#9 Conveying the Learner’s Special Gift: Best Practices for Written Evaluations

February 8, 2022 | By Era Kryzhanovskaya

With Dr. Suzanne Minor

Summary

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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Credits

• Producers, hosts, show notes, art: Era Kryzhanovskaya MD, Molly Heublein MD
• Show notes: John Ong DO
• Editor:  Clair Morgan of Nodderly (audio)
• Guest: Suzanne Minor MD

CME Partner: VCU Health CE

The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. See info sheet for further directions. Note: A free VCU Health CloudCME account is required in order to seek credit.

Show Segments

• Intro, disclaimer, guest bio
• Guest one-liner/ Best piece of advice
• Picks of the Week
• Value of good narrative evaluations
• Approach to writing these
• Tips for improving your written evaluations
• Redirecting feedback
• Things to avoid
• Case examples
• Take home points/additional resources
• Outro

Narrative Evaluation Pearls

1. Highlight what stands out for that learner by saying something like, “This student’s special gift is…”  
2. Describe specifics of how the learner is demonstrating certain qualities.  Consider the BOSS method (Brief Observation, Significance, and Suggestions) to provide detailed feedback.
3. Envision where you want the student to grow and what the next steps are to get there.  Give precise details to help the learner narrow down their next steps.  Think about what is foundational for them to reach their goals.   If they have not achieved those foundational goals, before addressing the end goal,  break it up into smaller pieces.  
4. Avoid putting anything new in written comments that hasn’t been discussed verbally with the learner. 
5. Racial or ethnic stereotypes have no place in evaluations.  Be mindful of your wording to avoid gendered comments.

Narrative Evaluations Notes

Well-written Narrative Evaluations are Important!

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.  

Feedback Basics

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.   

Tips to Improve Narrative Evaluations
(moving beyond comments like “you should read more”)

Include: 

• Highlight what stands out with them by saying something like, “This student’s special gift is…”  
• Briefly convey the overall gestalt of working with the learner.
• Clearly explain how the learner is demonstrating certain qualities (i.e. “She is proactive as evidenced by…”).  Consider the BOSS method (Brief Observation, Significance, and Suggestions) to help you ground the discussion and provide specific feedback.
• Use RIME and similar rubrics (specific milestones, EPAs, etc) to help learners gauge where they are and where the next step in growth are for them (Pangaro 1999)
• When envisioning where you want the student to grow, include concrete next steps in growth with specific details for their improvement. If you want the learner to speak up more, when?  Is it during presentations? Integrating more patient education? Etc? 
• Approach the learner’s evaluation with a growth mindset rather than a fixed mindset. Point out things like their effort and what they are demonstrating specifically to help the learners grow through application and practice.

What to Avoid in Written Evaluations:

• Avoid putting anything new in written comments that you haven’t discussed verbally with the learner. 
• Eliminate racial or ethnic stereotypes (in general, and specifically) in evaluations.  
• Don’t use “doubt raisers”, saying that someone did a great job for someone of their background for example (Madera 2019).
• Be careful of your language to avoid gendered comments.  Saying things like “pleasure to work with”, “kind”, “empathetic”, “helpful”, “needs to speak up more in clinic” has been associated with gender bias in evaluations (Turrentine 2019).  
  • If you are in a leadership position or reviewing others’ written feedback, approach questionable and/or inappropriate comments with an open mind and discuss these with the writer.  Listen to how they wanted the comment to come across, and try to help them see that some statements may be inappropriate (intent vs impact). 

Incorporating Redirecting Comments in Written Evaluations

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.  

Using narrative evaluations to reduce bias

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?

Dr. Minor Take Home Points

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. 

Resources to learn more as a clinician educator: 

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.

STFM (Society of Teachers of Family Medicine)

SGEA (Southern Group on Educational Affairs)

Links

Era’s pick of the week: The show, Ted Lasso; clip about being a goldfish; twitter thread #MedLasso

Goal

Listeners will improve their ability to complete narrative evaluations

Learning objectives

After listening to this episode listeners will be able to

1. Recognize the importance of writing a solid narrative evaluation
2. Approach how to improve a written narrative evaluation
3. Summarize aspects to avoid in a narrative evaluation

Disclosures

Dr. Minor reports no relevant financial disclosures. The Curbsiders Teach team report no relevant financial disclosures. 

Citation

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.