Goal Oriented Learner Driven-Entrustment (Gold-e) assessment tool.

By: Laura Molgaard (https://www.linkedin.com/in/laura-molgaard-75590210) and Erin Burton (https://www.linkedin.com/in/erin-burton-4a51a8a0/)

In a previous blog post, I wrote about the use of EPAs in veterinary medical education and the development of the Goal Oriented Learner Driven-Entrustment (GOLD-E) assessment tool. GOLD-E, a pilot project at the University of Minnesota College of Veterinary Medicine, is intended as a tool to facilitate and increase the frequency and quality of feedback our learners receive as part of workplace-based training and assessment. GOLD-E was designed with low-stakes formative assessment in mind. Our intent with implementing GOLD-E, was to enable a larger cultural change that supports coaching feedback and the development of a growth mindset and to eventually replace our ITER.

Initially, we trained a small group of clinical faculty, residents, interns and nursing staff to use a short entrustment form to capture ad hoc entrustment decisions. The training was held in-person and was approximately one-hour long. During the training, we provided a brief overview of:

  • The Competency-based Veterinary Education (CBVE) Competency Framework and Core EPAs,
  • The relevance of coaching feedback and its relationship to the development of a growth mindset, and
  • and, the entrustment scale.

We also included numerous opportunities for practice using recorded videotaped interactions of students interacting with pet owners and patients on routine primary care cases. During this practice time, participants worked on developing their coaching skills. Specifically they practiced providing coaching feedback that focused on improvement and growth by using the prompts Keep doing…and Next time try….. The training helped coaches to realize that their comments concerning any observed behaviors needed to be helpful, specific, and behaviorally actionable.

We gathered quantitative and qualitative data during and after the pilot period. During the pilot project we surveyed both coaches and learners to better understand how they integrated the entrustment form. Coaches and students were sent bi-weekly surveys to collect their feedback. Surveys were anonymous, incorporated Likert scale questions, and focused on understanding perceptions concerning feasibility (How much time did it take? How difficult was it? What type of observations? What was the perceived quality of their feedback? Who initiated it?).

We also gathered qualitative data by hosting focus groups at the end of the pilot period. Focus groups were held (independently) for both coaches and learners.

Given the extreme time pressure in a busy tertiary care teaching hospital, the GOLD-E pilot was a success, as coaches and learners reported that use of GOLD-E increased the quantity and quality of feedback and was quick and took less than 5 minutes to complete. Of course, there is room for improvement. Some of these revisions are already underway and significantly improve the GOLD-E tool user experience. These changes include, making it easier to use with single sign on technology, changing the entrustment scale slightly to emphasize the types of clinical observations that are being coached (e.g., direct versus indirect), and changing the prompts in the free response boxes to describe specific behaviors the learner should keep doing or next time try. Challenges remain. Learner training and learner comfort with asking for feedback is one area that seems ripe for improvement. These larger cultural and systems challenges will take more time.

About the authors:
Laura Molgaard, DVM is the Dean of the College of Veterinary Medicine at the University of Minnesota and a member of the Association of American Veterinary Medical Colleges (AAVMC) Competency-Based Veterinary Education Working Group. In 2018, the AAVMC published a groundbreaking framework and Entrustable Professional Activities that provide a modern, shared, core educational and assessment structure for veterinary graduates around the globe.

Erin Burton, DVM, MS, DACVP is an Associate Professor, Department of Veterinary and Biomedical Sciences at the University of Minnesota who is dedicated to enhancing the professional veterinary student experience by using innovative technology teaching tools to enhance student participation, feedback, and assessments.

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