Evaluation
Completing evaluations is part of Talking about performance, the third “T’ in the “3T Teaching blueprint” (shown below).
“Talking about performance” is made up of two parts, feedback and evaluation. Feedback and evaluation are separated because they are different entities and they serve different purposes. This section focuses on Evaluation. Click here to learn about Feedback.
What are Evaluations?
Evaluations are an in-depth formal review of learner performance. Evaluations should always be written (never verbal). Evaluations are reported to the residency programs (for residents) and medical schools (for students). Evaluations are the residency program’s and medical school’s only means of tracking learner performance. They are used to spot patterns of strength and weakness and provide the basis for remediation plans. Evaluations should always be done on New Innovations. Click hear to go to New Innovations.
Why are Evaluations important?
Good evaluations help you, helps them (residents & students) and helps us (GME).
Evaluation helps You
Correctly doing feedback & evaluation is important to YOU for several reasons.
1.It builds attending-learner rapport.
2.It increases resident “buy in”. When residents “buy in” they more often give you 110% effort. This is because it lets them know that you truly care about their wellbeing and growth.
3.It increases resident attention to detail when taking care of your patients.
Improving attending-resident rapport and increasing resident “buy in” helps the resident become productive members of your health care team and increases delivery of great patient care.
Evaluation helps Them
Feedback and Evaluation helps residents and students in the following ways
Feedback and evaluation are the primary means in which a resident can gauge how he/she is progressing.
“A resident DOES NOT know if he/she is underperforming/over performing if YOU do not tell them”.
If the resident does not know what to continue doing, what to stop doing and what to start doing, he/she cannot grow.
It is for this reason evaluations are critically important and are a requirement for faculty appointment.
It is also why the “lack of giving feedback” is one of the most common resident complaints about attendings.
Evaluation helps Us
Feedback & Evaluations help us is several ways
Evaluations allow residency programs to track and monitor resident’s progress. In fact, it is the only way for residency leaders to know how their residents are doing.
The residency programs need and depend on this information.
The information gained from evaluations is used by residency leadership to correct resident deficiencies and reinforce good performance.
This creates better residents which equals better care for your patient’s.
Evaluation. How?
To complete evaluations go to new innovations. Log in. Complete evaluation.
The numbers
Remember, milestone level 4 is appropriate for senior residents/junior attending (generally at end of final training year) and level 5 is generally a senior attending (examples are “writes national guidelines” or “maintains specialty board certification”).
IMPORTANT: If you really feel that the resident is performing at a level 4 or 5, you should provide ample detailed documentation as to the reasons why.
Note: The TY’s are allowed to reach level 5 by the end of the year. An evaluation should not have the same number score for every milestone (an example being…all level 3 scores). It would be very rare for a resident to be at the same level of performance for every milestone. These types of evaluations are generally not accurate and provide little to resident growth.
The comments
By far the most powerful, helpful, effective and accurate component of evaluations are the comments made by the attending. The comments should be your FOCUS when evaluating a resident.
Comments must be done correctly in order to get most benefit. Vague comments such as “read more” or “expand your differential” or “resident needs to be more efficient” are not very helpful. The best comments are those that describe the specific event/situation with details and your reasoning.
If you are providing constructive comments (i.e. negative feedback), the comments should also include an idea of how to address an issue. When comments are done in this manner, they tell the resident specifically WHAT they did well/did not do well. WHY they did it well/did not do it well and in the case of negative comments, HOW to work on the problem.
Here is an example of great comments “Dr. X needs to read up on aortic dissection and pulmonary embolism. Dr. X seemed to have trouble differentiating these two conditions. Dr. X should focus on how each condition presents and how to differentiate the two conditions because the treatment for a PE can be lethal if given to a patient with an aortic dissection, so making the correct diagnosis is critical”.
When making comments, at a minimum, you need to include specifically WHAT they did well/did not do well and WHY they did it well/did not do it well. This should refer to a specific event/instance.
