279- Make sure all faculty are trained in good feedback skills and encouraged to give
frequent real-time feedback to learners. This helps the faculty rater recall obser-
vations and reduces the potential for the resident to be surprised in the event
deficits are identified. - Ensure that rating forms are short and only include items that raters can actually
observe and assess. - Familiarize all raters with the rating instrument and the expected standards of
performance associated with each level on the rating scale. - Provide raters with convenient access to evaluation instruments as close to the
end of the evaluation period as possible. - Do not ask individual faculty members to make pass-fail assessments. Ask
them only to provide quality ratings about performance for the CCC and pro-
vide written details to support the ratings. - Analyze resident ratings in context (i.e., compare with historical average rat-
ings for past residents at the same level of training) and longitudinally (look for
trends in ratings over time). - Utilize the CCC for all resident progress decisions, reviewing all data. If perfor-
mance deficits are identified, act on them in a prompt and fair manner.
In addition to being frustrating for the faculty and program director, it is very
confusing for a resident to be counseled about underperformance after having
received several months or more of satisfactory rotation evaluations. In many pro-
grams, residents routinely receive copies of their rotation evaluations, but not all of
the other assessment data points, or updates on early CCC concerns. This can create
a situation in which the resident enters serious discussions about their performance
or even their progress in the program, with the belief that the process is unfair or the
decisions are being made on a basis other than clinical performance, such as person-
ality conflict or discrimination. It is never useful to have a conversation about the
vagaries of competency-based assessment at this point. While there are no easy
solutions to this dilemma, these steps can help residents maintain a more complete
picture of their progress:
- At orientation and frequently thereafter, educate residents about all assessment
instruments and processes utilized by the CCC. - Ensure that residents are getting frequent and focused feedback, so any discus-
sion about underperformance is not unexpected. - Make sure residents have access to all of the assessments in their file, not just
rotation evaluations.
Underperforming residents may come to attention either because of specific
behaviors or lapses or poorly differentiated concerns on the part of supervisors. The
first step is to gather information to more fully define the problem. When a resident
is early in training and the concerns are not impacting patient care, it can be tempt-
ing to view them as growing pains, hoping the resident improves. However, this is
not in the resident’s or the program’s best interest. Even with a minor lapse,
17 Optimizing Success for the Underperforming Resident