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Best Practices Precepting Models Student Self-Assessment

Best Practices Precepting Models Student Self-Assessment. Michelle E. Allen, PharmD, BCPS Clinical Specialist, Adult Critical Care Shands at the University of Florida Clinical Associate Professor University of Florida, College of Pharmacy. UF Fall Faculty Workshop Sept. 12, 2008.

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Best Practices Precepting Models Student Self-Assessment

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  1. Best Practices Precepting ModelsStudent Self-Assessment Michelle E. Allen, PharmD, BCPS Clinical Specialist, Adult Critical Care Shands at the University of Florida Clinical Associate Professor University of Florida, College of Pharmacy UF Fall Faculty Workshop Sept. 12, 2008

  2. Disclosures • None • Opinion and practice based

  3. The What and How • Rotation presentation(s) • UF rotation competencies • 1-month rotation: 3 self-evaluations • 2-month rotation: 4 – 5 evaluations

  4. Benefits • Saves me some time • Documentation, just in case… • Question of grade determination • Letters of recommendation • Student value • Learning how to be a life-long learner • Education vs. evaluation • Maintaining professional development and competence • Grade satisfaction

  5. Potential Problems • Expectations • Competency is a good thing, a great thing, that is the goal • Inaccurate self-assessment • Overestimation • Underestimation • Time consuming: particularly in the over-estimator

  6. Conflicting EvidenceAbilityAccuracy

  7. Inability to Self-Assess • Inability to peer-reference • Knowledge of standards • Knowledge of expectations • Process nonverbal feedback • Rewards or punishments to change one's actions Maki RH, Johas D, Kallod M. T. Psychonomic Bull Rev. 1994;1:126–9. Metcalf J. Pers Soc Psychol Rev. 1998;2:100–10.

  8. Self-Assessment Accuracy • Systematic review: 17 / 725 studies met inclusion criteria • 13: little, no or inverse relationship • 7: positive association Davis DA, Mazmanian PE, Fordis M, et.al. JAMA 2006;296:1094-1102.

  9. Procedure performance Dementia assessment Health promotion counseling Critical care skills Palliative care Explain evidence-based medicine Predict students assessments of teaching abilities Knowledge in primary care Dementia assessment Basic clinical skills Managing psychological aspects of family practice Sexual abuse by physical exam Diagnostic features of small pox Language and cultural competence Sensitivity to emotional and psychological stress Self-Assessment Accuracy Davis DA, Mazmanian PE, Fordis M, et.al. JAMA 2006;296:1094-1102.

  10. Self-Assessment Accuracy Those that performed the poorest by external review are the worst at self-assessment Davis DA, Mazmanian PE, Fordis M, et.al. JAMA 2006;296:1094-1102.

  11. Self-Assessment Accuracy • Evidence-based guidelines (required ACGME* competency) • Self-perceived competence (1st part of the survey) vs. actual performance (2nd) • Average actual score 55% • Chasm between perceived and actual performance *Accreditation Council for Graduate Medical Education’s Practice-Based Learning Caspi O, McKnight P, Kruse L, et al. Medical Teacher 2006;24:318-25.

  12. Self-Assessment Accuracy • Student self-assessment vs. resident/faculty • 3rd year medical students on Ob/gyn rotation • 5-point Likert scale • Suggest that students do not have an understanding of their own strengths and weaknesses  may not know personal or professional limitations Weiss PM, Koller CA, Hess LW, et.al. Medical Teacher 2005;27:445-9.

  13. Feedback • Shown a video, given a pre-test and randomized into groups: • Computer generated economy feedback • Above + expert reference values • Above + expert verbal feedback • 18 practice trials, post-test Porte MC, Xeroulis G, Reznick RK, et.al. Am J Surgery 2007;193:105-10.

  14. Feedback • 1-month later 5 sutures evaluated • Only the expert feedback group was able to predictably retain the skills • Evaluation vs. education • For education: technology cannot replace the expert Porte MC, Xeroulis G, Reznick RK, et.al. Am J Surgery 2007;193:105-10.

  15. William is a short shy man. He has a passion for reading and loves strolling through museums. As a child, he was bullied by his classmates. • Do you suppose William is a: • a) truck driver • b) classics professor Austin Z, Gregory PAM, Chiu S. Am J Pharm Ed 2008;72:1-8.

  16. Reflection and Self-Assessment • 24-item critical thinking test • Rule-based (logical) vs. short-cut (flawed) • Completed test without interference…or… • Prompted at question 13 and 18 to reflect and self-assess • Rate confidence in the answer • Provide an explanation of how they arrived at the confidence rating • Provide explanation, rationalization or justification of why they selected the answer Austin Z, Gregory PAM, Chiu S. Am J Pharm Ed 2008;72:1-8.

  17. Take Home Messages • Feedback: direct and immediate • Feedback: opportunity to develop skills under supervision and mentorship • Reflection: does not have to be complicated or cumbersome • Feedback: expert feedback cannot be replaced by technology

  18. Knowing is not enough;we must apply.Willing is not enough;we must do. Johann Wolfgang von Goethe 1749-1832

  19. Best Practices Precepting ModelsStudent Self-Assessment Michelle E. Allen, PharmD, BCPS Clinical Specialist, Adult Critical Care Shands at the University of Florida Clinical Associate Professor University of Florida, College of Pharmacy UF Fall Faculty Workshop Sept. 12, 2008

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