About the Book Table of Contents Sample Mistake #7 Sample Mistake #10

SAMPLE MISTAKE

Mistake # 10 - Remaining unaware of the factors that can cloud your evaluation

The clinical evaluation of students during rotations is far from perfect. Evaluators can be affected by a variety of factors, some of which can lead to ratings that are lower than the student deserves. These sources of bias are shown in the following table.

To guard against these errors, evaluators ideally should be trained on how to complete evaluation forms properly. Unfortunately, schools don't often offer this training and, even when they do, evaluators may not take advantage of the opportunity. As a result, rating errors can and do occur This is not because of any ill will. Evaluators are simply unaware that they are making these errors. What can you do to avoid being a vaictim of a rating error? Here are some recommendations:

• Work with your evaluators as closely as you can, letting them observe you as you complete your tasks and fulfill your responsibilities. If your evaluators have observed you frequently, they are less likely to rate you as average (provided that you have performed at a high level). Average ratings sometimes result when students are observed infrequently.
• Finish your rotation on a high note. As obvious as this may seem, for some students it can be difficult to put into practice. Why? Because as the rotation draws to a close, students naturally start spending more time preparing for the end-of-clerkship exam and less time reading about their patients. Do not lose sight of the fact that your evaluation will be completed either at the end of the rotation or soon after the rotation ends. Your performance at the end of the rotation will be fresh in the minds of your evaluators. Your work early in the rotation may not be remembered as well. Students who end their clerkship with a whimper rather than a bang may find that this is reflected in their evaluation.
• Don't underestimate the importance of making a good first impression. With every task you complete, strive to do your best work right from the start. This is especially true for your oral case presentations and write-ups. If you start off impressively, you may be seen as a student who is further along than most. Of course, after a good first impression, you must maintain a high level of performance.
• To avoid a lower rating due to severity bias, you need to have a number of evaluators submit evaluations. For example, you may have to work with an attending physician who is more stringent. Even if you perform at a high level, it may not be reflected as such on his evaluation form. To lessen the effects of this single evaluation, you will need to have other evaluations that speak more favorable of you. In fact, the literature supports this, with studies showing that multiple ratings are necessary to provide a more reliable estimate of clinical competence.

Note that even if you heed the above recommendations, you can't guarantee that a rating error won't occur. Clerkship directors realize that rating errors can occur and make attempts to overcome the effect of these tendencies. In many rotations, clerkship directors will solicit multiple evaluations from those that supervise your work. When a number of evaluations are obtained, assessments can be averaged, leading to a more accurate assessment of your performance. This will mitigate the effects of any one person's rating error.

Did you know...

At a study performed at five medical schools, 107 surgery faculty members each evaluated four or more students (Littlefield). A total of 1482 ratings were obtained. From these ratings, the investigators were able to determine that 14% of the raters were significantly more stringent. Stringent raters were shown to rank students with true clinical ability at the 50th percentile at the 23rd percentile or lower.