Marion Eyraud and Benoit Le Goff, CHU Nantes, Nantes, France
Background/Purpose: French medical studies have recently undergone radical changes. Several reforms put back competences in the forefront of medical education. One of their goals was also to promote the formal evaluation of competences. In this work, we wanted to assess if this reform had really changed the way assessment was perceived and performed in rheumatology in the different French University hospitals.
Methods: A questionnaire was sent to the 28 university hospitals that offer a fellowship program in Rheumatology. A survey was also sent to the rheumatology trainees, with the same questions on assessment and on their expectations as students. The survey recorded which moments were dedicated to assessment and the methods used (regarding the recently published points to consider by the EULAR). A special part was dedicated to the assessment of technical skills and to the final certification in rheumatology.
Results: All the centers responded to the questionnaire. The different assessment tools mentioned by the EULAR were still poorly known by the professors of rheumatology. If 93% of them knew the Objective Structured Clinical Examination (OSCE's), we found that Direct observation of practical skills (DOPS), Mini-Clinical examination and Multisource Feed-back (MSF/360°) were only known by 14%, 25% and 11% of them respectively. Only a third of the centers used one of these methods. They mostly used the validation of the e-learning on the national platform and one-to-one meetings. Technical competences were validated through an e-portfolio and a practical exam in 86% of the centers for US but only in 32% for bone densitometry. In 78% of the centers, rheumatology certification was validated through an oral presentation. The students had to summarizing their fellowship and competences acquired during the curriculum. In 11% on the centers, the completion of all the stages and the medical thesis were sufficient to obtain the certification without any formal evaluation. A third of the professors thought that formal evaluation using validated tools was not useful. They considered that a holistic, constructivist and professional approach was the best way to evaluate rheumatology fellows. Moreover, only 57% thought that a standardization for the final rheumatology certification was necessary. One hundred and twenty-six rheumatology fellows responded to the questionnaire. A large majority of them was in favor of formal evaluation (88%) with 94% of them considering that they should be formative and not summative. They saw assessments as an opportunity to improve and evaluate their strengths and weaknesses during their fellowship.
Conclusion: We confirm that educational changes and teachers' development of assessment practice takes time. Despite a reform that had for main objective to put back assessment at the core of medical training, there is still room for improvement in the knowledge and practice of validated evaluation methods. The fact that there are no compulsory tools to evaluate and validate fellows during their curriculum lead to a great heterogeneity in the assessments methods. A debate remains on the usefulness of formal evaluation among professors whereas fellows are in favor of being evaluated in a formative way.
