风险。之前对现有文献进行的现实主义综述显示,临床能力委员会(CCC)通常不会做出深思熟虑的委托决策,而是在没有警示的情况下默认学员的晋升和毕业。本研究试图通过实证数据进一步了解这些领域:作者开展了一项现实主义调查,以更好地了解儿科住院医师培训项目中如何进行 CCC 前瞻性委托决策。他们观察了四次 CCC 会议,并对八个地点的 CCC 成员进行了 18 次访谈,以努力证实、否定和阐述基于文献综述的现有理论:结果:基于文献的理论在本研究收集的经验数据面前表现良好。因此,作者没有修改该理论,而是提出了三个新的非规律性(在开展现实主义工作时数据中反复出现的模式),为他们之前对该模式的理解增添了细节和微妙之处。这些新的非规律性主要集中在:(i) 阐述了社区陪伴中心的刻意行动是如何更多地关注居民的发展而非居民的委托;(ii) 阐明了努力工作不仅是为了协调数据不足或不一致的数据,也是为了努力为居民 "做正确的事";(iii) 描述了项目是如何考虑偏见、公平和公正的,并具有从被动反应到积极主动的广泛意向性:本研究提供了社区关怀中心为支持居民发展所做努力的证据。展望未来,应更加持续地关注公平委托和晋升决定,以平衡这两个基本目标。
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来源期刊
Medical Education
Medical Education 医学-卫生保健
CiteScore
8.40
自引率
10.00%
发文量
279
审稿时长
4-8 weeks
期刊介绍: Medical Education seeks to be the pre-eminent journal in the field of education for health care professionals, and publishes material of the highest quality, reflecting world wide or provocative issues and perspectives. The journal welcomes high quality papers on all aspects of health professional education including; -undergraduate education -postgraduate training -continuing professional development -interprofessional education
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