Letters to the Editor

Assessment of medical students: Can one global question be meaningful?

Dear Sir

There are inherent challenges and barriers to produce meaningful assessment and feedback for students. One major challenge is faculty members’ unwillingness to assign low scores and write constructive, or what might be viewed as negative comments about students (Roman & Trevino 2006; Mazor et al. 2007). Failing to convey concerns about trainee performance not only does the trainee a disservice by giving false hope, but also does a disservice to patients and society.

One question, “Would you want this student participating in the care of a loved one?” was added to the traditional assessment form of students rotating on the medicine clerkship. This question was based on the American Board of Internal Medicine Peer and Patient Assessments of Physicians. Physician evaluators were given three possible responses to this question: “yes”, “no”, or no answer. We then compared the responses by looking for a difference in ratings of knowledge, skills, and professionalism on the traditional assessment form.

1435 assessments of 151 students were analyzed. Evaluators rarely identified that they would not want a student participating in the care of a loved one (9 or 0.6% of assessment). More interesting, a number of evaluators did not answer the question (46 or 3.2%). The scores given by the evaluators on all measures were significantly lower for the group of students with a “no”, but also with no answer as compared to students with a unanimous “yes”. This may indicate that when physicians assessing students do not fill in sections of an assessment form, it may be meaningful and indicate significant concern about the student's performance (“concern by omission”).

While one might argue that adding a global question to the assessment did nothing more but correlate to the traditional questions, we argue that any unanswered global question requires further investigation. To be provocative, one might use an assessment form with just one global question, with the caveat that the evaluator must include a descriptive narrative that supports their answer as to whether or not they would want the student participating in the care of a loved one. Making assessment forms less complex, and allowing evaluators more time to thoughtfully document their opinions of student performance would be much more meaningful to everyone.

Erica Brownfield, Jerome Abramson and Sally Santen

Emory University School of Medicine and

Emory University Rollins School of Public Health

Emory University

49 Jesse Hill Jr. Drive SE

Atlanta, GA 30303

USA

FAIMER Regional institutes: A positive direction in medical education

Dear Sir

We, medical educators from Nepal who recently completed a fellowship from the PSGFAIMER Regional Institute, India read with great interest the article by Burdick et al. on the FAIMER Institute in a recent issue of Medical Teacher (Burdick et al. 2010).

The FAIMER program has certain built in features worthy of emulation by other fellowship programs elsewhere which make it more likely to contribute to development of health science education in the faculty's home institute and country. Each applicant has to submit an educational innovation project (EIP) with a written letter of support from the head of his/her institution. EIP ensures the fellowship directly benefits the fellow's institution and country. Periodic submission of progress reports and the necessity of coming back for session III with a completed project poster ensure the fellow has strong motivation to continue. The online group (listserv) comprising of faculty, alumni, senior fellows and contemporaries is a readily accessible means of motivation and support. Having year 2 fellows and graduating fellows interact with new entrants and share their experience is a great idea. Fellows are motivated to hear from others who have crossed the hurdle. The other noteworthy features are monthly discussions on a health science education topic with two first year and second year fellows moderating. The exercise of summarizing the discussions by year 1 fellows and writing a scholarly report on the month's deliberations by year 2 fellows teach and strengthen fellow's ability for scholarly writing. The requirement to prepare an abstract of one's project for submission to Medical Education or South-East Asian Journal of Medical Education reinforces writing skills.

The program has certain weaknesses which have to be addressed also. In the Indian FAIMER institutes Indian fellows predominate. Fellows from other South Asian countries are not well represented. To address this FAIMER institutes can be started in other countries or more representation provided to fellows from other countries in existing institutes. Clinical faculty and teachers from other programs are less. There are discrepancies in facilities provided to Philadelphia and regional institute fellows which have to be addressed. Regional institutes should start Masters in Health Professions Education and other programs to meet continuing educational needs of fellows …

PR Shankar PR

KIST Medical College, Lalitpur, Nepal

S Bhandary

Patan academy of Health Sciences, Lalitpur, Nepal

Correspondence: Dr. P. Ravi Shankar

P.O. Box 14142

Kathmandu

Nepal

E-mail: [email protected]

Notes

*E-mail: [email protected]