title: In-training assessment: qualitative study of effects on supervision and feedback in an undergraduate clinical rotation.
abstract: BACKGROUND
  Supervision and feedback are essential factors that contribute to the learning environment in the context of workplace learning and their frequency and quality can be improved. Assessment is a powerful tool with which to influence students' learning and supervisors' teaching and thus the learning environment.
  
  
  OBJECTIVE
  To investigate an in-training assessment (ITA) programme in action and to explore its effects on supervision and feedback.
  
  
  METHODS
  A qualitative study using individual, semistructured interviews.
  
  
  METHODS
  Eight students and 17 assessors (9 members of staff and 8 residents) in the internal medicine undergraduate clerkship at Vrije Universiteit Medical Centre, Amsterdam, the Netherlands.
  
  
  RESULTS
  The ITA programme in action differed from the intended programme. Assessors provided hardly any follow-up on supervision and feedback given during assessments. Although students wanted more supervision and feedback, they rarely asked for it. Students and assessors failed to integrate the whole range of competencies included in the ITA programme into their respective learning and supervision and feedback. When giving feedback, assessors rarely gave borderline or fail judgements.
  
  
  CONCLUSIONS
  If an ITA programme in action is to be congruent with the intended programme, the implementation of the programme must be monitored. It is also necessary to provide full information about the programme and to ensure this information is given repeatedly. Introducing an ITA programme that includes the assessment of several competencies does not automatically lead to more attention being paid to these competencies in terms of supervision and feedback. Measures that facilitate change in the learning environment seem to be a prerequisite for enabling the assessment programme to steer the learning environment.
authors.affiliation: Skills Training Department, Vrije Universiteit Medical Centre, 5th Floor, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. hem.daelmans@vumc.nl
authors.forename: H E M
authors.initials: HE
authors.lastname: Daelmans
authors.forename: R M
authors.initials: RM
authors.lastname: Overmeer
authors.forename: H H
authors.initials: HH
authors.lastname: van der Hem-Stokroos
authors.forename: A J J A
authors.initials: AJ
authors.lastname: Scherpbier
authors.forename: C D A
authors.initials: CD
authors.lastname: Stehouwer
authors.forename: C P M
authors.initials: CP
authors.lastname: van der Vleuten
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D015510:Clinical Medicine / Q000592:standards*; D004503:Education, Medical, Graduate / Q000379:methods*; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005246:Feedback; D009426:Netherlands; D010559:Personnel Management