Thread by @medicalaxioms

My ratio of positive evaluations* of medical students and residents to negative is about 9:1.

*Above average to downright glowing

Nobody told me how to write evaluations of learners. Come along while I discuss what I have learned. 1/

First of all, realize that almost all learners you ever evaluate will become doctors. Decent ones, too.

The number of times your negative evaluation will save the world is zero. 2/

The scar you leave by intermingling a person’s character or value as a human being with their ability to remember labs or present at the bedside can last a lifetime. 3/

Thus a negative evaluation—one that does something other than celebrate the talents and efforts of this learner—should be treated with pause and seriousness. 4/

Upon “completing” a negative evaluation, the first thing I do is not complete it. I “Save as Draft” and walk away for a day. 5/

The first questions I ask myself are:

1. When did I notice this learner had a problem?
2. When did I tell this learner they had a problem?
3. Was I sufficiently honest and clear about what needed to change?
4. How far did they come? 6/

Let me dispel the myth that negative evaluations are seeds for improvement.

Usually, the learner is weeks down the road in a different hospital on a different service with a whole host of new expectations to deal with. You are a rapidly fading memory. 7/

You job as a teaching attending is not to hold up a score card like a figure skating judge on the side of the rink.

You are a coach. As quickly as possible, you must discover the weaknesses in each learner as set about to strengthen them. 8/

The last moment you have to help a student or resident is at what I nostalgically call The Mid-month Evaluation. Due to modern scheduling and the hospitalist lifestyle, this sometimes comes @ or 2 days after meeting someone. Usually ~7 days. 9/

The Mid-month Evaluation is done in person and in private.

About twice I have delivered a mid month evaluation in a room where other people could overhear and that was some bone-headed shit. 10/

The Mid-month Evaluation is delivered kindly as coaching in the shit sandwich format.

🍞💩🍞

What you do well.
Problem areas and what to do about them.
Positive things ~I have observed about you as a human being~ that portend good things in your life in medicine and life.

Here’s what nobody ever told you:

The final evaluation is simply an evaluation OF THE LEARNER’S ADJUSTMENTS IN RESPONSE TO YOUR MID-MONTH EVALUATION.

That’s it. 12/

The qualities we seek in medicine are:

1. Ability to accept coaching.
2. Ability to increase the slope of the learning trajectory.

13/

Some start as ordinary students from humble beginnings. They weren’t valedictorian of their high school class nor do they have one of those gold-plated east coast educational pedigrees.

They pick up speed as they go. They will be better doctors at 60 than at 50. 14/

Others started strong and were dissecting frogs in kindergarten. Some of them are losing steam as they go. Or have trouble accepting correction. Or can only learn on a certain frequency “from someone they like.” 15/

(I know this because I was like this). 15/

While your negative review is cooling off in your pile of unfinished business, take 5 minutes and do this:

Take a card and make to columns.
1. Same as me
2. Different

And run through all the characteristics you can think of about this learner. 16/

- home town
- family structure
- country of birth
- religion
- education
- hobbies
- gender
- ethnicity
- parents occupations

On and on. As far as you can go. 17/

PS If you don’t know all this stuff about your students and residents:

a) What the hell are you doing in an academic institution and
b) You are likely making tons of assumptions & suffering from tons of biases that you have hidden from yourself by not knowing these people. 18/

Now stare at your list of “Same as me” and “Different”...

... and suffer. 19/

Suffer the realization:

You grade learners who are different from you harder than familiar residents who share more of your traits. /20

It may even be necessary as you get started to make the two-column list for everybody. Every month. To start to see how your sneaky brain is working. 21/

Anyway come back after a day and look at your evaluation. First of all you were too rough. Second of all you never took the time to tell this person what they needed to improve when you saw it, because you were afraid.

That’s the end of the thread. 22/22