360 Rating Form 360 Evaluation Instrument 360 Assessment Tool by ezm24188

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									    360 Rating Form
360 Evaluation Instrument
  360 Assessment Tool
               Assessing
            professionalism:
                A Word of Caution
                in the First Steps!




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                 The elements are reliability
               and responsibility, honesty and
           integrity, maturity, respect for others,
           critique, altruism, interpersonal skills,
     and [absence of ] impairment (i.e., psychological/
                           chemical).




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                additional
   humanistic qualities; honor, integrity,
      ethical and moral standards;
             accountability;
     excellence; and duty/advocacy.




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                                 altruism
                    demands that the best interests
            of patients, not self-interest, guide physicians.
                           Honor and integrity
                entail the highest standards of behavior
                    and the refusal to violate one’s
                   personal and professional codes.
                     Duty is the free acceptance of
                         commitment to service.




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    Society expects physicians to act professionally.
                        In response
 to recent criticism regarding unprofessional behavior
                      in medicine,
  some argue that improving medical professionalism
   can only occur through changes in teaching and
                      .assessing it




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       There are at least three types of
     studies, however, that may point the
       way for future evaluation thrusts.




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                                  Some
              work evaluates professional behavior as
                    part of clinical performance.
                                  Other
            studies evaluate only professional behavior,
                    as a comprehensive entity in
                             and of itself.
                    Still other research evaluates
              single elements of professional behavior
                such as humanism, self-assessment,
                   dutifulness, altruism, empathy
              and compassion, honesty, integrity, and
            ethical behavior, as well as communication.




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   Although assessing professionalism poses many
    challenges,gauging and detecting changes in
professionalism is impossible without measurement.
           There was a review of techniques
  used to assess professionalism during the past 20
                       years.




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  The authors searched five electronic databases and
                    reference lists
                  from 1982 to 2002.
     Eighty-eight assessments were retained and
                     organized into :




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            content area:
1-ethics
2-personal
Characteristics
3- comprehensive professionalism
4- diversity


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Diversity pertained to assessments that addressed cultural
issues, socioeconomic status, gender, age or disability.
    Validity and reliability were examined for five of 10
                       instruments




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      Type of outcome examined:
1-affective
2- cognitive
3- behavioral
4-environmental




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                           personal        comprehensive
                ethics                                       diversity
                         Characteristics   professionalism




  cognitive




  affective




  behavioral




environmental




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                     Ethics

Forty-nine assessments addressed various aspects of
 ethics such as morality, ethical principles, honor
                   codes, social
 norms, deception, abuse or mistreatment, cheating,
                    disclosure,
               and sexual misconduct.




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            Personal characteristics
          The category labeled ‘personal characteristics’ included
        assessments that addressed attributes such as emotional
          intelligence, personal values, empathy, trustworthiness,
       cynicism and dogmatism. All of the personal characteristics
     instruments assessed affective outcomes. Validity and reliability
                    were examined for 13 of 15 (Table 1a).




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                          Humility
                          Honesty
   Balance between commitment at hospital and commitment at
                          home
                          Altruism
                      Respectfulness
                       Compassion
                         Sensitivity
                        Tactfulness
                             ….




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                              Tip 1
     Build a positive view of the importance of training in
                         professional
      attitudes with all those involved in the curriculum




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                               Tip 2
            Use examples of good practice from elsewhere




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                             Tip 3
  Ensure that professional development objectives are set
                        throughout
                   the training curriculum




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                               Tip 4
            Use learning methods that match the objectives




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                         Tip 5
            Tutors must be good role models




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                             Tip 6
    Create a learning culture that examines shortcomings
                           openly




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                          Tip 7
            Use peer influence systematically




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                             Tip 8
            Assess the learning objectives formally




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                            Tip 9
 Support the learner in vulnerability and strengthen coping




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                           Tip 10
        Reward good performance by students and staff




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                          Tip 11
            Secure necessary resources and skills




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                              Tip 12
            Use levers for change within the curriculum




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                          As the saying goes,
   ‘‘It is easier to kill a man than to change his ways’’. The
                               author
      hopes these tips may be useful to those who wish to
                 preserve life in all its fullness.




