Introducing guest blogger: Franklin Medio, PhD
Editor’s note: After hearing how much attendees of our 3rd Annual Residency Program Management Workshop enjoyed Franklin’s presentations, we had to bring him on board as a blogger for Residency Manager. I’m sure his blog posts will be just as informative and entertaining. Look out for his future monthly posts.
The semi-annual performance review: An opportunity for summative evaluation and self-assessment
It is the time of year for programs to conduct the semi-annual performance review of residents and fellows. This one-on-one meeting between the resident or fellow and the program director (or his/her designee) not only provides the time for a formal summative evaluation of the individual’s performance over the previous six months, but also offers a valuable opportunity for the trainee to develop his or her self-assessment (or self-evaluation) skills.
It is important that program directors set aside a portion of this meeting time for residents and fellows to reflect on their performance, identifying areas of strength and those in need of improvement. As adult learners, residents and fellows must develop the ability to assess their own knowledge and skills in order to identify areas for continued learning. Likewise, they need to determine how others perceive them professionally based upon the behaviors and actions they exhibit while performing their clinical duties.
In the October issue of Residency Program Alert, I offered several strategies to help program directors and program coordinators overcome the obstacles that prevent faculty from providing accurate information on evaluation forms about a resident’s or fellow’s performance. It was my intention to provide practical ways in which faculty members can fulfill their obligation to provide good evaluation data, especially when the performance is unsatisfactory or unacceptable. However, I do realize that despite the program director or coordinator’s best efforts to prod, plead, coax, cajole, coerce (or, as a last resort, threaten), some faculty will continue to present a formidable challenge.
Remind these recalcitrant faculty (and all faculty) that the evaluation data they provide is crucial to carrying out the program’s most important responsibility, documenting the resident or fellow’s progress (or lack of progress) toward fulfillment of the residency program requirements. Point out to the faculty that missing data, inaccurate data, and the lack of data to substantiate behavioral problems or clinical skill deficiencies can make the performance review a meaningless exercise at best, and give the trainee a false sense of accomplishment at the worst.
Let’s assume the program director and coordinator have overcome these obstacles, have collected accurate, comprehensive evaluation data on each resident or fellow, and are preparing to hold the semi-annual performance review. Here are some suggestions for conducting an effective performance review meeting:
- Compile summaries of each subset of evaluation data (i.e., faculty evaluations, non-physician evaluations of professionalism and communication skills, evaluations from his or her peers, reports on scholarly activities). If the resident is a chief resident, the performance review should include a discussion of how he or she is performing those additional duties.
- Direct the residents to complete each of the same evaluation forms others fill out about their performance. Instruct trainees to grade themselves based on their own assessments-(not as they think others would them. Inform residents and fellows that, “this is the time to step outside and look back at yourself.” Making them the same evaluation forms that others used to judge their performance provides a common base for discussion.
- Prepare a template for the meeting that includes the six competencies, a rating system to determine progress (or lack of), as well as space to summarize information from each of the evaluator groups, to describe the residents strengths, and to describe any deficiencies or areas requiring improvement. For each deficiency, prepare a set of specific instructions for the resident or fellow to follow and a timetable to reassess skills. If the deficiency is serious or was noted in previous evaluations, institute a formal remedial plan and specify the consequences of meeting (or not meeting) its requirements. (Note: If the resident will be placed on formal remediation, there should be another person at the meeting—–the coordinator, the resident’s mentor, assistant program director, chief resident, etc.).
- Begin the meeting on a positive note by emphasizing the importance of summative feedback as a key facet of the residency education process that formally documents progress in the program. State that the information discussed in the review meeting will reinforce the formative feedback trainees have been receiving during the past six months. Point out that this is an opportunity for them to develop the self-assessment (i.e., self-reflection) skills needed for life-long, professional improvement. With that entrée, ask trainees to share what they have written on each of the evaluation forms. If an individual identifies deficiencies or areas for improvement, solicit elaboration on what can be done to address each one.
- Following this discussion, take time to compare the trainee’s self-assessment with the summarized information from each group. Reinforce the resident’s self-assessment when there is agreement between the two evaluations and explore why any discrepancies, if they occur, may exist.(Note: most individuals who perform well tend to grade themselves “lower” or more critical, but many who have performance problems grade themselves “higher” and do not recognize the problem. Helping this second group understand the disparity will be the “teachable moment” for them.).
- Conclude the meeting on a positive note by emphasizing concordance between the resident or fellow’s self-assessment and his or her evaluations from others. Reiterate exemplary comments about the individual’s strengths, especially any outstanding accomplishments during the past six months. Highlight instructions for correcting any noted deficiencies or modifying problematic behavior(s) and the procedure for follow-up assessment, repeatedly pointing out that this is part of the learning process. For an individual who will be placed on formal remediation, underscore the seriousness of the situation, while providing encouragement and support to help the individual successfully meet the terms of the remediation plan. Carefully review the terms of the remediation plan to be sure there is no misunderstanding.
- Prepare a summary of each performance review meeting. Both the resident or fellow and the program director, or the designee who conducted meeting, must sign the summary to document that the meeting took place. If a resident or fellow does not agree with any information contained in the summary, he or she can write a response. If the individual is placed on formal academic remediation, both the individual and the program director must sign the remediation plan.
How do you encourage residents to self assess during summative evaluations? Share your comments in the box below.
If you would like to contact Franklin Medio, e-mail him at franklinmedio@gmail.com
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Franklin Medio, PhD
Franklin J. Medio, Ph.D. is a professional educator in a private, independent, consulting practice. From 1997-2007, Medio directed the GME Office at the Medical University of South Carolina, serving as assistant dean and then as associate dean for graduate medical education. From 2004-2007, he served as the ACGME designated institutional official (DIO) for GME. He was also an associate professor in the Department of Internal Medicine. Prior to his appointment at MUSC, Dr. Medio held faculty positions at one other allopathic medical school and two osteopathic medical schools.Franklin has written 1 posts.
Comments
Great information and advice. To answer your question, we use the ABIM’s self-assessment tool, have the residents complete and bring to their meetings to review together with the evaluator. Generally, they are pretty self aware and right on target with what they need to work on. These are done electronically, so we can track, and they can review when they do another one in 6 months!
My wife is a licensed MD from IL.
During her residentship[1st year] she experienced biased evaluation which she challenged as her academic record has been impeccable.
Above led to victimization by the team of resident doctors.
They have claimed to have remediated her, which my wife has absolute no knowledge about – not informed categorically of remediation and its procedures.
When challenged to produce a remediation record/plan- the attending physician has produced a hand written scribble which only states mm/date with year missing AND no signature as to who has written the note
Moreover the plan itself is to be scorned at in the manner it is written.
We would like to further pursue this matter and establish the correct facts.
The medical hospital has been punitive and very aristocratic high handed behaviour by the head of department leading to gangster style behaviour.
We would like to pursue the procedures and due methods to close a remediation in order to prove she was never remediated nor informed of this process, hence leading to false allegations and cover up.
Your truly
IK
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