Abstract
Competency-based assessment is undergoing an evolution with the popularisation of programmatic assessment. Fundamental to programmatic assessment are the attributes and buy-in of the people participating in the system. Our previous research revealed unspoken, yet influential, cultural and relationship dynamics that interact with programmatic assessment to influence success. Pulling at this thread, we conducted secondary analysis of focus groups and interviews (n = 44 supervisors) using the critical lens of Positioning Theory to explore how workplace supervisors experienced and perceived their positioning within programmatic assessment. We found that supervisors positioned themselves in two of three ways. First, supervisors universally positioned themselves as a Teacher, describing an inherent duty to educate students. Enactment of this position was dichotomous, with some supervisors ascribing a passive and disempowered position onto students while others empowered students by cultivating an egalitarian teaching relationship. Second, two mutually exclusive positions were described—either Gatekeeper or Team Member. Supervisors positioning themselves as Gatekeepers had a duty to protect the community and were vigilant to the detection of inadequate student performance. Programmatic assessment challenged this positioning by reorientating supervisor rights and duties which diminished their perceived authority and led to frustration and resistance. In contrast, Team Members enacted a right to make a valuable contribution to programmatic assessment and felt liberated from the burden of assessment, enabling them to assent power shifts towards students and the university. Identifying supervisor positions revealed how programmatic assessment challenged traditional structures and ideologies, impeding success, and provides insights into supporting supervisors in programmatic assessment.
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References
Andreassen, P., & Christensen, M. K. (2018). We’re at a watershed: The positioning of PhD nurses in clinical practice. Journal of Advanced Nursing, 74(8), 1908–1918. https://doi.org/10.1111/jan.13581
Aronowitz, R., Deener, A., Keene, D., Schnittker, J., & Tach, L. (2015). Cultural reflexivity in health research and practice. American Journal of Public Health, 105(S3), S403–S408. https://doi.org/10.2105/AJPH.2015.302551
Barbour, R. S., & Flick, U. (2018). Doing focus groups. Sage.
Bearman, M., Mahoney, P., Tai, J., Castanelli, D., & Watling, C. (2021). Invoking culture in medical education research: A critical review and metaphor analysis. Medical Education, 55(8), 903–911. https://doi.org/10.1111/medu.14464
Berger, R. (2015). Now I see it, now I don’t: Researcher’s position and reflexivity in qualitative research. Qualitative Research, 15(2), 219–234. https://doi.org/10.1177/1468794112468475
Bok, H. G., de Jong, L. H., O’Neill, T., Maxey, C., & Hecker, K. G. (2018). Validity evidence for programmatic assessment in competency-based education. Perspectives on Medical Education, 7(6), 362–372. Retrieved.
Bok, H. G., Teunissen, P. W., Favier, R. P., Rietbroek, N. J., Theyse, L. F. H., et al. (2013). Programmatic assessment of competency-based workplace learning: when theory meets practice. BMC Medical Education, 13(1), 123–134. https://doi.org/10.1186/1472-6920-13-123
Bourgeois-Law, G., Regehr, G., Teunissen, P. W., & Varpio, L. (2020). Educator, judge, public defender: Conflicting roles for remediators of practising physicians. Medical Education, 54(12), 1171–1179. https://doi.org/10.1111/medu.14285
Cantillon, P., D’Eath, M., De Grave, W., & Dornan, T. (2016). How do clinicians become teachers? A communities of practice perspective. Advances in Health Sciences Education: Theory and Practice, 21(5), 991–1008. https://doi.org/10.1007/s10459-016-9674-9
Cantillon, P., Dornan, T., & De Grave, W. (2019). Becoming a clinical teacher: Identity formation in context. Academic Medicine, 94(10), 1610–1618. https://doi.org/10.1097/ACM.0000000000002403
Castanelli, D. J., Weller, J. M., Molloy, E., & Bearman, M. (2022). Trust, power and learning in workplace-based assessment: The trainee perspective. Medical Education, 56(3), 280–291. https://doi.org/10.1111/medu.14631
Christensen, M. K., Henriksen, J., Thomsen, K. R., Lund, O., & Mørcke, A. M. (2017). Positioning health professional identity: On-campus training and work-based learning. Higher Education, Skills and Work-Based Learning, 7(3), 275–289. https://doi.org/10.1108/HESWBL-01-2017-0004
Clarke, D., & Molloy, E. (2005). The positioning of physiotherapy students and clinical supervisors in feedback sessions. Focus on Health Professional Eeducation, 7(1), 79–90. https://doi.org/10.3316/informit.055985799653922
