Listen in as we take a deep dive into the world of narrative evaluations in medicine with Dr. Suzanne Minor (@minor_se). Dr. Minor discusses specific elements to beef up how we write and what we write–highlighting what we should definitely include and what to avoid when writing learner summaries or letters of recommendation. Come learn how to take your narrative evaluation game to the next level!
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Written comments from faculty educators help learners know where they can improve, what their next steps in growth are, and what they can continue doing well. Well-written assessments help competency committees and advisors support learners in their growth.
Written assessments should not come as a surprise to the learner: everything that goes into narrative evaluations should be discussed ahead of time, ideally verbally and in person! When having a feedback conversation, label it as feedback to clearly let the learner know what is happening–and that it’s feedback!
Ask the learners what they want to improve on, what they did well, and what stood out. Use a SMART framework to help them to create goals for what they want to improve on.
Have learners email their reflections from the feedback conversation so you can understand what they understood–it can also help with written comments that can be edited and used later for your formative or summative written evaluations!
Framing feedback in the setting of competencies, milestones, and entrustable professional activities (EPAs) (Vanderbilt’s simplified version of the AAMC’s EPAs) can help keep focused on the expectations of the learners’ development. From the 30,000 foot view, the RIME (Reporter, Interpreter, Manager, Educator) framework can be helpful to help learners see where they are and where they are headed.
Frame redirecting comments in a way that is meant to support the learner’s growth. Dr Minor suggests saying something such as, “I want you to be a physician I would send my loved ones to.” It’s ok to give nitpicky feedback (and name that you are doing that) at the beginning of someone’s training to help them polish their skills.
Help the learner narrow down their next steps. Think about what is foundational for them to reach their goals, and if they have achieved key foundational (developmental, clinical) goals before addressing the end goal. Break it up into smaller pieces, someone with underdeveloped communication skills may not be ready to practice end of life conversations, but can start with smaller rapport building and counseling skills. As another example, if the issue is more knowledge-based, just like how we have clinical or diagnostic scripts, teachers having teaching scripts can help direct the learner on ways to improve in that domain (Marcdante 1999). Dr Minor suggests talking about can’t miss diagnoses or using an organ system approach to help learners expand their differentials.
When writing evaluations, learners who are average or meeting expectations don’t necessarily need comments, but anything above or below that rating requires a comment on why that is. Make sure the grades (or where the learner is on the development scale/competency) and your comments are in alignment. If you say they exceed expectations, you should add a comment as to why they exceed expectations and vice versa. If they have more positive comments but equal grades compared to someone else, why would you say they are only meeting expectations?
What is your motivation for writing feedback and comments?
Consider a framework when writing evaluations, BOSS framework.
Come at writing narrative evaluations with a growth mindset. Assuming positive intent and the kindest motivation of others when reviewing narrative comments.
FIU clinical faculty development website has free online modules on clinical teaching topics
Alliance for Clinical Education: Guidebook for Clerkship Directors a helpful text that includes lots of details for clerkship directors, including guides for written feedback.
Listeners will improve their ability to complete narrative evaluations
After listening to this episode listeners will be able to
Dr. Minor reports no relevant financial disclosures. The Curbsiders Teach team report no relevant financial disclosures.
Minor S, Heublein M, Kryzhanovskaya E. “Conveying the Learner’s Special Gift: Best Practices for Written Evaluations.” The Curbsiders Teach Podcast. http://thecurbsiders.com/teach February 8, 2022.
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