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      Relationship Between Peer Assessment During Medical School, Dean’s Letter Rankings, and Ratings by Internship Directors

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          Abstract

          Background

          It is not known to what extent the dean’s letter (medical student performance evaluation [MSPE]) reflects peer-assessed work habits (WH) skills and/or interpersonal attributes (IA) of students.

          Objective

          To compare peer ratings of WH and IA of second- and third-year medical students with later MSPE rankings and ratings by internship program directors.

          Design and Participants

          Participants were 281 medical students from the classes of 2004, 2005, and 2006 at a private medical school in the northeastern United States, who had participated in peer assessment exercises in the second and third years of medical school. For students from the class of 2004, we also compared peer assessment data against later evaluations obtained from internship program directors.

          Results

          Peer-assessed WH were predictive of later MSPE groups in both the second ( F = 44.90, P < .001) and third years ( F = 29.54, P < .001) of medical school. Interpersonal attributes were not related to MSPE rankings in either year. MSPE rankings for a majority of students were predictable from peer-assessed WH scores. Internship directors’ ratings were significantly related to second- and third-year peer-assessed WH scores ( r = .32 [ P = .15] and r = .43 [ P = .004]), respectively, but not to peer-assessed IA.

          Conclusions

          Peer assessment of WH, as early as the second year of medical school, can predict later MSPE rankings and internship performance. Although peer-assessed IA can be measured reliably, they are unrelated to either outcome.

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          Most cited references17

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          Disciplinary action by medical boards and prior behavior in medical school.

          Evidence supporting professionalism as a critical measure of competence in medical education is limited. In this case-control study, we investigated the association of disciplinary action against practicing physicians with prior unprofessional behavior in medical school. We also examined the specific types of behavior that are most predictive of disciplinary action against practicing physicians with unprofessional behavior in medical school. The study included 235 graduates of three medical schools who were disciplined by one of 40 state medical boards between 1990 and 2003 (case physicians). The 469 control physicians were matched with the case physicians according to medical school and graduation year. Predictor variables from medical school included the presence or absence of narratives describing unprofessional behavior, grades, standardized-test scores, and demographic characteristics. Narratives were assigned an overall rating for unprofessional behavior. Those that met the threshold for unprofessional behavior were further classified among eight types of behavior and assigned a severity rating (moderate to severe). Disciplinary action by a medical board was strongly associated with prior unprofessional behavior in medical school (odds ratio, 3.0; 95 percent confidence interval, 1.9 to 4.8), for a population attributable risk of disciplinary action of 26 percent. The types of unprofessional behavior most strongly linked with disciplinary action were severe irresponsibility (odds ratio, 8.5; 95 percent confidence interval, 1.8 to 40.1) and severely diminished capacity for self-improvement (odds ratio, 3.1; 95 percent confidence interval, 1.2 to 8.2). Disciplinary action by a medical board was also associated with low scores on the Medical College Admission Test and poor grades in the first two years of medical school (1 percent and 7 percent population attributable risk, respectively), but the association with these variables was less strong than that with unprofessional behavior. In this case-control study, disciplinary action among practicing physicians by medical boards was strongly associated with unprofessional behavior in medical school. Students with the strongest association were those who were described as irresponsible or as having diminished ability to improve their behavior. Professionalism should have a central role in medical academics and throughout one's medical career. Copyright 2005 Massachusetts Medical Society.
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            Failure to fail: the perspectives of clinical supervisors.

            Clinical supervisors often do not fail students and residents even though they have judged their performance to be unsatisfactory. This study explored the factors identified by supervisors that affect their willingness to report poor clinical performance when completing In-Training Evaluation Reports (ITERs). Semistructured interviews with 21 clinical supervisors at the University of Ottawa were conducted and qualitatively analyzed. Participants identified four major areas of the evaluation process that act as barriers to reporting a trainee who has performed poorly: (1) lack of documentation, (2) lack of knowledge of what to specifically document, (3) anticipating an appeal process and (4) lack of remediation options. The study provides insight as to why supervisors fail to fail the poorly performing student and resident. It also offers suggestions of how to support supervisors, increasing the likelihood that they will provide a valid ITER when faced with an underachieving trainee.
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              Peer assessment of competence.

              This instalment in the series on professional assessment summarises how peers are used in the evaluation process and whether their judgements are reliable and valid. The nature of the judgements peers can make, the aspects of competence they can assess and the factors limiting the quality of the results are described with reference to the literature. The steps in implementation are also provided. Peers are asked to make judgements about structured tasks or to provide their global impressions of colleagues. Judgements are gathered on whether certain actions were performed, the quality of those actions and/or their suitability for a particular purpose. Peers are used to assess virtually all aspects of professional competence, including technical and non-technical aspects of proficiency. Factors influencing the quality of those assessments are reliability, relationships, stakes and equivalence. Given the broad range of ways peer evaluators can be used and the sizeable number of competencies they can be asked to judge, generalisations are difficult to derive and this form of assessment can be good or bad depending on how it is carried out.
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                Author and article information

                Contributors
                +1-585-2734323 , +1-585-2733290 , Stephen_Lurie@urmc.rochester.edu
                Journal
                J Gen Intern Med
                Journal of General Internal Medicine
                Springer-Verlag (New York )
                0884-8734
                1525-1497
                11 January 2007
                January 2007
                : 22
                : 1
                : 13-16
                Affiliations
                Office of Educational Evaluation and Research, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 601, Rochester, NY 14624 USA
                Article
                117
                10.1007/s11606-007-0117-4
                1824780
                17351836
                90bed319-820b-4a2a-a73d-d39c5c73759d
                © Society of General Internal Medicine 2007
                History
                Categories
                Original Article
                Custom metadata
                © Society of General Internal Medicine 2007

                Internal medicine
                undergraduate medical education,assessment,professionalism
                Internal medicine
                undergraduate medical education, assessment, professionalism

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