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Judging residents’ performance: a qualitative study using grounded theory

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      BackgroundAlthough program directors judge residents’ performance for summative decisions, little is known about how they do this. This study examined what information program directors use and how they value this information in making a judgment of residents’ performance and what residents think of this process.MethodsSixteen semi-structured interviews were held with residents and program directors from different hospitals in the Netherlands in 2015–2016. Participants were recruited from internal medicine, surgery and radiology. Transcripts were analysed using grounded theory methodology. Concepts and themes were identified by iterative constant comparison.ResultsWhen approaching semi-annual meetings with residents, program directors report primarily gathering information from the following: assessment tools, faculty members and from their own experience with residents. They put more value on faculty’s comments during meetings and in the corridors than on feedback provided in the assessment tools. They are influenced by their own beliefs about learning and education in valuing feedback. Residents are aware that faculty members discuss their performance in meetings, but they believe the assessment tools provide the most important proof to demonstrate their clinical competency.ConclusionsResidents think that feedback in the assessment tools is the most important proof to demonstrate their performance, whereas program directors scarcely use this feedback to form a judgment about residents’ performance. They rely heavily on remarks of faculty in meetings instead. Therefore, residents’ performance may be better judged in group meetings that are organised to enhance optimal information sharing and decision making about residents’ performance.Electronic supplementary materialThe online version of this article (10.1186/s12909-018-1446-1) contains supplementary material, which is available to authorized users.

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        Although competency-based medical education (CBME) has attracted renewed interest in recent years among educators and policy-makers in the health care professions, there is little agreement on many aspects of this paradigm. We convened a unique partnership - the International CBME Collaborators - to examine conceptual issues and current debates in CBME. We engaged in a multi-stage group process and held a consensus conference with the aim of reviewing the scholarly literature of competency-based medical education, identifying controversies in need of clarification, proposing definitions and concepts that could be useful to educators across many jurisdictions, and exploring future directions for this approach to preparing health professionals. In this paper, we describe the evolution of CBME from the outcomes movement in the 20th century to a renewed approach that, focused on accountability and curricular outcomes and organized around competencies, promotes greater learner-centredness and de-emphasizes time-based curricular design. In this paradigm, competence and related terms are redefined to emphasize their multi-dimensional, dynamic, developmental, and contextual nature. CBME therefore has significant implications for the planning of medical curricula and will have an important impact in reshaping the enterprise of medical education. We elaborate on this emerging CBME approach and its related concepts, and invite medical educators everywhere to enter into further dialogue about the promise and the potential perils of competency-based medical curricula for the 21st century.
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           R Tindale,  N. Kerr (2003)
          Theory and research on small group performance and decision making is reviewed. Recent trends in group performance research have found that process gains as well as losses are possible, and both are frequently explained by situational and procedural contexts that differentially affect motivation and resource coordination. Research has continued on classic topics (e.g., brainstorming, group goal setting, stress, and group performance) and relatively new areas (e.g., collective induction). Group decision making research has focused on preference combination for continuous response distributions and group information processing. New approaches (e.g., group-level signal detection) and traditional topics (e.g., groupthink) are discussed. New directions, such as nonlinear dynamic systems, evolutionary adaptation, and technological advances, should keep small group research vigorous well into the future.

            Author and article information

            [1 ]ISNI 0000 0004 0444 9382, GRID grid.10417.33, Department of Internal Medicine and Health Academy, Radboud Health Academy, , Radboud University Medical Centre, ; Gerard van Swietenlaan 4, Postbus 9101, 6500 HB Nijmegen, the Netherlands
            [2 ]ISNI 0000 0004 0444 9382, GRID grid.10417.33, Health Academy, Department of Research in Learning and Education, , Radboud University Medical Centre, ; Nijmegen, the Netherlands
            [3 ]ISNI 0000 0004 0631 9063, GRID grid.416468.9, Martini Hospital, ; Groningen, the Netherlands
            [4 ]ISNI 000000040459992X, GRID grid.5645.2, Department of Obstetrics and Gynaecology, , Erasmus University Medical Centre, ; Rotterdam, the Netherlands
            [5 ]ISNI 0000 0004 0444 9382, GRID grid.10417.33, Department of Internal Medicine, , Radboudumc Nijmegen, ; Nijmegen, the Netherlands
            [6 ]ISNI 0000 0000 9558 4598, GRID grid.4494.d, Centre for Education Development and Research in Health Professions, , University Medical Centre Groningen, ; Groningen, the Netherlands
            ORCID:, +31648495035 ,
            BMC Med Educ
            BMC Med Educ
            BMC Medical Education
            BioMed Central (London )
            8 January 2019
            8 January 2019
            : 19
            © The Author(s). 2019

            Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

            Funded by: Dutch Federation of Medical Specialists
            Award ID: none
            Research Article
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            © The Author(s) 2019


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