"They were very very nice but just not very good": The interplay between resident-supervisor relationships and assessment in the emergency setting.

Purpose: Clinical supervisors hesitate to report learner weaknesses, a widely documented phenomenon referred to as "failure to fail." They also struggle to discuss weaknesses with learners themselves. Their reluctance to report and discuss learner weaknesses threatens the validity of assessment-of-learning decisions and the effectiveness of assessment for learning.

If we assess, will they learn? Students' perspectives on the complexities of assessment-for-learning.

Introduction: Assessment can positively influence learning, however designing effective assessment-for-learning interventions has proved challenging. We implemented a mandatory assessment-for-learning system comprising a workplace-based assessment of non-medical expert competencies and a progress test in undergraduate medical education and evaluated its impact.

Methods: We conducted semi-structured interviews with year-3 and 4 medical students at McGill University to explore how the assessment system had influenced their learning in year 3.

Impact of emotional competence on physicians' clinical reasoning: a scoping review protocol.

Introduction: Clinical reasoning (CR) is a key competence for physicians and a major source of damaging medical errors. Many strategies have been explored to improve CR quality, most of them based on knowledge enhancement, cognitive debiasing and the use of analytical reasoning. If increasing knowledge and fostering analytical reasoning have shown some positive results, the impact of debiasing is however mixed.

Learner handover: Perspectives and recommendations from the front-line.

Introduction: Current medical education models increasingly rely on longitudinal assessments to document learner progress over time. This longitudinal focus has re-kindled discussion regarding learner handover-where assessments are shared across supervisors, rotations, and educational phases, to support learner growth and ease transitions. The authors explored the opinions of, experiences with, and recommendations for successful implementation of learner handover among clinical supervisors.

Does Educational Handover Influence Subsequent Assessment?

Purpose: Educational handover (i.e., providing information about learners' past performance) is controversial.

Nudging clinical supervisors to provide better in-training assessment reports.

Introduction: In-training assessment reports (ITARs) summarize assessment during a clinical placement to inform decision-making and provide formal feedback to learners. Faculty development is an effective but resource-intensive means of improving the quality of completed ITARs. We examined whether the quality of completed ITARs could be improved by 'nudges' from the format of ITAR forms.

A Scoping Review of Physicians' Clinical Reasoning in Emergency Departments.

Study Objective: Clinical reasoning is considered a core competency of physicians. Yet there is a paucity of research on clinical reasoning specifically in emergency medicine, as highlighted in the literature.

Methods: We conducted a scoping review to examine the state of research on clinical reasoning in this specialty.

The challenges of detecting progress in generic competencies in the clinical setting.

Context: Competency-based medical education has spurred the implementation of longitudinal workplace-based assessment (WBA) programmes to track learners' development of competencies. These hinge on the appropriate use of assessment instruments by assessors. This study aimed to validate our assessment programme and specifically to explore whether assessors' beliefs and behaviours rendered the detection of progress possible.

Examining the effects of gaming and guessing on script concordance test scores.

Introduction: In a script concordance test (SCT), examinees are asked to judge the effect of a new piece of clinical information on a proposed hypothesis. Answers are collected using a Likert-type scale (ranging from -2 to +2, with '0' indicating no effect), and compared with those of a reference panel of 'experts'. It has been argued, however, that SCT may be susceptible to the influences of gaming and guesswork.

Diagnosis and management of clinical reasoning difficulties: Part I. Clinical reasoning supervision and educational diagnosis.

There are many obstacles to the timely identification of clinical reasoning difficulties in health professions education. This guide aims to provide readers with a framework for supervising clinical reasoning and identifying the potential difficulties as they may occur at each step of the reasoning process.

Diagnosis and management of clinical reasoning difficulties: Part II. Clinical reasoning difficulties: Management and remediation strategies.

Part II of this AMEE Guide provides a detailed overview of the main difficulties in clinical reasoning, including the cues to look out for in clinical supervision, the root causes of each difficulty and targeted remediation strategies. Specific challenges and issues related to the management of clinical reasoning difficulties will also be discussed.

