Clinical Training Translating to Clinical Excellence

Clinicians who are authentically committed to clinical excellence feel a responsibility to train those coming up behind them. These efforts include teaching, coaching, mentoring, giving feedback, and completing evaluations. Evaluating learners isn’t straight forward and can be easily influenced by our biases. Here’s a common story that illustrates this, followed by my tips for how to avoid biases when evaluating learners.

A common story

A senior resident had just finished her first month as an upper-level resident on the inpatient service. The narrative comments on her evaluation read, “Compassionate resident who devotes substantial time to patients. Good fund of knowledge. Could be more assertive.” She was a little disappointed to read “good fund of knowledge.” She’d sent articles to the team most days on content that she looked up to guide clinical decisions—“good” didn’t seem like a fair descriptor. And what did the attending mean by “could be more assertive?” She’d worked carefully with her team to craft plans for all of their patients and supported her students and interns. She felt confident in her team management. Why did the attending think she wasn’t “assertive” enough?

The unfortunate truth

This story demonstrates a common problem in evaluations—bias. Studies show systematic bias in the language we use to describe students, residents, and faculty in evaluations and letters of recommendation. This occurs because of cultural stereotypes and expectations that are based in gender, race, and/or ethnicity. None of us are free from biases, sometimes even about our own gender or race. This isn’t about us disapproving of others. It’s about us not recognizing how social norms frame our interpretations of behaviors.

What we can do

All of us need to work to avoid bias and stereotypes, especially when evaluating others. It’s difficult to completely avoid bias given that they were formed based on years of social norms. However, we can work to recognize and mitigate our biases using the steps below.

1. When writing evaluations, describe behaviors, not your interpretation of them.

Instead of saying that a resident wasn’t “assertive” enough, describe why you thought that and reflect on potential reasons. Did the resident not give input during team discussions? Or agree with any alterations you made to the plan? Maybe the resident preferred to let the students/interns lead discussions about their patients. Or maybe the resident grew up in a culture that values deference to elders. You can explore this in your verbal feedback session with the trainee.

2. Comment on all core competencies.

Women tend to get more feedback on communal characteristics like compassion, dependability, and hard work, rather than on knowledge and ability. To give more balanced feedback, comment on all competencies.

3. After writing your evaluation, try to read it through the lens of another gender, race, or ethnicity. If you’re unsure, you could ask a colleague for feedback.

After, consider rephrasing comments that need revision.

4. Look at a list of common “biased” words to ensure you avoid common stereotypes.

There are many resources that highlight how certain words or characteristics may contribute to common stereotypes. This guide from the University of California San Francisco is helpful. And you can even copy and paste your narrative in this website to see if your language is gender-biased.

Being aware of our biases will help us not only in our interactions with learners, but also in our interactions with patients. Studies show that care differs for individuals of different genders, races, and ethnicities because of these biases. We all have bias. The important thing is that we recognize it and mitigate it.

This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.