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26-03-2019 | Original Article | Uitgave 2/2019 Open Access

Perspectives on Medical Education 2/2019

Identifying the narrative used by educators in articulating judgement of performance

Perspectives on Medical Education > Uitgave 2/2019
Nyoli Valentine, Lambert Schuwirth



Modern assessment in medical education is increasingly reliant on human judgement, as it is clear that quantitative scales have limitations in fully assessing registrars’ development of competence and providing them with meaningful feedback to assist learning. For this, possession of an expert vocabulary is essential.


This study aims to explore how medical education experts voice their subjective judgements about learners and to what extent they are using clear, information-rich terminology (high-level semantic qualifiers); and to gain a better understanding of the experts’ language used in these subjective judgements.


Six experienced medical educators from urban and rural environments were purposefully selected. Each educator reviewed a registrar clinical case analysis in a think out loud manner. The transcribed data were analyzed, codes were identified and ordered into themes. Analysis continued until saturation was reached.


Five themes with subthemes emerged. The main themes were: (1) Demonstration of expertise; (2) Personal credibility; (3) Professional credibility; (4) Using a predefined structure and (5) Relevance.


Analogous to what experienced clinicians do in clinical reasoning, experienced medical educators verbalize their judgements using high-level semantic qualifiers. In this study, we were able to unpack these. Although there may be individual variability in the exact words used, clear themes emerged. These findings can be used to develop a helpful shared narrative for educators in observation-based assessment. The provision of a rich, detailed narrative will also assist in providing clarity to registrar feedback with areas of weakness clearly articulated to improve learning and remediation.
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