2018-2019 – Andrea Gingerich | Medical Council of Canada
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2018-2019 – Andrea Gingerich

Incompetence described: Documenting two-dimensional assessment judgments


Andrea Gingerich, ND, MMEd, PhD


Sebok-Syer, S.
Watling, C.
Lingard, L.


Competency-based medical education demands reliable workplace-based assessments that differentiate competent trainees and performances from incompetent trainees and performances. This distinction requires an assessment design that supports assessors as they document when trainees have demonstrated competence and when they have not. Furthermore, assessors are reluctant to document judgments of incompetence using current rating scales. Research, focused on differentiating competence from incompetence, shows that anything other than ‘competent’ is ill-defined. Therefore, we lack a clear understanding of how assessors conceptualize incompetence in the workplace. An inability to identify incompetence threatens the reliability and validity of measuring critical and emerging competencies through competency-based assessment in the clinical workplace. In contrast, recognizing incompetence in others is a primary function of social judgments. The social judgment literature asserts that we judge people based on the benevolence of their intentions (i.e., “warm” for good intentions that benefit others and “cold” for selfish or harmful intentions) and on their ability to carry out those intentions (i.e., competence or incompetence). Our recent proof of concept study found that assessors could categorize a resident using social judgment categorizations of ‘warm and competent’, ‘cold and competent’, ‘warm and incompetent’ or ‘cold and incompetent’ and that categorization predicted ratings made on 5 Mini-CEX subscales (R2: 53-61%). A set of categorical descriptors based on two dimensional judgments could provide a concise format for documenting judgments of competence more frequently, However, terms like “incompetent” have pejorative connotations in an assessment context and assessors are reluctant to label their trainees as such. Therefore, we aim to develop an understanding of how clinical assessors conceptualize incompetence in the workplace by attending to the social processes around describing incompetence. We will examine assessors’ conceptualizations of incompetence for categorical descriptors that could improve communication during clinical workplace learning and facilitate documentation of assessment judgments.