CAEP GeMES | What affects a trainee’s ability to generate self-directed learning goals

In Great Evidence in Medical education Summary (GEMeS) by Carla AngelskiLeave a Comment

“So, how do you think the shift went?” 
Gregor reflects for a moment and recalls having difficulty diagnosing a sick elderly patient with abdominal pain. “I think I’ll read about red flags in abdominal pain.”
“That’s a great idea,” says Dr. Tran, “Why don’t you read about the sensitivity of serum lactate in acute mesenteric ischemia?”
One of the valuable teaching moments in Emergency Medicine is at the end of the shift, where direct feedback is given to the learner (and sometimes, to the preceptor). Most other specialties lack this regular opportunity for directed feedback. During this discussion, both learners and preceptors can identify learning goals for the next study session. These goals often but do not always align. This “Great Evidence in Medical education Summary” (GEMeS – pronounced “gems”) was originally posted by the CAEP EWG GEMeS Team on January 23, 2015 and answers the question: “What affects a trainee’s ability to generate self-directed learning goals and carry them out to a greater degree? ” A PDF version of the GEMeS summary is available here.

Education Question or Problem

What affects a trainee’s ability to generate self-directed learning goals and carry them out to a greater degree? Their own self-assessment or a faculty’s feedback?

Bottom Line

Learners are more likely to work towards goals based on their own self-assessment than faculty driven feedback, so faculty need to align their feedback with learner self-assessment to optimize trainee development.
Emergency medicine residents’ self-assessments play a critical role when receiving feedback.
Bounds R1, Bush C, Aghera A, Rodriguez N, Stansfield RB, Santen SA; MERC at CORD Feedback Study Group.
Academic Emergency Medicine, Vol 20, No 10, October 2013
DOI: 10.1111/acem.12231
Study Design
This was a multi-centre, cross-sectional educational study.
Funding sources
Four emergency medicine (EM) programs participated via the Medical Education Research Certificate (MERC) program in the United States of America.
Level of Learning
Post-graduate year (PGY) 2 to 5 (large majority of R2s and R3s).

Synopsis of Study

To determine the effect that resident self-assessment and faculty feedback have on generation of learning goals as well as their execution, 72 EM residents underwent a standardized oral board examination scenario. Following this, the residents, blinded to the list of critical actions or the feedback checklist, completed a self-assessment form.

Examiners used a standardized checklist to deliver positive and negative feedback. After the feedback the residents were asked to generate “SMART” learning goals (specific, measurable, attainable, realistic, and time-bound). Within four weeks, residents described what they had done to achieve these goals. Forty-seven percent of the generated learning goals were based on residents’ self-assessment alone, versus 27% generated by faculty feedback alone. Poorly performing residents were more likely to incorporate feedback into learning goal generation than high performers. At four weeks, recalled learning goals from self-assessment and faculty feedback were similar. However, 40% of the goals attained were notably from those where self-assessment and feedback were congruent. This study suggests that for feedback to have the most impact on eventual learner behaviour, faculty must incorporate the learner’s self-assessment into it.

Why is it relevant to Emergency Medicine Education?

We place much emphasis as educators and faculty on effective and constructive feedback to learners. This paper suggests that despite quality of feedback, if the trainee’s self-assessment of performance is not congruent with our own, lack of uptake of the feedback ensues which ultimately hinders performance improvement.
For learners, what are your strategies for coming up with learning objectives after a shift? For preceptors, what do you find are tactful ways of broaching important learning objectives to the learner if the learner does not bring them up themselves?

More About the CAEP GEMeS

This post was originally authored for the Canadian Association of Emergency Physicians (CAEP) Great Evidence in Medical Education Summaries (GEMeS) project sponsored by the CAEP Academic Section’s Education Working Group and edited by Drs. Teresa Chan and Julien Poitras. CAEP members receive GEMeS each month in the CAEP Communiqué. CanadiEM will be reposting some of these summaries, along with a case/contextualizing concept to highlight some recent medical education literature that is relevant to our nation’s teachers.

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Carla Angelski

Carla Angelski

Dr. Angelski is a pediatric emergency physician at the University of Saskatchewan. Her research interests include prehospital care, simulation and medical education.
Daniel Ting

Daniel Ting

Daniel Ting is an Emergency Physician and Clinical Instructor at the University of British Columbia, based in Vancouver. He is the Editor-in-Chief of CanadiEM and a Decision Editor at the Canadian Journal of Emergency Medicine. He completed the CanadiEM Digital Scholarship Fellowship in 2017-18.
Daniel Ting
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