Abstract
BackgroundPhysicians need a set of specific competences to perform well in interprofessional teams in their first year of residency. These competences should be achieved with graduation from medical school. Assessments during undergraduate medical studies are mostly rated by supervisors only. The aim of our study was to compare the rating of core facets of competence of medical students late in their undergraduate training as well as the rating confidence between three different groups of assessors (supervisors, residents, and nurses) in an assessment simulating the first day of residency.MethodsSixty-seven advanced medical students from three different medical schools (Hamburg, Oldenburg and Munich) participated in a 360-degree assessment simulating the first working day of a resident. Each participant was rated by three assessors – a supervisor, a resident and a nurse – in seven facets of competence relevant for the first year of residency: (1) responsibility, (2) teamwork and collegiality, (3) knowing and maintaining own personal bounds and possibilities, (4) structure, work planning and priorities, (5) coping with mistakes, (6) scientifically and empirically grounded method of working, and (7) verbal communication with colleagues and supervisors. Means of all assessed competences and confidences of judgement of the three rating groups were compared. Additionally, correlations between assessed competences and confidence of judgement within each group of raters were computed.ResultsAll rating groups showed consistent assessment decisions (Cronbach’s α: supervisors = .90, residents = .80, nurses = .78). Nurses assessed the participants significantly higher in all competences compared to supervisors and residents (all p ≤ .05) with moderate and high effect sizes (d = .667–1.068). While supervisors’ and residents’ ratings were highest for “teamwork and collegiality”, participants received the highest rating by nurses for “responsibility”. Competences assessed by nurses were strongly positively correlated with their confidence of judgment while supervisors’ assessments correlated only moderately with their confidence of judgment in two competences.ConclusionsDifferent professional perspectives provide differentiated competence ratings for medical students in the role of a beginning resident. Rating confidence should be enhanced by empirically derived behavior checklists with anchors, which need to be included in rater training to decrease raters’ subjectivity.
Highlights
Physicians need a set of specific competences to perform well in interprofessional teams in their first year of residency
We extended and re-designed an assessment of competences relevant for recently graduated physicians in the role of a beginning resident [27], which had been developed earlier [8]
Nurses assessed the participants significantly higher in all facets of competence compared to supervisors and residents with moderate and high effect sizes (d = .667–1.068), while ratings of both groups of physicians showed no significant differences in any of the facet of competence (Table 1)
Summary
Physicians need a set of specific competences to perform well in interprofessional teams in their first year of residency. Common conceptualizations of observed rater cognition developed from the literature describe an underlying three-phase framework of rating: (1) identifying relevant information about the candidate (observation of performance), (2) giving meaning to the collected information (processing), and (3) forming an over-all judgement of the performance and rating (integration and rating) [3]. Despite such concepts, rater-based assessment is – like other social interaction – often based on an assessor’s first impression of a candidate [1], which can be overcome, though, when the performance of a candidate changes [4]. A negative cue would carry a greater weight, if the examiner fears to pass an examinee who should not pass [4], and could lead to an unwillingness to change a negative first impression
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