Dart, J., Twohig, C., Anderson, A., Bryce, A., Collins, J., et al. (2021). The value of programmatic assessment in supporting educators and students to succeed: A qualitative evaluation. Journal of the Academy of Nutrition and Dietetics. https://doi.org/10.1016/j.jand.2021.01.013
Davies, B., & Harré, R. O. M. (1990). Positioning: The discursive production of selves. Journal for the Theory of Social Behaviour, 20(1), 43–63. https://doi.org/10.1111/j.1468-5914.1990.tb00174.x
de Jonge, L. P. J. W. M., Timmerman, A. A., Govaerts, M. J. B., Muris, J. W. M., Muijtjens, A. M. M., et al. (2017). Stakeholder perspectives on workplace-based performance assessment: Towards a better understanding of assessor behaviour. Advances in Health Sciences Education, 22(5), 1213–1243. https://doi.org/10.1007/s10459-017-9760-7
Dennen, V. P. (2011). Facilitator presence and identity in online discourse: Use of positioning theory as an analytic framework. Instructional Science, 39(4), 527–541. https://doi.org/10.1007/s11251-010-9139-0
Gale, K. N., Heath, G., Cameron, E., Rashid, S., & Redwood, S. (2013). Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology, 13(1), 117–124. https://doi.org/10.1186/1471-2288-13-117
Govaerts, M. J. B., van der Vleuten, C. P. M., & Holmboe, E. S. (2019). Managing tensions in assessment: Moving beyond either-or thinking. Medical Education, 53(1), 64–75. https://doi.org/10.1111/medu.13656
Govaerts, M. J. B., van der Vleuten, C. P. M., Schuwirth, L. W. T., & Muijtjens, A. M. M. (2007). Broadening perspectives on clinical performance assessment: Rethinking the nature of in-training assessment. Advances in Health Sciences Education: Theory and Practice, 12(2), 239–260. https://doi.org/10.1007/s10459-006-9043-1
Green, J., Brock, C., Baker, D., & Harris, P. (2020). Positioning theory and discourse analysis. In N. Na’ilah Suad, C. D. Lee, R. Pea, & M. M. K. de Royston (Eds.), Handbook of the cultural foundations of learning. Routledge.
Harré, R. (2012). Positioning theory: Moral dimensions of socio-cultural psychology. In J. Valsiner (Ed.), The Oxford handbook of culture and psychology. Oxford Unversity Press.
Harré, R., & Moghaddam, F. (2003). The self and others: Positioning individuals and groups in personal, political, and cultural contexts. Praeger Publishers.
Harré, R., & Moghaddam, F. M. (2013). The psychology of friendship and enmity: Relationships in love, work, politics, and war. Westport: ABC-CLIO, LLC.
Harré, R., Moghaddam, F. M., Cairnie, T. P., Rothbart, D., & Sabat, S. R. (2009). Recent advances in positioning theory. Theory and Psychology, 19(1), 5–31. https://doi.org/10.1177/0959354308101417
Hattie, J. (2009). Visible learning: A synthesis of over 800 meta-analyses relating to achievement. Routledge.
Health Workforce Australia (2014) Australia's health workforce series—Dietitians in focus. Retrived November 9, 2022, from https://www.myhealthcareer.com.au/wp-content/uploads/2019/03/2014-Dietitians-in-Focus.pdf
Heeneman, S., de Jong, L. H., Dawson, L. J., Wilkinson, T. J., Ryan, A., et al. (2021). Ottawa 2020 consensus statement for programmatic assessment—1. Agreement on the Principles. Medical Teacher, 43(10), 1139–1148. https://doi.org/10.1080/0142159X.2021.1957088
Hodges, B. (2013). Assessment in the post-psychometric era: Learning to love the subjective and collective. Medical Teacher, 35(7), 564. https://doi.org/10.3109/0142159X.2013.789134
Hu, W. C. Y., Woodward-Kron, R., & Flynn, E. (2019). Educator as diagnostician, judge and confidant: A positioning analysis of medical student support encounters. Advances in Health Sciences Education, 24(4), 707–724. https://doi.org/10.1007/s10459-019-09892-7
Jamieson, J., Hay, M., Gibson, S., & Palermo, C. (2021). Implementing programmatic assessment transforms supervisor attitudes: An explanatory sequential mixed methods study. Medical Teacher, 43(6), 709–717. https://doi.org/10.1080/0142159X.2021.1893678
Janss, R., Rispens, S., Segers, M., & Jehn, K. A. (2012). What is happening under the surface? Power, conflict and the performance of medical teams. Medical Education, 46(9), 838–849. https://doi.org/10.1111/j.1365-2923.2012.04322.x
Konopasek, L., Norcini, J., & Krupat, E. (2016). Focusing on the formative: Building an assessment system aimed at student growth and development. Academic Medicine, 91(11), 1492–1497. https://doi.org/10.1097/ACM.0000000000001171
Loo, D. B., Trakulkasemsuk, W., & Jimarkon Zilli, P. (2019). Examining power through social relations in teachers’ discourse about intercultural education. Intercultural Education (London, England), 30(4), 398–414. https://doi.org/10.1080/14675986.2018.1540110
McVee, M., Silvestri, K. N., Barret, N., & Haq, K. S. (2018). Positioning Theory. In D. E. Alvermann, N. Unrau, & R. B. Ruddell (Eds.), Theoretical models and processes of reading. International Reading Association.
