5 minute read
Education & Training Four Strategies to Increase the Written Evaluations for Learners
By Mallory G Davis, MD, MPH; Carolyn V. Commissaris, MD; and Esther H Chen, MD
How often do you hear from your learners that they don’t get enough feedback from faculty? When writing a summative evaluation for your learner, how often are you frustrated by the few end-of-shift written evaluations that are available or have no more helpful comments than “keep reading?” Faculty engagement in completing written assessments of emergency medicine (EM) trainees is a difficult task. Faculty have competing responsibilities, deadlines, and time commitments. However, EM trainee advancement during residency training is based on measuring milestones and competencies, which are heavily dependent on EM faculty assessments. We present four strategies that have worked in our institutions to increase the written evaluations for all our learners. Even though we focus on EM trainees, these strategies may be adapted to all learners in the emergency department (ED).
Cultivate a Culture of Feedback and Assessment
Most academic faculty understand the importance of feedback and assessment in EM training. For some, it may be helpful to emphasize the importance of faculty assessments to provide insight into the EM trainees’ progression through residency. Trainees
“…the value of high-quality EM faculty assessments contributes to a more robust and complete training experience for EM trainees.” expect to receive feedback to improve their clinical skills, and education leaders use written assessments to determine milestone achievements for each trainee. Specific expectations for providing timely feedback using written evaluations should be clear and discussed at faculty meetings, new faculty orientation, or relevant staff meetings. Encourage faculty to provide feedback about the assessment tools and workflow or provide suggestions for improvement. This two-way
conversation helps to cultivate a culture of feedback within ED.
Furthermore, this conversation might include faculty development highlighting the EM milestones and progressive responsibilities for each residency year, as well as examples of effective and less-effective written feedback. Remind faculty that assessments completed in a timely manner and focused on specific behaviors or skills that may be improved are the most helpful observations for EM trainees. Praise faculty whom trainees have identified as people who provide excellent feedback. Solicit those faculty to lead faculty development workshops that focus on strategies to create more relevant and actionable feedback for trainees. Report programmatic and national survey results from trainees about their perceptions of faculty feedback to celebrate successes or highlight opportunities for improvement. While this may seem like a lot of work, the value of high-quality EM faculty assessments contributes to a more robust and complete training experience for EM trainees.
Simplify the Workflow
Even after faculty are informed of the expectations for completing timely written evaluations, reminders will need to be deployed. Depending on the evaluation software being used, reminder emails, texts, or pages may be sent directly to the faculty with a link to the evaluation form. Sending an email or page at the start of a shift to remind faculty about completing evaluations can be an easy and quick gesture to encourage participation. Another strategy is to encourage trainees to be proactive about soliciting feedback from their faculty directly, or learners can email their supervising faculty with a list of their patients as a reminder to complete their evaluation.
Use the system that works best for the faculty and trainees in your ED. Some institutions still use low-tech solutions such as paper evaluations or end-of-shift cards that are completed and dropped into a locked box in the clinical area. High-tech solutions can also be utilized, such as an app installed on a smartphone that can be easily accessed at any time during a clinical shift. In addition, a link to an electronic evaluation can also be available at clinical workstations or installed in the electronic health record to enable easy access to the evaluation platform. Finally, install a dictation program on your computers to facilitate completion of patient charts and trainee evaluations.
Link Incentives to Educational Productivity
Incentives may be used to boost faculty completion of EM trainee evaluations if they are transparent and clear to everyone. An inexpensive way to recognize faculty is to highlight an exceptional teacher every quarter during faculty meetings for their bedside teaching or their feedback comments. A faculty-of-the-year award might be given during graduation to recognize an exceptional teaching moment. This gesture acknowledges the value of feedback to the educational mission of the department and reinforces positive behaviors. If bonus or incentive programs are available, educational relative value units (RVUs) that include completion of evaluations, conference teaching and attendance, mentorship, and scholarship might be incorporated into faculty expectations for being in “good standing,” just like chart completion or patient throughput. Analogous to clinical RVUs, this may provide a familiar incentive structure for faculty to engage in and improve their educational productivity.
Diversify Your Evaluation Tools
Academic faculty may suffer survey fatigue from the often-numerous surveys that need to be completed throughout the year on top of the trainee evaluations that are required. Keep the written trainee evaluations short and focused on the most relevant and important questions. Diversify your evaluation tools. Evaluations for which faculty and trainees had an opportunity to work together for a significant amount of time (i.e., a full clinical shift, multiple shifts) may be most effective, but focused evaluations, such as a resuscitation assessment, procedural feedback, or chart review, may be easier for faculty to complete, while also relevant to improve clinical practice. Leverage the expertise of your faculty. For example, some faculty pay more attention to documentation than others and might be more likely to complete a chart review than a general EM shift evaluation.
Conclusions
Engaging faculty in completing written evaluations is challenging but providing this feedback to learners is so critical to their development during training. Cultivating a culture of feedback and assessment requires faculty development, addressing barriers, and an open dialogue about expectations and workflows. Recognizing faculty with teaching awards and incorporating educational activities into incentive structures may help to reinforce the importance of feedback to the department’s educational mission, which is to provide the best clinical experience for their trainees.
ABOUT THE AUTHORS
Dr. Davis is a medical education fellow and assistant residency program director at the University of Michigan in Ann Arbor, Michigan. mallodav@med.umich.edu
Dr. Commissaris is an assistant residency director at the Harvard Affiliated Emergency Medicine Residency in Boston, Massachusetts. ccommissaris@bwh.harvard.edu
Dr. Chen is a professor of clinical emergency medicine and associated residency director at the University of California San Francisco in San Francisco, California. esther.chen@ucsf.edu