Consistency
Finally, when making comments they should be consistent with any numerical score/value that you mark on the evaluation.
High numerical scores combined with negative comments or vice versa, only cause confusion for the resident and for the residency leadership.
Below compares and contrasts the two components of Talking about performance, feedback & evaluation.
Evaluation vs Feedback
Talking about performance focuses on providing feedback and evaluation. Feedback and evaluation are similar but different entities.
Formality:
- Feedback is an informal discussion between the attending and the learner (medical student, PA student or resident).
- Evaluations are formal reviews of resident/Student performance. Evaluations are always done on new innovations. Click here to log in to new innovations.
Mode
- Feedback is usually done via verbal discussion between attending and learner.
- However feedback can be done by means of written communication or a combination of written/verbal communication. Evaluations should always be written (never verbal).
Frequency
- Feedback is done at a higher frequency as compared with evaluations.
- Feedback is often provided during a shift or work day (often after patient encounters) and at the end of a shift or work day. Feedback is often given multiple times during day.
- Evaluations are usually only done at completion of the attending-learner encounter. This changes depending on the rotation. On emergency medicine, evaluations should be completed after each shift. On other rotations, they may be completed weekly or at end of rotation.
Awareness
- Feedback is generally kept between the attending and the learner (it is not tracked by GME or medical schools).
- Evaluations are tracked by the learners educational program (i.e GME residency program, medical school, PA school).
Evaluation Myths
“I can’t make an accurate assessment”
This is a commonly held attending misbelief. The truth is, most attendings CAN provide accurate/quality resident evaluations.
- In fact, the resident’s attending has the most situational awareness about the resident’s performance on shift. So the attending’s evaluation is actually the best source of information for the residency program.
- Best Practice Strategy: Attendings can use a simple method to ensure that their evaluation is accurate and of quality. The method is as follows: first, use the Ask-Tell-Ask feedback approach (see section on Feedback. How?) to safely provide feedback to the resident. Then use the information gained from the feedback to make the resident’s written evaluation.
Click Below for More Myths
Many attendings have “The resident will hate” fear when it comes to feedback and evaluation, especially when it comes to providing constructive feedback. Methods exist to turn these situations into positive opportunities for growth. In the short future we will introduce these methods.
Many attendings sometimes have the fear “People will say I am attacking the resident” when it comes to feedback and evaluation, especially when it comes to providing constructive feedback. Like Methods exist to turn these situations into positive opportunities for growth. In the short future we will introduce these methods.
Many attendings sometimes have the fear “I will have to fix the problem if I report it” when it comes to feedback and evaluation, especially when it comes to providing constructive feedback. The primary responsibility for “fixing the problem” lies with the residency program not the attending. Generally, the residency program just wants the attending to provide the needed details and context for a solution to be made.
Many attendings sometimes have the fear “The resident is just having a bad day” when it comes to feedback and evaluation, especially when it comes to providing constructive feedback. It’s true that the resident may be having a bad day, but it may be a sign that the resident needs help. Residency programs generally don’t make judgements based on single evaluations in isolation, they take a wide lens look at patterns and trends. The exception is something that indicates the resident needs immediate help or is in danger. The residencies understand that individual attendings are not responsible for determining this, which is why the attendings need to report what they see. The evaluations give the residency program the ability to help the resident succeed and shine. This can’t be stressed enough…these evaluations are used to help the residents, not hurt them.
Many attendings sometimes have the fear “What I say will get the resident in trouble” when it comes to feedback and evaluation, especially when it comes to providing constructive feedback. It is important to know that evaluations give the residency program the ability to help the resident succeed and shine. This can’t be stressed enough…these evaluations are used to help the residents, not hurt them. The GME mission is to make great doctors. The only real way to do that is to use evaluations for help and guide the residents.
Sometimes attendings think that doing evaluations is a waste of time/energy because they feel residency programs won’t use them. This is not true. Evaluations are reviewed by each program several times per year. Each evaluation is useful and is incorporated into the programs overall evaluation of the resident.