Meeuwissen, S. N. E., Stalmeijer, R. E. E., & Govaerts, M. (2019). Multiple-role mentoring: Mentors’ conceptualisations, enactments and role conflicts. Medical Education, 53(6), 605–615. https://doi.org/10.1111/medu.13811
Møller, J. E., & Malling, B. V. (2019). Workplace-based communication skills training in clinical departments: Examining the role of collegial relations through positioning theory. Medical Teacher, 41(3), 309–317. https://doi.org/10.1080/0142159X.2018.1464647
Monrouxe, L. V. (2010). Identity, identification and medical education: Why should we care? Medical Education, 44(1), 40–49. https://doi.org/10.1111/j.1365-2923.2009.03440.x
O’Connor, A., Cantillon, P., Parker, M., & McCurtin, A. (2019). Juggling roles and generating solutions: Practice-based educators’ perceptions of performance-based assessment of physiotherapy students. Physiotherapy, 105(4), 446–452. https://doi.org/10.1016/j.physio.2018.11.008
O’Connor, A., McCurtin, A., Cantillon, P., & McGarr, O. (2018). Illusions of specificity in power-laden clinical performance assessment. Medical Teacher, 40(3), 313–314. https://doi.org/10.1080/0142159X.2017.1340637
Palermo, C., Gibson, S. J., Dart, J., Whelan, K., & Hay, M. (2017). Programmatic assessment of competence in dietetics: A new frontier. Journal of the Academy of Nutrition and Dietetics, 117(2), 175–179. https://doi.org/10.1016/j.jand.2016.03.022
Pearce, J., & Tavares, W. (2021). A philosophical history of programmatic assessment: Tracing shifting configurations. Advances in Health Sciences Education: Theory and Practice, 26(4), 1291–1310. https://doi.org/10.1007/s10459-021-10050-1
Peterson, M. W., & Spencer, M. G. (1990). Understanding academic culture and climate. New Directions for Institutional Research, 17(4), 3–18. https://doi.org/10.1002/ir.37019906803
Rees, C. E., Crampton, P. E. S., & Monrouxe, L. V. (2020a). Re-visioning academic medicine through a constructionist Lens. Academic Medicine, 95(6), 846–850. https://doi.org/10.1097/ACM.0000000000003109
Rees, C. E., Davis, C., King, O. A., Clemans, A., Crampton, P. E. S., et al. (2020b). Power and resistance in feedback during work-integrated learning: Contesting traditional student-supervisor asymmetries. Assessment and Evaluation in Higher Education, 45(8), 1136–1154. https://doi.org/10.1080/02602938.2019.1704682
Roberts, C., Khanna, P., Lane, A. S., Reimann, P., & Schuwirth, L. (2021). Exploring complexities in the reform of assessment practice: A critical realist perspective. Advances in Health Sciences Education: Theory and Practice, 26(5), 1641–1657. https://doi.org/10.1007/s10459-021-10065-8
Sargeant, S., McLean, M., Green, P., & Johnson, P. (2016). Applying positioning theory to examine interactions between simulated patients and medical students: A narrative analysis. Advances in Health Sciences Education: Theory and Practice, 22(1), 187–196. https://doi.org/10.1007/s10459-016-9691-8
Schoenherr, J. R., & Hamstra, S. J. (2015). Psychometrics and its discontents: An historical perspective on the discourse of the measurement tradition. Advances in Health Sciences Education: Theory and Practice, 21(3), 719–729. https://doi.org/10.1007/s10459-015-9623-z
Schut, S., Maggio, L. A., & Driessen, E. (2021). Where the rubber meets the road: An integrative review of programmatic assessment in health care professions education. Perspectives on Medical Education, 10(1), 6–13. https://doi.org/10.1007/s40037-020-00625-w
Sheehan, D., & Wilkinson, T. J. (2022). Widening how we see the impact of culture on learning, practice and identity development in clinical environments. Medical Education, 56(1), 110–116. https://doi.org/10.1111/medu.14630
Soedirgo, J., & Glas, A. (2020). Toward active reflexivity: Positionality and practice in the production of knowledge. Political Science and Politics, 53(3), 527–531. https://doi.org/10.1017/S1049096519002233
