Assessment of Resident Physicians' Communicator and Collaborator Competencies by Interprofessional Clinicians: A Mixed-Methods Study

ABSTRACT

Phenomenon: As we move toward competency-based medical education, greater emphasis is being placed on assessing a more comprehensive skill set, including the ability to communicate and collaborate effectively in the workplace. Nonphysician members on interprofessional (IP) teams have valuable perspectives on actual resident performance and are often not adequately engaged in the provision of feedback to residents. Based on the educational theories of collaborative evaluation and social constructivism, this research examined the ability of IP clinicians to provide feedback to residents. The aim of this study was to examine IP clinicians' perceptions of their ability to provide formative feedback, through their observations and assessments of developmental pediatric residents, compared to physician supervisors on the rotation, and to qualitatively explore potential barriers to the feedback process from their perspective. Approach: This explanatory, sequential mixed-methods design study first examined which and how many of the CanMEDS Communicator and Collaborator training objectives (N = 40) were considered to be observable and assessable by IP clinicians and physicians. A comparison of the mean number of objectives that were observed and practically assessed by (a) each group (IP clinicians vs. physicians) and (b) clinical service teams during the core developmental pediatrics rotations, were examined using independent t tests. Second, a thematic qualitative analysis of focus groups was used to develop a contextual understanding of the factors that influenced this process. Data were analyzed using three levels of open coding and descriptive qualitative analysis techniques. Findings: Physicians reported they could observe (M = 33.3, SD = 5.2, 83.3%) and assess (M = 31.5, SD = 7.3, 79%) a larger number of objectives compared to the IP clinician group (M = 24.7, SD = 8.6, 61.8% and M = 20.3, SD = 10.6, 51%, respectively). There were no differences between the clinical service teams (i.e., preschool/school-age and pediatric rehabilitation). The objective that was most observable and assessable by the IP clinicians was “Demonstrates a respectful attitude towards other colleagues and members of an interprofessional team.” Four themes identified by the IP clinicians provided more in-depth qualitative information: (a) assessment requires more than simple observation, (b) assumptions and indirect observation influence assessment, (c) clinic culture and structure shapes observation and assessment, and (d) specific assessment criteria are required by IP clinicians. Insights: IP clinicians have the desire and ability to provide formative feedback to residents. Formalized processes with specific evaluation criteria would facilitate meaningful feedback from IP clinicians in the assessment of residents as they journey toward competence.

KEYWORDS:

• Assessment
• collaboration
• interprofessional clinicians
• competency-based medical education
• communication

Funding

This study was funded by a Teaching and Learning Enhancement Fund Grant from the Provost's Office at the University of Alberta. Dr. Pritchard-Wiart is supported by the Canadian Child Health Clinician Scientist Training Program, the Women and Children's Health Research Institute through the generous support of the Stollery Children's Hospital Foundation and Alberta PolicyWise for Children and Families.