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          General
  recommendations for
        assessing
     professionalism

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            •Encourage formative and
                   Start early
            Summative assessment, often undertaken to classify learners,
             dominates medical education. Using assessment to improve
                learning is gaining credibility, however, with reports of
            formative assessments appearing more often in the literature.
             Some evidence suggests that focused teaching can improve
                 moral reasoning (Self et al., 1992; Goldie et al., 2002);
              more specifically, that feedback derived from assessment
               may improve professional behaviors (Phelan et al., 1993;
                  Papadakis et al., 2001). These findings suggest that
            professionalism should be formatively assessed. This means
              that assessment should begin early (Lowe et al., 2001) be
                 conducted frequently, be implemented long term, and
               provide learners with opportunities to change (Van Luijk
                                      et al., 2000).




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           The educational environment, whether through formal
        or informal curricula, appears to influence learner attitudes
       and behavior (Stern, 1996). One study discerned relationships
          between the ethical environment and medical students’
         ethical behavior (Feudtner et al., 1994). In another study,
         residents reported learning most about professionalism
            from observing role models (Brownell & Cote, 2001).




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    Research suggests that the business (Freeman et al., 1999)
          and cultural environment (Hoffmaster et al., 1991)
      influence professionalism among practicing physicians.
     Consequently, assessments that gauge professionalism in
   the environment may provide insight into the professionalism
                            of individuals.




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          Systematic assessment of professionalism should also
       include many different assessors, more than one assessment
       method and assessment in different settings (Littlefield et al.,
             1996; Van Luijk et al., 2000; Ginsburg et al., 2002).
         Research indicates that different assessors offer different
         perspectives, thus enhancing the breadth of assessment
         (Wooliscroft et al., 1994) and multiple assessors enhance
                        reliability (Swanson, 1987).
                       Each assessment method has
                        strengths and weaknesses.




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              Rating forms are considered
relatively easy to use, but are plagued with the ‘halo’ or
               ‘horns’ effect (Gray, 1996).




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            THE HALO EFFECT
   The halo effect results when a supervisor
              overrates employee by:
• Failing to see deteriorating performance
  because of a good past record or personal
  friendship.
• Rewarding those with similar beliefs or
  background as his or her own.
• Believing that, because performance is
  outstanding in one area, there are no
  problems in other areas.
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            THE HORNS EFFECT

   The horns effect results when a supervisor
         underrates employees who:
• Does not meet the impossible high standards
  the supervisor sets.
• Achieves results by different methods that
  the supervisor uses.
• Fails at one thing – and find that this one
  instance is influencing the supervisor’s
  future evaluations.
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           Using more than
  one assessment method may help to
         compensate for the
 weaknesses associated with any single
             approach.


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 Using more thanBecause professionalism is a
 complex construct, it is unlikely that a single
   assessment will adequately measure it.
Using a combination of assessments, however,
such as a moral reasoning assessment
together with a behavioral assessment,
may be adequate.




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               Different Settings
       Assessment in different settings can help to
        determine the generalizability of learners’
                    professionalism
      and identify context specific issues relevant to
                        learners.
       Suggestions for assessing medical students,
                residents, and practicing
              physicians Medical students.




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                         Assessment of medical
       student professionalism is often delayed until clerkship
      rotations. The Physicianship Evaluation Form (Papadakis
       et al., 2001), however, indicates that it is both desirable
      and possible to begin assessing student professionalism
                 during the first year of medical school.




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                  Initial use of this
   assessment is formative; students are invited to
                   present their
perspective and data are used to provide feedback and
                       guide
                     remediation.




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           Persistent patterns of unprofessional behavior,
      despite remediation, may provide grounds for dismissal.
    This performance-based, longitudinal approach helps to set
    professionalism expectations early, both for learners and for
     faculty who must commit to addressing and attempting to
              improve students’ professional behavior.




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Arnold suggested that assessments could be improved
                         by
   focusing on professionalism as a separate entity,
including rigorous qualitative approaches, exploring
                 the extent to which
      the environment supports assessment, and
                   determining the
usefulness of developmental expectations in assessing
                  professionalism.