Stenfors-Hayes, T., Hult, H., & Dahlgren, L. O. (2010). What does it mean to be a good teacher and clinical supervisor in medical education? Advances in Health Sciences Education: Theory and Practice, 16(2), 197–210. https://doi.org/10.1007/s10459-010-9255-2
Tavares, W., Hodwitz, K., Rowland, P., Ng, S., Kuper, A., et al. (2021). Implicit and inferred: On the philosophical positions informing assessment science. Advances in Health Sciences Education: Theory and Practice, 26(5), 1597–1623. https://doi.org/10.1007/s10459-021-10063-w
Telio, S., Ajjawi, R., & Regehr, G. (2015). The “Educational Alliance” as a framework for reconceptualizing feedback in medical education. Academic Medicine, 90(5), 609–614. https://doi.org/10.1097/ACM.0000000000000560
Telio, S., Regehr, G., & Ajjawi, R. (2016). Feedback and the educational alliance: Examining credibility judgements and their consequences. Medical Education, 50(9), 933–942. https://doi.org/10.1111/medu.13063
Torre, D., Rice, N. E., Ryan, A., Bok, H., Dawson, L. J., et al. (2021). Ottawa 2020 consensus statements for programmatic assessment—2. Implementation and practice. Medical Teacher, 43(10), 1149–1160. https://doi.org/10.1080/0142159X.2021.1956681
Torre, D., Schuwirth, L. W. T., & van der Vleuten, C. P. M. (2020). Theoretical considerations on programmatic assessment. Medical Teacher, 42(2), 213–220. https://doi.org/10.1080/0142159X.2019.1672863
Torre, D., Schuwirth, L., van der Vleuten, C., & Heeneman, S. (2022). An international study on the implementation of programmatic assessment: Understanding challenges and exploring solutions. Medical Teacher. https://doi.org/10.1080/0142159X.2022.2083487
van der Vleuten, C. P. M., Schuwirth, L. W. T., Driessen, E. W., Dijkstra, J., Tigelaar, D., et al. (2012). A model for programmatic assessment fit for purpose. Medical Teacher, 34(3), 205–214. https://doi.org/10.3109/0142159X.2012.652239
van der Vleuten, C. P. M., Schuwirth, L. W. T., Driessen, E. W., Govaerts, M. J. B., & Heeneman, S. (2015). Twelve tips for programmatic assessment. Medical Teacher, 37(7), 641. https://doi.org/10.3109/0142159X.2014.973388
Varpio, L., Paradis, E., Uijtdehaage, S., & Young, M. (2020). The distinctions between theory, theoretical framework, and conceptual framework. Academic Medicine, 95(7), 989–994. https://doi.org/10.1097/ACM.0000000000003075
Varprio, L., Aschenbrener, C., & Bates, J. (2017). Tackling wicked problems: How theories of agency can provide new insights. Medical Education, 51(4), 353–365. https://doi.org/10.1111/medu.13160
Watling, C. J., Ajjawi, R., & Bearman, M. (2020). Approaching culture in medical education: Three perspectives. Medical Education, 54(4), 289–295. https://doi.org/10.1111/medu.14037
Watling, C. J., & Ginsburg, S. (2019). Assessment, feedback and the alchemy of learning. Medical Education, 53(1), 76–85. https://doi.org/10.1111/medu.13645
Williams, L. H., Christensen, M. K., Rytter, C., & Musaeus, P. (2015). Clinical positioning space: Residents’ clinical experiences in the outpatient oncology clinic. Qualitative Health Research, 25(9), 1260–1270. https://doi.org/10.1177/1049732314553596
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We would like to acknowledge Sue Kleve and Amanda Anderson who conducted interviews with supervisors affiliated with University.
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by JJ and CP. The first draft of the manuscript was written by JJ, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Jamieson, J., Gibson, S., Hay, M. et al. Teacher, Gatekeeper, or Team Member: supervisor positioning in programmatic assessment. Adv in Health Sci Educ 28, 827–845 (2023). https://doi.org/10.1007/s10459-022-10193-9
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DOI: https://doi.org/10.1007/s10459-022-10193-9