Writing Effective Performance-Based Narrative Evaluations Workshop
Guidelines for Writing Performance-based Narrative Evaluations
Evaluation, is a judgment or calculation about the quality, importance, or value of something; evaluations are formulated and made meaningful in relation to relevant institutions including the departments, schools, and professional communities, and therefore should reflect important features and qualities that are relevant to those communities.
Purposes of evaluation:
Assessment of competence related to expected levels:
Use defined domains to structure your evaluation (ie competencies)
Use specific and relevant areas (e.g. technical/procedural skills)
Effective assessments are written using an explicit framework
Documentation of learner experience
Be concrete about what you observed, e.g., a clinical example, rather than making a general statement on the learner’s overall skill
Comment on anything that is unique or was particularly impressive
Effective assessments report specific, detailed examples that characterize learner behaviors
Feedback for improvement; which requires
plan in place identifying goals to be accomplished,
routine data collection about progress, and
frequent opportunity to discuss clinical learning (learner-teacher)
Effective assessments will (ideally) provide feedback to the learner that is explicit, positive, and corrective
Numeric
ratings are useful to capture performance on a spectrum, but must be
justified by well-written,
performance-based comments.
Performance-based comments are:
Specific,
detailed, and use concrete examples to validate and characterize a
learner’s clinical skills and observed behaviors.
Linked
to the learning objectives and/or competencies:
Patient care skills (history and physical examination, oral presentation, written notes, and procedures)
Medical knowledge, clinical reasoning
Practice-based learning (use of information technology and evidence, ability for self-reflection and improvement)
Interpersonal and communication skills (interactions with patients and families, and the medical team)
Professionalism (in interactions with patients, setting boundaries, accountability and dependability, ethical behavior)
Systems-based practice (ability to successfully navigate health care system)
Useful
tips
Write the entire narrative as one integrated summary that organizes and synthesizes comments. Base the narrative on overall performance by competency domain rather than separately commenting on the learner’s performance in each setting.
Focus on competencies and skills, rather than personality.
Provide specific information about learner performance (history taking, physical exam, oral presentation, clinical reasoning, etc) to validate the overall assessment.
Be consistent with your use of summary superlatives.
Summary comments should be matched to the rating on a corresponding assessment. For a student who received 3 in Fund of Knowledge, avoid saying, “Her knowledge base was above the level of her peers.” and instead say “Her knowledge base was at the expected level.”
We all have a difficult time documenting areas of concern. Concerns about a student’s skills or performance that you think should be documented in the summary evaluation, rather than constructive comments, should be written in performance-based language without personal opinion. Rather than, “Jane feels the need to continually seek approval, and should learn to admit when she does not know the answer,” one might say, “Jane would at times respond to questions with an incorrect answer, and did not often admit when she did not know something.”
Common errors to avoid
Avoid vague generalities without examples. Instead of “Jack is a very personable and bright student” say, “Jack was kind to his patients and eager to help the team. He demonstrated a superior fund of knowledge particularly in the case of a patient with Castleman disease.”
Avoid evaluating the personality, such as likability or enthusiasm. Instead, comment on professional attributes, such as initiative and demonstrating respect.
Do not include constructive comments in the summary comments section. An easy test for this is that comments referring to actions in the future (eg, Jack needs to be better attuned to appropriate moments to ask his questions) belong in the constructive comments section.
Avoid encouraging work hour violations by saying that students came early and/or stayed late; comment instead on hard work, dedication, and/or self-improvement.
Do not include numerical scores on clerkship exams. A qualitative phrase, such as “She performed at the highest level on the exam,” is more descriptive.
Avoid references to grading. Instead of “She would receive Honors if this were an option,” use a qualitative statement such as, “She performed at an outstanding level throughout this two-week rotation.”
Omit references to limited time spent by evaluator with the student, eg, “I didn’t work very much with this student.” Instead comment on what was observed, such as “The patient presentation and topical review I observed were concise yet thorough.”
