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Developed a method to estimate the cutscore precisions for empirical standard-setting methods by using resampling. Illustrated the method with two actual datasets consisting of 86 Dutch medical residents and 155 Canadian medical students taking objective structured clinical examinations. Results show the applicability of the method. (SLD)

Medical Education 2012: 46: 593-603 Objectives Regulatory focus theory posits the existence of two systems of self-regulation underlying human motivation: promotion focus, which is concerned with aspirations and accomplishments, and prevention focus, which is concerned with obligations and responsibilities. It has been proposed that regulatory focus theory may help to explain learners' variable responses to feedback, predicting that positive feedback is motivating under promotion focus, whereas negative feedback is motivating under prevention focus. We aimed to explore this link between regulatory focus theory and response to feedback using data collected in a naturalistic setting. Methods In a constructivist grounded theory study, we interviewed 22 early-career academic doctors about experiences they perceived as influential in their learning. Although feedback emerged as important, responses to feedback were highly variable. To better understand how feedback becomes (or fails to become) influential, we used the theoretical framework of regulatory focus to re-examine all descriptions of experiences of receiving and responding to feedback. Results Feedback could be influential or non-influential, regardless of its sign (positive or negative). In circumstances in which the individual's regulatory focus was readily determined, such as in choosing a career (promotion) or preparing for a high-stakes examination (prevention), the apparent influence of feedback was consistent with the prediction of regulatory focus theory. However, we encountered many challenges in applying regulatory focus theory to real feedback scenarios, including the frequent presence of a mixed regulatory focus, the potential for regulatory focus to change over time, and the competing influences of other factors, such as the perceived credibility of the source or content of the feedback. Conclusions Regulatory focus theory offers a useful, if limited, construct for exploring learners' responses to feedback in the clinical setting. The insights and predictions it offers must be considered in light of the motivational complexity of clinical learning tasks and of other factors influencing the impact of feedback. [ABSTRACT FROM AUTHOR]

Medical Education 2012: 46 : 192-200 Context: How learners interpret their clinical experiences to create meaningful learning has not been well studied. We explored experiences considered by doctors to be influential in their learning in order to better understand this process. Methods: Using a grounded theory approach, we interviewed 22 academic doctors who had been in practice for ≤ 5 years. Participants were asked to reflect on experiences they considered to have been influential during their training. Constant comparative analysis for emerging themes was conducted iteratively with data collection. Results: A model of clinical learning emerged in which the clinical work itself is central. As they observe and participate in clinical work, learners can attend to a variety of sources of information that facilitate the interpretation of the experience and the construction of knowledge from it. These 'learning cues' include feedback, role models, clinical outcomes, patient or family responses, and comparisons with peers. The integration of a cue depends on the learner's judgement of its credibility. Certain cues, such as clinical outcomes or feedback from patients, are seen as innately credible, whereas other cues, particularly feedback from supervisors, are subjected to critical judgement. Conclusions: Learners make complex judgements regarding the credibility of information about clinical performance. Credibility judgements influence the learning that arises from the clinical experience. Further understanding of how such judgements are made could guide educators in providing credible information to learners. [ABSTRACT FROM AUTHOR]

Background: Despite acknowledgement that the Canadian Medical Educational Directives for Specialists (CanMEDS) framework covers the relevant competencies of physicians, many educators and medical professionals struggle to translate the CanMEDS roles into comprehensive training programmes for specific specialties., Aim: To gain insight into the applicability of the CanMEDS framework to guide the design of educational programmes for specific specialties by exploring stakeholders' perceptions of specialty specific competencies and examining differences between those competencies and the CanMEDS framework., Methods: This case study is a sequel to a study among ObsGyn specialists. It explores the perspectives of patients, midwives, nurses, general practitioners, and hospital boards on gynaecological competencies and compares these with the CanMEDS framework., Results: Clinical expertise, reflective practice, collaboration, a holistic view, and involvement in practice management were perceived to be important competencies for gynaecological practice. Although all the competencies were covered by the CanMEDS framework, there were some mismatches between stakeholders' perceptions of the importance of some competencies and their position in the framework., Conclusion: The CanMEDS framework appears to offer relevant building blocks for specialty specific postgraduate training, which should be combined with the results of an exploration of specialty specific competencies to arrive at a postgraduate curriculum that is in alignment with professional practice.