Misbehavior or misalignment? Examining the drift towards bureaucratic box-ticking in Competency-Based Medical Education.

Within competency-based medical education (CBME) residency programs, Entrustable Professional Activity (EPA) assessments endeavor to both bolster learning and inform promotion decisions. Recent implementation studies describe successes but also adverse effects, including residents and preceptors drifting towards bureaucratic / purely administrative behaviors and attitudes, although the drivers behind this tendency are not adequately understood. This study sought to examine resident and faculty experiences with implemented EPA processes to elucidate what leads them toward a 'tick-box' approach that has been described in the literature.

Impact of tablet-scoring and immediate score sheet review on validity and educational impact in an internal medicine residency Objective Structured Clinical Exam (OSCE).

The Objective Structured Clinical Examination (OSCE) is used globally for formative and summative purposes. The objective of this study was to examine the impact of tablet-scoring on sources of validity evidence for an Internal Medicine residency OSCE. We compared paper-scored OSCEs from 2014 to tablet-scored OSCEs in 2015 for missing data, amount of comments, and time to pass/fail decision.