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                       Ginsburg and colleagues (2000)
        examined existing assessments in terms of types of raters,
                   such as faculty supervisors and peers.
                              They reasoned that
       difficulties involved in assessing professionalism are due to
  the frequent use of abstract idealized definitions, the context specific
    nature of professionalism, and evaluator reluctance to address
                          relatively minor lapses.
                         The same authors proposed
       that professionalism assessments should address cognitive
                          and behavioral outcomes.




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                       For Students
                                Students should
       also be prepared to address ethical issues in clinical settings.
       Behavioral simulations, such as the Moral Behavior Analysis
          (Sheehan et al., 1987) and the Ethics OSCE (Singer et al.,
         1996), in which ethical dilemmas are role-played, are ideal
         for this purpose, especially if they include post-encounter
           oral or written assessments that probe reasoning used
           during encounters. To obtain reliable data, many cases
         would be required, thus, these simulations should be used
                        for formative assessment only.




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                   For Residents
         Residents typically rotate through many different
   settings and interact with a broad range of personnel. These
  characteristics of residency training may present challenges to
     coordinating comprehensive assessment and providing
   opportunities for the development of long-term relationships
               helpful to assessing professionalism.




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                  On the other hand,
  changing rotations provide the option of obtaining
                    input from
 various observers (e.g. nurses, patients, supervising
                    physicians
and peers), and assessing the extent to which resident
       professionalism varies across settings.




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                               To assess residents’
        knowledge of professionalism and to stimulate instructional
            discussion, the Barry’s Challenges to Professionalism
                Questionnaire may be used (Barry et al., 2000).
                              This self-administered
               questionnaire consists of vignettes that address
        conflict of interest, gifts and physician impairment. Research
         results indicated that the questionnaire was able to detect a
            broad range of knowledge about professionalism and
           discriminate among respondents depending on years of
                                    experience.




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            For Practicing physicians
  Assessments of ethics knowledge by surveys and of comprehensive
 professionalism by patient questionnaires were the most frequently
 used, and are probably the most feasible, approaches to assessing
              professionalism in practicing physicians.
         For instance, the Defining Issues Test, a written test in
     which ethical dilemmas are presented in vignettes, is capable
      of discriminating different levels of moral reasoning among
      practicing physicians (Baldwin & Bunch, 2000). The Barry’s
      Challenges to Professionalism Questionnaire would also be
               suitable for use with practicing physicians.




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Examples of patient questionnaires designed to assess
   practicing physician professionalism include the
                      Humanism
    Scale (Hauck et al., 1990) and the Wake Forest
                       Physician
 Trust Scale (Hall et al., 2002). Both have yielded valid
                           and
                      reliable data.




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     Patient questionnaires have advantages: they
   obtain information about physicians’ behaviors in
                        actual
practice, they seem to be acceptable to physicians, and
                         they
     may prompt changes in behaviors assessed.




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                  Summary
  At least 88 professionalism assessments have been
                        used
            in medical education since 1982.




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                  For Student
    Useful approaches to assessing medical student
  professionalism include a longitudinal, performance-
                       based
        method and behavioral simulations with
                    post-encounter
                        probes.




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               For Resident
 Useful approaches to assessing resident physician
professionalism include a 360-degree assessment and
     a cognitive assessment of professionalism.




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            For Practicing Physician

 Useful approaches to assessing practicing physician
 professionalism include patient questionnaires and a
      cognitive assessment of professionalism.




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   No single method exists for
     the reliable and valid
   evaluation of professional
           behavior.



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                      more studies
on the predictive validity of assessments and their use
                      as part of
   formative evaluation systems are recommended




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        Instead of creating new
           professionalism
        assessments,existing
       assessments should be
              improved.

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            A Word of Caution!

        The new
professionalism needs
   to be tackled at a
   number of levels.

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Teaching :unprofessionalism(by role
             model)
                 +
      Assessment:assessing
         professionalism
                 =
  Absolute unprofessionalistic act



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                            Shell
                          (surface)



              Core
             (depth)




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                            Shell
                          (surface)



              Core
             (depth)




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                            Shell
                          (surface)




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                          0 degree

                          360
                          degree




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            ‫باسپاس‬
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