CanMEDS based daily evaluation cards for multi-level
learners: One size CAN fit all!
Author: Debbi Andrews, MD, FRCP(C )
Date: 29 September 2013
I do not have an affiliation (financial or otherwise)
with a pharmaceutical, medical device or
communications organization.
Je n’ai aucune affiliation (financière ou autre)
avec une entreprise pharmaceutique, un fabricant
d’appareils médicaux ou un cabinet de communication.
Author: Debbi Andrews, MD, FRCP(C )
Date: 28 September 2013
Session/Presentation Name | Presenter Name
Does this sound like your program?
• Each month you get a new group of similarly trained
learners all at the same stage of development.
• Each learner receives a standardised learning
experience of exactly the same clinics with the same
well-trained clinical preceptors
• Each learner can be evaluated using the same
evaluation
PROBABLY NOT!!!
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Many types of learners
• Elective med students (Y3 and 4)
• General peds residents (R1 and 3)
• Elective residents from peds and other
specialties
• PMR residents (R4 or 5)
• Neonatology fellows
• Devtl Peds subspecialty residents (R4 and 5)
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Many types of preceptors
– Developmental pediatricians
– Peds rehab medicine specialists &
physiatrists
– General pediatricians
– Family medicine doctors
– Child psychiatrists
– Nurse practitioners
– Allied health professions team members
– Medical educators, clinicians & researchers
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Many learning settings
• Primary rehab hospital setting (Glenrose)
– Outpatient clinics
– Outpatient programmes and in-house day school
– Inpatient rehab unit
• Community general peds clinics (screening)
• Level 2 Learning and Devt Clinics
• Consultations at Stollery Children’s Hospital
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PROBLEM
• How can we provide frequent high-quality
individualised learner feedback without
overburdening our busy and diverse
teaching staff?
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Daily evaluation “cards”
• One page, double-sided form
• Organised by CanMEDS roles
• Includes marking cues appropriate for ALL
learners
• Prefilled with some content, colour-coded
sheets
• Learners receive a stack of cards one Day 1
• Learners oriented to and encouraged to use!
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Evaluation tool development
• Started with the old “too many lines, too many
checkboxes” evaluation
• Simplified content by CanMEDS, focus on global
LOs
• Increased whitespace and room for narrative
• Piloted for 1 month to get feedback and check
for problems
• Revised new form
• Presented at a Divisional education workshop
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Session/Presentation Name | Presenter Name
From this to this. . . .
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“Meets expectations” sheet
• One page reference document that
describes what learners at different
levels are supposed to be working on
• Summarises formal learning objectives
into a handy reference form
• Does NOT repeat universal content but
focuses on differences amongst levels
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Composite ITER/eval
• Most learners have collected cards for at least
half of their clinic days.
• Daily cards can be easily summed up for a
composite mark
• If ordered by date, growth can be documented
over rotation/elective
• Narrative examples supporting ratings give
validity to learner feedback
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Staff training workshop
• Introduced new forms
• Reviewed qualities of good feedback
• Concept of “meets expectations”
– Most residents are doing well—this is
AVERAGE
– Save “superior” for the truly exceptional
learner
• Practice cases with fictional learners
• Q and A
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What changed
• 8 block samples pre/post change
• Sample size
» Pre = 26 (7MS, 19 R)
» Post = 20 (4 MS, 16 R)
• Return rates
» Pre 55%
» Post 63%
• Ratings and content
» Pre 18/19 residents above average (1 not rated)
» Post 70% = meets expectations, 30% = above
» 4.5 instances of formative feedback/rotation (“next
steps)
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Acknowledgements
• Form development team
– Dr. Cara Dosman, junior block coordinator
– Dr. John Andersen, senior block coordinator
– Ms. Brandy Burns, education admin assistant
• Faculty reviewers from Division of
Developmental Pediatrics
• All our developmental learners
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Questions?
Debbi Andrews, MD, FRCPC
[email protected]
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