Many of you have faculty responsibilities that include evaluating trainees of different levels, specifically undergraduate and graduate medical education. These assessments are often used as the foundation for both formative and summative feedback and play an important role in determining medical competence. As the goal of any training program is to graduate professionals who can provide high quality patient care, it is of upmost importance that assessments are accurate, informative and truly reflective of a trainee’s performance. The implications of inaccurate assessments can potentially have real world repercussions, namely effects upon patient outcomes. There is evidence to support that gaps in clinical performance can persist into independent practice and speak to the quality of training received. Therefore it is reasonable to conclude that training programs must trust that assessments submitted by faculty are precise to the greatest extent possible.
It is this need for precision and accuracy that can make assessment challenging. It also can be a source of stress due to having an inbox full of reminders to complete pending forms or concern about the quality or accuracy of them. From a faculty perspective the underlying reasons for these feelings can be organized into categories that may seem familiar to you- perceived lack of organization support, limited clarity or understanding of purpose and desire to do no harm. Assessments of suitable quality require time. Time not only to complete, but also sufficient time to gather enough data to inform narratives comments. This time can often come at odds with the productivity expectations of an organization, thus creating tension. In the absence of dedicated time for observation that allows for the generation of assessment a faculty member is often left to squeeze this activity into an already busy academic medicine schedule. Absence of adequate faculty development can also be a barrier. Lengthy assessment forms that are cumbersome to complete are even more onerous when not explicitly linked to the underlying educational framework. It is hard to create an accurate assessment if you do not understand the frame of reference.
Finally, faculty in medicine are all too aware of the rigor and struggle that specialty training entail. As such, we can easily empathize with our trainees. This ability which allows us to support them can at the same time make it hard for us to honestly appraise them. This is in line with the human tendency to avoid providing negative information. We do not necessarily want to be the reason a trainee does not pass or advance. As a result, how many times has the truth been watered down or an evaluation generalized to avoid this trouble? We cannot forget about the trainee perspective in this as they are the recipients of these assessments. Like faculty, trainees can find the process of assessment challenging for numerous reasons. One recent review found that trainees’ perspectives were dependent upon whether they had a growth or fixed mindset. It also showed that evaluations by enthusiastic or engaged faculty as perceived by trainees are more valued.
Is there a way to make the process of assessment easier? I propose the following approach based upon a review of available literature:
1) Think about what you are trying to assess: Is the goal to provide observations necessary to judge a trainee’s competency? Maybe your assessment is meant to support growth? Perhaps it is both. Thinking about the purpose of your assessment can help you choose the best language and shape it in a way that conveys the most authentic narrative.
2) Remember frameworks to help guide your judgements: It can be challenging to know what to look for in our trainees and to make sure those observations actually translate into meaningful educational language. This is where understanding educational frameworks can be helpful. Educational frameworks can help guide us in our observations by providing a scaffold of what to look for and defining the domains deemed important for competency. Examples of frameworks commonly used include: ACGME Competencies, CanMeds, and RIME. Although they can be used individually to guide a particular type of assessment such as evaluation of a patient encounter in clinic, it is important to remember that they can complement each other. For example, ACGME competencies map onto the RIME framework which allows you to create more useful and valid evaluations.
3) Embrace simplicity and subjectivity: Sometimes we can be our own worst enemy when it comes to assessment. For those of us in clinical practice, it can be helpful to approach our assessment of trainees just as we approach our patient evaluations. We can apply the same skill of pattern recognition that we use with patients to our trainee assessments. Ask yourself do my observations fit a certain pattern seen in other trainees? Doing this may make assessment simpler. Additionally it can be helpful to remember and accept that there is some degree of subjectivity in assessment as they are a reflection of our observations. We probably should embrace subjectivity more in assessment as it likely provides a more nuanced picture of our trainees.
As the field of medical education continues to move towards a more competency based framework the need for accurate, high quality assessment will only increase. Using the tips outlined above can help faculty involved in medical education meet this challenge.
Did you know that the Harvard Macy Institute Community Blog has had more than 260 posts? Previous blog posts have explored topics including designing programmatic assessment structures to support learning, engaging students virtually, and systems of assessment in educational settings.