The Emergence of an Autonomy-Oriented Assessment Culture in Pediatric Residency Education: a Case Study

Abstract

This case study examines the emergence of an autonomy-oriented assessment culture in Pediatric residency education in the School of Medicine at Queen’s University. Through a case study approach this research explores how an assessment system to capture residents’ performance in the clinical environment was initiated, how that process supported a shift in assessment cultural, and how assessment innovation is eclipsing departmental boundaries. The case has instrumental value in illuminating how an autonomy-oriented assessment system and culture can be cultivated in residency education. The analytic frame for the case was constructed based on research literature that identified weaknesses in assessment practices in residency education more generally. The approach was theoretical, with the intent to explain how a shift in assessment culture is emerging in Pediatrics. A longitudinal approach was adopted to expose shifts in the culture. The narrative structure distills the journey into a manageable story. Three watershed events that exemplified change were systematically selected from data collected over a three-year period and constitute the findings of this research. The central contribution this research makes is that it is possible to shift the culture of assessment within a Pediatric residency program. That shift can be understood to unfold over a prolonged period through a process of mediating both social and regulatory requirements. Beginning to shift the assessment culture in Pediatrics was achieved by: recognizing the need for change in assessment practice, re-conceptualizing and realizing that change, and engaging and empowering the community to support a shift in assessment culture. Strong leadership, widening community engagement and the Rubric Descriptor Bank supported this process. Five theoretically informed principles guided the emergence of the autonomy-oriented assessment culture in Pediatrics including: (a) conceptualizing learning as a social, active process: (b) focusing attention on residents’ multidimensional growth; (c) moving away from a high-stakes orientation to assessment based on the false dichotomy between formative and summative assessment and embracing it as a tool for supporting and monitoring growth over time and across contexts; (d) actively supporting residents’ learning strategy and assessment skill development; and (e) fostering a growth orientation to learning, embracing the concept of graduated autonomy.