In Brief: Validity of Case Summaries in Written Examinations of Clinical Reasoning.

Unlabelled: Construct: The purpose of this study was to provide initial evidence of the validity of written case summaries as assessments of clinical problem representation in a classroom setting.

Background: To solve clinical problems, clinicians must gain a clear representation of the issues. In the clinical setting, oral case presentations-or summaries-are used to assess learners' ability to gather, synthesize, and "translate" pertinent case information.

Do emergency physicians trust their patients?

The primary focus of research on the physician-patient relationship has been on patients' trust in their physicians. In this study, we explored physicians' trust in their patients. We held semi-structured interviews with expert emergency physicians concerning a patient they had just been managing.

Considering "Nonlinearity" Across the Continuum in Medical Education Assessment: Supporting Theory, Practice, and Future Research Directions.

The purpose of this article is to propose new approaches to assessment that are grounded in educational theory and the concept of "nonlinearity." The new approaches take into account related phenomena such as "uncertainty," "ambiguity," and "chaos." To illustrate these approaches, we will use the example of assessment of clinical reasoning, although the principles we outline may apply equally well to assessment of other constructs in medical education.

From Context Comes Expertise: How Do Expert Emergency Physicians Use Their Know-Who to Make Decisions?

Study Objective: Decisionmaking is influenced by the environment in which it takes place. The objective of our study was to explore the influence of the specific features of the emergency department (ED) environment on decisionmaking. In this paper, we specifically report on the way emergency physicians use their knowledge of their collaborators to make their decisions.

Insights into emergency physicians' minds in the seconds before and into a patient encounter.

Clinical reasoning is a core competency in medical practice. No study has explored clinical reasoning occurring before a clinical encounter, when physicians obtain preliminary information about the patient, and during the first seconds of the observation phase. This paper aims to understand what happens in emergency physicians' minds when they acquire initial information about a patient, and when they first meet a patient.

Social dominance theory and medical specialty choice.

Understanding how medical students select their specialty is a fundamental issue for public health and educational policy makers. One of the factors that students take into account is a specialty's prestige which hinges partly on its focus on technique rather than whole person. We examine the potential of a psychological framework, social dominance theory, to explain why some students, and not others, are drawn to more prestigious, technique-oriented specialties, based on their desire for hierarchy.

Beliefs, identities and educational practice: a Q methodology study of general practice supervisors.

Introduction: Quality of supervisory practices varies. According to the integrative model of behaviour prediction, supervisors' beliefs may influence practice. This study aimed to examine the belief profiles of general practice supervisors, and their potential relationship with supervisory practice.

Multifaceted assessment in a family medicine clerkship: a pilot study.

Background And Objectives: Programs of assessment should reflect the multifaceted nature of medical competence. We experimented with new testing methods, ie, script concordance testing (SCT) and clinical reasoning problems (CRPs), combined with the habitual OSCE for an end of family medicine clerkship. Our aims were to compare students' scores with experts' scores, to determine whether the new tests detected learning over a 3-month period, and to examine whether the tests were redundant.

Using script theory to cultivate illness script formation and clinical reasoning in health professions education.

Script theory proposes an explanation for how information is stored in and retrieved from the human mind to influence individuals' interpretation of events in the world. Applied to medicine, script theory focuses on knowledge organization as the foundation of clinical reasoning during patient encounters. According to script theory, medical knowledge is bundled into networks called 'illness scripts' that allow physicians to integrate new incoming information with existing knowledge, recognize patterns and irregularities in symptom complexes, identify similarities and differences between disease states, and make predictions about how diseases are likely to unfold.

What steps are necessary to create written or web-based selected-response assessments?

Before we work out what constitutes an assessment's value for a given cost in medical education, we must first outline the steps necessary to create an assessment, and then assign a cost to each step. In this study we undertook the first phase of this process: we sought to work out all the steps necessary to create written selected-response assessments. First, the lead author created an initial list of potential steps for developing written assessments.