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Putting the Cart Before the Horse: Learner Satisfaction and Faculty Promotion

Karly Pippitt, MD, University of Utah; David Norris, MD, University of Mississippi Medical Center

An article published in 2013 titled “Why Rating Your Doctor Is Bad for Your Health” discussed evidence that patient satisfaction scores do not have a positive correlation with quality of care. Evidence suggests that highly rated physicians may have worse patient outcomes at a greater cost. Too many patients believe they see physicians to get what they want, such as antibiotics or pain medications, rather than to consult with an expert to improve their health. We agree with the authors that more information about patient outcomes is needed to determine if patient satisfaction should be a significant determinant of physician quality and by extension, physician pay. And this got us thinking:

Have we created the same situation in medical education?

Learner satisfaction, like patient satisfaction, may have as much, or more, to do with fulfilling personal desires as it does with professional training needs. Obtaining feedback from students about the quality of teaching is an important part of being a medical educator; however, students need to understand that often these comments are being used for more than just feedback to the lecturer; they are used in the promotion and tenure (P&T) process.

Feedback from students can often take a personal tone that does not provide any constructive information for an educator to act upon; for example, one of us received a comment that said the faculty member “made no effort to teach us. I barely managed the course only because of all the extra time I personally put in.” Of note, this was part of a self-directed learning experience. Some comments can be painful to read but when put in perspective are unprofessional in nature and show a lack of insight on the part of the student. Personal pain aside, this type of comment can pose problems when reviewed by department chairs and P&T committees. In particular, committee members may have little to no personal knowledge of candidates for promotion, and student evaluations can be a large part of their impression of the candidate’s teaching, and by extension, their appropriateness for promotion. Comments like the one above do not represent a thoughtful evaluation of teaching quality.

Students should be held accountable for the content of their evaluations, while also having their anonymity protected from those grading them. As students often feel their faculty are harping on them about being professional, it is imperative for upper-class students and faculty to model this behavior and deans to let students know that inappropriate feedback will not be sent to faculty. If deans are going to be discarding unhelpful feedback, faculty and administration need to educate students about what is helpful criticism. Demonstrating to learners the impact of their feedback may empower students to provide more thoughtful feedback to help improve teaching quality, rather than focusing on personal needs, such as pressuring faculty for a better grade. Administration should also seriously consider removing unprofessional comments that lack merit in a faculty member’s P&T file. It might also be helpful to include reviews by other faculty members of a colleague’s teaching for a more complete view of the medical educator’s skill set as part of their P&T files. Further, we propose an independent review of unprofessional comments by someone from the Dean’s office or an Office of Professionalism. A faculty member would face serious professional repercussions if she or he used profanity in a student evaluation or made personally derogatory comments. Why should our students be held to a lower standard?

Evaluations and feedback are an important part of continually improving ourselves as physician educators. Let’s work on improving the quality information gained such that we no longer have to dread reading evaluations and instead can use them for their intended purpose.

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