title: Examining the barriers to meaningful assessment and feedback in medical training.
abstract: BACKGROUND
  Recent reports from both accreditation bodies in North America highlight problems with current assessment practices in postgraduate medical training. Previous work has shown that educators might be reluctant to report poor performance or fail underperforming trainees. This study explores the barriers perceived by medical educators to providing more meaningful assessment and feedback to trainees.
  
  
  METHODS
  Semistructured interviews were conducted with 22 physician educators. Interviews were audiotaped and transcribed verbatim. Three researchers analyzed the transcripts using a grounded theory approach.
  
  
  RESULTS
  Participants expressed a reluctance to provide poor assessments or feedback to trainees. Fifty-five percent of the participants reported passing trainees who could have benefited from additional training. Our data revealed a number of barriers which may account for these findings. Implementing more frequent formative assessments could help educators more effectively evaluate trainees and provide feedback, although a shift in the culture of medicine may be required.
  
  
  CONCLUSIONS
  It is imperative that the barriers to effective assessment and feedback identified in this study be addressed to improve postgraduate medical training and enhance patient care.
authors.affiliation: Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada; Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
authors.forename: Sydney A
authors.initials: SA
authors.lastname: McQueen
authors.affiliation: Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
authors.forename: Bradley
authors.initials: B
authors.lastname: Petrisor
authors.affiliation: Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
authors.affiliation: Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Fahim
authors.affiliation: Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
authors.forename: Victoria
authors.initials: V
authors.lastname: McKinnon
authors.affiliation: Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada; Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada. Electronic address: ranil@skillslab.ca.
authors.forename: Ranil R
authors.initials: RR
authors.lastname: Sonnadara
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002170:Canada; D002983:Clinical Competence; D004501:Education, Medical; D005260:Female; D000068156:Formative Feedback; D013502:General Surgery / Q000193:education*; D066296:Grounded Theory; D006801:Humans; D007400:Interprofessional Relations; D008297:Male
keywords: Assessment; Feedback; Postgraduate medical education; Residency; Surgical education