Evaluation Methods
There are numerous clinical evaluation methodologies presently utilized by medical schools. These include:
How the Student Will Be Evaluated
An important tool for evaluating students in both the CPC and PCC curricula will continue to be the Blue Evaluation Form. This form specifies nine general categories in which you evaluate the student and each of the nine areas are broken down into sub-categories.
A recommended way to use the Blue Form effectively is to make two copies of the original and at the mid-point of the clerkship, spend about 15-20 minutes conducting an evaluation session with the student. In this session have the student complete the form as a self-assessment activity. At the same time, complete your copy of the form. Then compare ratings with the student and discuss them. This is what we call a "formative evaluation." By doing this you are helping the student "form" his/her knowledge and skills based on feedback during the clerkship. Conducting the formative evaluation helps you avoid a situation in which the clerkship is near completion, the student is not meeting expectations and it is too late to help the student take corrective action. At the end of the clerkship, time should be set aside again for a "summative evaluation." At this session the preceptor has completed the evaluation form and discusses it with the student. Dialogue should take place regarding differences the preceptor and student have on any particular rating (s), but the final decision on each rating rests with the preceptor.
A critical feature of the Blue Form is the space after each of the nine categories for preceptor comments. Comments written on the formative evaluation should specify what the student is doing well, what the student is not doing well, and specific suggestions for improvement. "Specific suggestions" is a key phrase here. Summative evaluation comments can follow the same format but there should also be statements specifying how the student improved during the clerkship. Additionally, there should be statements specifying the student's strengths as well as comments about areas still in need of improvement. Perhaps the best way to think of the written statements on both the formative and summative evaluation is to view them as justification and clarification of the ratings you circle.
Principles of Evaluation
A very basic principle of evaluation is to evaluate the learner based on a set of written standards and to use multiple sources of data in the process. The Blue Form provides a generic set of written standards for all clerkships. The trainer who had the most contact with the learner should be the primary data source for determining the rating on the Blue Form but it is also important to seek the input of others (e.g. residents, nurses, other preceptors) who had contact with the student. It is also important to base your evaluation of the learner on direct observation as much as possible. Direct observation may help prevent two common evaluation errors. These include:
The Halo/Horn Effect - This occurs when the preceptor has heard from others that the student coming on his/her service is excellent so bias in a positive direction is already in place at the beginning of the clerkship. Bias could also go in the opposite direction if the preceptor has head negative information about the student. Utilizing direct observation can help counter bias in either direction.
Restriction of Range - An example of this phenomenon is when a preceptor has a tendency to always give a student 4s and 5s on a rating scale of 1 to 5. This happens in part because in the mind of clinicians and students any rating lower than a 4 on the 1 to 5 scale is considered "really bad." Some might call it the Lake Woebegone Effect -"where all the citizens are above average." To correct for this problem, the preceptor needs to set an expectation with the student at the beginning of the clerkship that the full range of numbers will be used, especially on the formative evaluation. Additionally, data based on direct observation as opposed to inferential information will also help in justifying any rating below a 4 on the 1 to 5 scale.
References and Resources:
Books & Articles
Alguire, P.C., DeWitt, D.E., Pinsky, L.E., and Ferenchick, G.S. (2001). Teaching in Your Office: A Guide to Instructing Medical Students and Residents. (For information on this book call 800-523-1546 ext 2600)
Whitman, N. (1990). Creative Medical Teaching. (This book can be ordered from the Society of Teachers of Family Medicine at http://stfm.org/bookstore/)
On-Line Resources
Evaluation Using the GRADE Strategy by Langlois, J. and Tach, S. (An on-line article)
Evaluation as a Dynamic Process by LeBaron, S.W.M. and Jernick, J. (An on-line article)
Evaluating Without Fear by Kaprielian, V. and Bell, H. (An on-line article)
Observing Students in the Clinical Setting by Qualters, D. (An on-line article)
Evaluation: Making it Work (An on-line monograph on the OUCOM/CORE Office of Faculty Development web page)
Evaluation (A brief on-line reading from the New Preceptor Packet on clinical teaching located on the OUCOM/CORE Office of Faculty Development web page.)