Avoid praising one student while denigrating others. Instead of “Jane was involved in patient care and truly conscientious in a way that was rare for an MS3 on a two-week rotation,” say “Jane was highly motivated, involved in patient care, and truly conscientious.”
Specific references to career choice are not useful in a performance evaluation (as opposed to a letter of recommendation) either in the positive (“will make a terrific anesthesiologist” “will recruit actively to our residency program”) or in the negative (“for a future PC doc, she demonstrated great procedural abilities”).
Personal factors that are not performance-based should not be included (eg, “despite a death in the family,” “for a student with mobility limitations”).
Comments that are not based on this clinical performance, but rather on other experiences with the learner, should not be included (eg, “I also served as her LCE preceptor, and she did a fantastic job here as well;” “he is also involved in many leadership activities”).
Dropping “a bomb” in the written evaluation, ie, no prior direct discussion of difficult information.
Overused
or problematic phrases or words to use sparingly or avoid:
1. “above and beyond” (overused)
2. “went the extra mile” (overused)
3. “overall” loses its meaning if used repeatedly in one evaluation
4. “came early and stayed late” (gives the message that students work extra hours will receive better grades; undermines duty hours policies)
5. “very” (often it is better to leave this adjective out)
6. “S/he is bright/smart/intelligent” (judgment or opinion, not performance based)
Sample good summary comments
Jane performed in outstanding fashion on the emergency medicine sub-internship. She earned high marks for her fund of knowledge, work ethic, professionalism, and technical ability. Jane participated in all departmental academic activities, and gave an excellent oral presentation on the uses of hyperbaric oxygen therapy at Student Grand Rounds. One of the senior residents commented, “Jane was particularly helpful to the team in carefully coordinating communication with a seriously injured patient’s primary care physician.” This and other comments validated her outstanding team work skills.
Positive aspects: Well synthesized, performance based, specific example of her presentation topic, one verbatim comment to help individualize the evaluation.
Jill’s diligence resulted in a great performance on pediatrics. She had a very good fund of knowledge that she worked to augment by taking the time to read about her patients and specific issues related to their care. She could be depended upon to take excellent histories and perform thorough physical exams, and her presentations were always on target. Jill showed great improvement in synthesis of information and presentation skills and with her kind and honest demeanor put patients at ease with her bedside manner. She was a very hard worker and great team player when things were busy.
Positive aspects: Well synthesized, easy to discern that this student’s performance was at the expected level of competency, all voiced positively. This could easily be contrasted with someone who demonstrated higher levels of competency.
Jack is an enthusiastic, hardworking, motivated team player. He integrated well into the inpatient team, interacted wonderfully with patients, and demonstrated a fund of knowledge that exceeds his peers’ at this level of training. More importantly, he is self-motivated and adeptly incorporates new knowledge from each pediatric experience into his clinical care and decision making. His presentations were concise, focused, and well developed, his documentation was thorough, and he developed great rapport with the medical team. He will be a well-rounded and thoughtful clinician in the field of his choice.
Positive aspects: Well synthesized, Covered a range of competency domains. Gave a sense of fund of knowledge compared to peers without knocking peers. Delved into medical knowledge by describing how he uses new knowledge.
Jane did an excellent job during her neurology rotation. On a very challenging case, she helped the team gather information and presented summaries of her readings. Her neurological knowledge base grew appropriately over the course of the month. During the outpatient clinics, she was able to reliably get a good history and pick up on neurological findings. Comments from the observed neurological examination include, “She performed a well-organized, professional exam on a challenging patient.” Her empathy is outstanding: she frequently spent time with patients at the bedside, listening and providing support, and was often able to facilitate communication of the medical plan to the patient. This wonderful approach will be of value to her as she moves forward in her training.
Positive aspects: Areas where this student is at the expected level of competency and where she really shines are clearly differentiated, conveying confidence that the team knew her well.
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