PS4-11: BEYOND âGOOD TEAM PLAYERâ: AN EXTENDED CLINIC EXPERIENCE WITH A SURGICAL FACULTY MEMBER RESULTS IN MORE DESCRIPTIVE NARRATIVE CLINICAL EVALUATIONS.
Sarah L Larson, BA, Sarah Sullivan, PhD, Ann P O'Rourke, MD, MPH; University of Wisconsin
Background: Clinical evaluations, with narrative content, aim to provide learners with more targeted and individualized assessments. Students perceive narrative evaluations as an indicator of their academic performance and competitiveness on residency applications, yet students are often dissatisfied with the quality of narrative comments received on surgical evaluations. We proposed assigning students a mentor through a three-month continuity clinic, which encourages longitudinal one-on-one faculty and student interaction, would result in an effective evaluation of performance. Our objective was to compare narrative evaluations given to students in a surgical continuity clinic (CC) program to those given on another surgical rotation (No-CC) in the same clerkship.
Methods: The clinical performance of medical students was assessed using a combined rating scale and comment-based evaluation from January-October 2018. The Professionalism-Reporter-Interpreter-Manager-Educator (PRIME) evaluation framework was used to code narrative assessments. PRIME was adapted to the surgical context by adding a domain for Skills assessment (S-PRIME). We conducted a content analysis of narrative comments from 81 CC and 81 No-CC evaluations to compare quality based on word count, S-PRIME competency domains, and reinforcing or corrective content. Differences were compared between CC and No-CC evaluations using the chi-square test, p<0.05 was considered significant.
Results: Reinforcing comments significantly differed in the domains of Interpreter (16% vs 8%) and Manager (8% vs 3%) between CC and No-CC. Corrective comments significantly differed in the domains Interpreter (36% vs 17%) and Manager (16% vs 5%). There was no significant difference between CC and No-CC corrective comments in the domains Skills, Reporter, or Educator. The CC program elicited more narrative comments. In both groups, faculty gave significantly more reinforcing comments than corrective.
Conclusions: As evidenced by significant differences in the domains I and M, extended contact between faculty and students in a CC setting allows faculty to give improved and focused comments on student abilities to interpret H&P data, formulate differential diagnoses, and determine a patient plan. Although corrective comments increased among CC preceptors, all faculty struggle with applying corrective feedback. These findings present an opportunity for education and development for faculty within the CC program to focus on providing effective corrective feedback.