Setting Expectations, Observation, Feedback, and Evaluation
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Setting Expectations
Your students need a road map at the start of the rotation. What is the student’s role as a practice partner, and how will she/he be integrated into your patient care model? To what extent will she/he work independently with patients. The student will look to you also for an understanding of your expectations for the month and how s/he will be evaluated. Finally, ask the student about her/his goals for the rotation and try to incorporate them.
Observation
Good observation skills are essential to become a good teacher, as they are essential to become a good clinician. The challenge in observation is withholding judgment.
What are the benefits of direct observation?
- Establishes a baseline for each learner
- Enables clinical teachers to assess interviewing style, history taking, rapport building, and technique and organization of physical exam
Suggestions for Preceptors
- Select a few specific activities that you will make a conscious effort to observe
- Make a conscious effort to describe what you are seeing before providing other feedback
- Ask the student to observe something you are doing and describe it to you
- To conserve time, observe portions of students’ histories and physical exams
Feedback
“The tradition in medical education has emphasized negative feedback; if you did something well, it was quietly accepted, but if you did something wrong, everyone heard about it on rounds.” J.Ende, 1983
Feedback is the provision of information by the observer (preceptor) to the performer (student) about the performance, without judgment about quality.
Effective Feedback is…
- Descriptive rather than evaluative
- Specific rather than general
- Focused on behavior not the person
- Timely: should occur in close proximity to the behavior it addresses
- Balanced: includes both strengths and areas for improvement
- Planned and private: establish a mid-rotation feedback opportunity
- Brief and concise: limitations are time and the ability of learners to integrate too much information
- Modeled: your willingness to hear students’ opinions and act on their suggestions will make them more receptive to your feedback
Evaluation
Evaluation is the process of making judgments based on factual information and observations in order to rate, rank, or assess an individual’s status.
Purposes of Evaluation
- Summarize performance at a given point in time
- Provide information for planning future educational experiences
- Communicates summary information to other parties
If there has been sufficient feedback throughout the rotation, your evaluation of the student should come as no surprise. It is part of your student’s final clerkship grade, which is derived from the evaluations from all preceptors the student worked with, plus scores from written tests and performance on a practical clinical examination.
Potential Evaluation Pitfalls
- Halo effect - an enthusiastic, caring learner w/ mediocre skills receiving high marks, while a shy student w/ superior knowledge does less well
- “Oops” insufficient evidence - describe student’s shortcomings without providing specific examples and ways student could have improved
- “But you never TOLD me that” - evaluating the learner at the end of rotation that he has not met expectations when expectations were not stated clearly at the beginning and throughout
- “But I NEED honors” - find out at the end of rotation that student had high expectations
- “Uh-oh, should they pass?” - realizing that despite preceptor’s effort learner’s performance remained substandard and will not pass
- The Lake Wobegon effect - the average medical student is above average, which doesn’t help the school or the student
Summary
An effective final evaluation of a learner begins with setting clear expectations early. Continual observation and assessment of portions of the student’s work with patients and staff provides the substance. Behaviorally oriented feedback gives the student the opportunity to improve in specific areas and reinforces her/his strengths. Include these important elements and your evaluations of medical students will be valuable to them and to the College of Medicine.
References:
Ende, J. Feedback in clinical medical education. JAMA 1983;250(6):777-81.
Kaprielian, V.S. and Gradison, M. Effective use of feedback. Family Medicine 1998;30(6): 406-7.
Langlois, J.P. and Thach, S. Evaluation using the GRADE strategy. Family Medicine2001;33(3):158-60.