TY - JOUR
T1 - Use of Resident-Sensitive Quality Measure Data in Entrustment Decision Making
T2 - A Qualitative Study of Clinical Competency Committee Members at One Pediatric Residency
AU - Schumacher, Daniel J.
AU - Martini, Abigail
AU - Sobolewski, Brad
AU - Carraccio, Carol
AU - Holmboe, Eric
AU - Busari, Jamiu
AU - Poynter, Sue
AU - van der Vleuten, Cees
AU - Lingard, Lorelei
N1 - Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/11
Y1 - 2020/11
N2 - PurposeResident-sensitive quality measures (RSQMs) are quality measures that are likely performed by an individual resident and are important to care quality for a given illness of interest. This study sought to explore how individual clinical competency committee (CCC) members interpret, use, and prioritize RSQMs alongside traditional assessment data when making a summative entrustment decision.MethodIn this constructivist grounded theory study, 19 members of the pediatric residency CCC at Cincinnati Children's Hospital Medical Center were purposively and theoretically sampled between February and July 2019. Participants were provided a deidentified resident assessment portfolio with traditional assessment data (milestone and/or entrustable professional activity ratings as well as narrative comments from 5 rotations) and RSQM performance data for 3 acute, common diagnoses in the pediatric emergency department (asthma, bronchiolitis, and closed head injury) from the emergency medicine rotation. Data collection consisted of 2 phases: ( 1) observation and think out loud while participants reviewed the portfolio and (2) semistructured interviews to probe participants' reviews. Analysis moved from close readings to coding and theme development, followed by the creation of a model illustrating theme interaction. Data collection and analysis were iterative.ResultsFive dimensions for how participants interpret, use, and prioritize RSQMs were identified: (1) ability to orient to RSQMs: confusing to self-explanatory, (2) propensity to use RSQMs: reluctant to enthusiastic, (3) RSQM interpretation: requires contextualization to self-evident, (4) RSQMs for assessment decisions: not sticky to sticky, and (5) expectations for residents: potentially unfair to fair to use RSQMs. The interactions among these dimensions generated 3 RSQM data user profiles: eager incorporation, willing incorporation, and disinclined incorporation.ConclusionsParticipants used RSQMs to varying extents in their review of resident data and found such data helpful to varying degrees, supporting the inclusion of RSQMs as resident assessment data for CCC review.
AB - PurposeResident-sensitive quality measures (RSQMs) are quality measures that are likely performed by an individual resident and are important to care quality for a given illness of interest. This study sought to explore how individual clinical competency committee (CCC) members interpret, use, and prioritize RSQMs alongside traditional assessment data when making a summative entrustment decision.MethodIn this constructivist grounded theory study, 19 members of the pediatric residency CCC at Cincinnati Children's Hospital Medical Center were purposively and theoretically sampled between February and July 2019. Participants were provided a deidentified resident assessment portfolio with traditional assessment data (milestone and/or entrustable professional activity ratings as well as narrative comments from 5 rotations) and RSQM performance data for 3 acute, common diagnoses in the pediatric emergency department (asthma, bronchiolitis, and closed head injury) from the emergency medicine rotation. Data collection consisted of 2 phases: ( 1) observation and think out loud while participants reviewed the portfolio and (2) semistructured interviews to probe participants' reviews. Analysis moved from close readings to coding and theme development, followed by the creation of a model illustrating theme interaction. Data collection and analysis were iterative.ResultsFive dimensions for how participants interpret, use, and prioritize RSQMs were identified: (1) ability to orient to RSQMs: confusing to self-explanatory, (2) propensity to use RSQMs: reluctant to enthusiastic, (3) RSQM interpretation: requires contextualization to self-evident, (4) RSQMs for assessment decisions: not sticky to sticky, and (5) expectations for residents: potentially unfair to fair to use RSQMs. The interactions among these dimensions generated 3 RSQM data user profiles: eager incorporation, willing incorporation, and disinclined incorporation.ConclusionsParticipants used RSQMs to varying extents in their review of resident data and found such data helpful to varying degrees, supporting the inclusion of RSQMs as resident assessment data for CCC review.
KW - IMPLEMENTATION
KW - WORK
U2 - 10.1097/ACM.0000000000003435
DO - 10.1097/ACM.0000000000003435
M3 - Article
C2 - 32324637
SN - 1040-2446
VL - 95
SP - 1726
EP - 1735
JO - Academic Medicine
JF - Academic Medicine
IS - 11
ER -