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Erika N Ringdahl1, John E Delzell2 & Robin L Kruse. Evaluation of interns by senior residents and faculty: is there any difference? Medical Education 2004;Volume 38: 646 - June 2004 Reviewed by Sherilyn Smith, University of Washington


Erika N Ringdahl1, John E Delzell2 & Robin L Kruse. Evaluation of interns by senior residents and faculty: is there any difference? Medical Education 2004;Volume 38: 646 - June 2004

Reviewed by Sherilyn Smith, University of Washington

Background: Written evaluations of learner performance should give meaningful suggestions about clinical skills. However, encouraging evaluators to give meaningful written comments to trainees is difficult. Additionally, there may be differences between evaluations given by peers, residents, junior and senior faculty members.

Methods: Blinded retrospective analysis of 1341 written comments given to PGY-1 trainees by PGY-2 or PGY-3 residents, junior (< 6 years as a faculty member) and senior faculty members. Comments were categorized into 12 groups, analyzed for positive/negative/neutral tone and effects of evaluator/learner gender.

Results: The authors had good agreement about categorization of comments and the method of analysis was sound. The majority of comments given were positive (81.9%). Junior faculty and residents were more likely to make "negative comments" than senior faculty (15.5%, 15.9% vs 9.8% respectively). There was no gender effect. Most comments were general and provided no specific feedback (generic "a great resident": 20.2%; resident attributes; "a great sense of humor" 18.0%, competence; "did a good job with a delivery" 14.1%). The remaining categories describing, knowledge, teamwork, decision making skills, patient interactions were infrequently used (<10% of the time). No information was provided about the areas for improvement or types of "negative comments".

Significance: This article illustrates how qualitative methods can be used to clarify important issues in medical education and inform future research projects. The similar findings apply to medical students (Carline et al Surgery 1986.). This type of information provides specific information that can inform faculty development and skills building sessions. It also provides a backdrop for future studies to assess the effectiveness of faculty/resident development in the area of giving feedback. The limitations of the study include a single institution and no description of the training the evaluators received regarding use of the evaluation instrument. Finally, I am not sure I agree with the assertion that senior faculty give less negative feedback than junior faculty/residents because they are "better evaluators." There was no specific data given about the negative comments and we didn't see examples of the feedback to gauge this for ourselves. Often, it is the resident who works closely with the student/intern who has insight into professional behaviors that are problematic.

(Do you think that the lack of "negative comments" in writing reflects lack of feedback in general or an unwillingness to put things that have been said in writing? Or - is it both - nothing said and nothing written? Steve Miller)

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