Introduction

In the context of competency-based medical education, poor student performance must be accurately documented to allow learners to improve and to protect the public. However, faculty may be reluctant to provide evaluations that could be perceived as negative, and clerkship directors report that some students pass who should have failed. Student perception of faculty may be considered in faculty promotion, teaching awards, and leadership positions. Therefore, faculty of lower academic rank may perceive themselves to be more vulnerable, and therefore be less likely to document poor student performance. This study investigated faculty characteristics associated with low performance evaluations.

Method

The authors analyzed individual faculty evaluations of medical students who completed the third-year clerkships over 15 years using a generalized mixed regression model to assess the association of evaluator academic rank with likelihood of a low performance evaluation (LPE). Other available factors related to experience or academic vulnerability were incorporated including faculty age, race, ethnicity, and gender.

Results

The authors identified 50,120 evaluations by 585 faculty on 3447 students between January 2007 and April 2021. Faculty were more likely to give LPEs at the midpoint (4.9%), compared to the final (1.6%), evaluation (OR=4.004, 95% CI (3.59, 4.53); p<0.001). The likelihood of LPE decreased significantly during the 15-year study period (OR=0.94 (0.90, 0.97); p< 0.01). Full professors were significantly more likely to give a LPE than assistant professors (OR=1.62 (1.08, 2.43); p=0.02). Women were more likely to give LPEs than men (OR=1.88 (1.37, 2.58); p 0.01). Other faculty characteristics including race and experience were not associated with LPE.

Conclusions

The number of LPEs decreased over time and senior faculty were more likely to document poor medical student performance compared with assistant professors.