The McMaster Modular Assessment Program (McMAP): A Theoretically Grounded Work-Based Assessment System for an Emergency Medicine Residency Program.

PROBLEM To assess resident competence, generalist programs such as emergency medicine (EM), which cover a broad content and skills base, require a substantial number of work-based assessments (WBAs) that integrate qualitative and quantitative data. APPROACH The McMaster Modular Assessment Program (McMAP), implemented in McMaster University's Royal College EM residency program in 2011-2012, is a programmatic assessment system that collects and aggregates data from 42 WBA instruments aligned with EM tasks and mapped to the CanMEDS competency framework. These instruments incorporate task-specific checklists, behaviorally anchored task-specific and global performance ratings, and written comments. They are completed by faculty following direct observation of residents during shifts. The rotation preceptor uses aggregated data to complete an end-of-rotation report for each resident in the form of a qualitative global assessment of performance. OUTCOMES The quality of end-of-rotation reports-as measured by comparing report quality one year prior to and one year after McMAP implementation using the Completed Clinical Evaluation Report Rating tool-has improved significantly (P < .001). This may be a result of basing McMAP's end-of-rotation reports on robust documentation of performance by multiple raters throughout a rotation rather than relying on a single faculty member's recall at rotation's end as in the previous system. NEXT STEPS By aligning theory-based assessment instruments with authentic EM work-based tasks, McMAP has changed the residency program's culture to normalize daily feedback. Next steps include determining how to handle "big data" in assessment and delineating policies for promotion decisions.