Impact of workplace based assessment on doctors' education and performance: a systematic review.
Impact of workplace based assessment on doctors' education and performance: a systematic review.
复制标题
DOI：
10.1136/bmj.c5064
复制
发表时间：
2010-09-24
期刊：
影响因子：
--
通讯作者：
Archer, Julian
中科院分区：
文献类型：
--
作者：
Miller, Alice;Archer, Julian
目的：设计：系统评价，资料来源：Journals@奥维德，Medline，Embase，CINAHL，PsycINFO，ERIC数据库。通过健康信息资源网站访问和检索循证综述（Bandolier、科克伦图书馆、DARE、HTA数据库和NHS EED）。还检索了相关研究的参考文献列表和综述文章的参考书目。审查方法研究的任何设计，试图评估工作场所为基础的评估的教育影响，或工作场所为基础的评估对医生的表现的影响，被包括在内。如果抽样人群为非医学人群或研究对象为医学生，则排除研究。综述文章、评论和信件也被排除。最终排除标准是使用模拟患者或模型，而不是真实的生活中的临床encounters.RESULTS：16项研究被纳入。其中15项为非比较性描述性或观察性研究;另一项为随机对照试验。研究质量参差不齐。八项研究检查了多频反馈，结果好坏参半;大多数医生认为多频反馈具有教育价值，尽管实践改变的证据相互矛盾。一些初级医生和外科医生表现出很少的意愿，以改变回应多渠道的反馈，而家庭医生可能更愿意主动改变。当反馈是可信的和准确的，或当提供辅导，以帮助受试者确定自己的优势和劣势时，更有可能发生性能变化。四项研究探讨了微型临床评估工作，一个着眼于直接观察的程序技能，三个涉及多种评估方法：所有这些研究报告了积极的结果，为教育工作场所为基础的评估工具的影响。然而，没有客观的证据表明，这些tools.Conclusions提高性能：考虑到重点放在工作场所为基础的评估作为一种方法，形成性能评估，很少有已发表的文章探讨其对医生的教育和性能的影响。这篇评论表明，多尺度反馈可以导致绩效的提高，虽然个人因素，反馈的背景下，和促进的存在有深远的影响的反应。没有证据表明，替代工作场所为基础的评估工具（微型临床评估练习，直接观察的程序技能，和基于案例的讨论）导致性能的改善，虽然他们的教育影响的主观报告是积极的。
OBJECTIVE: To investigate the literature for evidence that workplace based assessment affects doctors' education and performance.DESIGN: Systematic review.DATA SOURCES: The primary data sources were the databases Journals@Ovid, Medline, Embase, CINAHL, PsycINFO, and ERIC. Evidence based reviews (Bandolier, Cochrane Library, DARE, HTA Database, and NHS EED) were accessed and searched via the Health Information Resources website. Reference lists of relevant studies and bibliographies of review articles were also searched. Review methods Studies of any design that attempted to evaluate either the educational impact of workplace based assessment, or the effect of workplace based assessment on doctors' performance, were included. Studies were excluded if the sampled population was non-medical or the study was performed with medical students. Review articles, commentaries, and letters were also excluded. The final exclusion criterion was the use of simulated patients or models rather than real life clinical encounters.RESULTS: Sixteen studies were included. Fifteen of these were non-comparative descriptive or observational studies; the other was a randomised controlled trial. Study quality was mixed. Eight studies examined multisource feedback with mixed results; most doctors felt that multisource feedback had educational value, although the evidence for practice change was conflicting. Some junior doctors and surgeons displayed little willingness to change in response to multisource feedback, whereas family physicians might be more prepared to initiate change. Performance changes were more likely to occur when feedback was credible and accurate or when coaching was provided to help subjects identify their strengths and weaknesses. Four studies examined the mini-clinical evaluation exercise, one looked at direct observation of procedural skills, and three were concerned with multiple assessment methods: all these studies reported positive results for the educational impact of workplace based assessment tools. However, there was no objective evidence of improved performance with these tools.CONCLUSIONS: Considering the emphasis placed on workplace based assessment as a method of formative performance assessment, there are few published articles exploring its impact on doctors' education and performance. This review shows that multisource feedback can lead to performance improvement, although individual factors, the context of the feedback, and the presence of facilitation have a profound effect on the response. There is no evidence that alternative workplace based assessment tools (mini-clinical evaluation exercise, direct observation of procedural skills, and case based discussion) lead to improvement in performance, although subjective reports on their educational impact are positive.