Anonymous Evaluations: Helpful or Hurtful?

If you are in medicine, you are probably quite familiar with the process of writing and collecting online evaluations that are anonymous and generally unhelpful. (I’m sure this is true of many other professions too, but my only experience with them is in medicine.) They do form the bulk of our MSPEs (short for medical student performance evaluations) and later for other self-promotion when looking for a job, but are they actually helpful in practice?

First, let’s talk about why positive evaluations are nice but not helpful. Everyone gets to cherry pick their best comments to showcase how great they are when sending them out for review, so out of the many applications I’ve read for both med school and residency candidates, I’ve seen one mildly negative comment. One. Ever. And they framed it in a way that showed the person had addressed a shortcoming based on in-person feedback, so in the end it was actually nice and demonstrated how important real life communication is. The anonymity of online evaluations does nothing to improve performance, and by their nature it is difficult to use them to stratify applicants. If the evaluation is written about you, it makes you feel good about yourself for a minute and maybe even a little complacent, but the vast majority of evaluations are generic and non-specific, something along the lines of “Elizabeth has an excellent fund of knowledge for her level of training and was a pleasure to work with on a busy service.” We’ve all gotten that exact comment on more than one occasion, and according to the numerical component of our evaluations we are all above average. But that’s just not how math (or life) works!

I know I am not alone in my frustration about the Embarrassment of Riches awarded to medical trainees in that they are difficult to wade through and often rather superfluous. The linked article comes from the Journal of Pediatrics (Rockney, 2014) and is written by someone who is both a clerkship director and a residency selection committee member. What are we achieving with our overabundance of positive comments?

Conversely, negative evaluations given behind a veil of secrecy have the power to be really hurtful. Although I’ve been fortunate to mostly avoid negativity in evaluations I’ve received, I exist in the real world and therefore there have been occasions where I’ve been on the receiving end of rude or thoughtless criticism. They come from people I’ve worked with who haven’t given me any face-to-face feedback but then weeks or months later drop an anonymous comment that makes me feel really terrible about myself, just because there is a compliance deadline and they feel some sort of clerical urge to put pen to paper. It’s confusing when all other evaluations from the rotation are positive and then this one person takes it upon him or herself to let you know they think you suck. It leaves you wondering who you rubbed the wrong way and makes you wary of anyone who could have been the author. It has the potential to poison you against a large group of people and that is not a healthy dynamic to create between people working together to save lives.

Regardless of the positive or negative nature of the feedback, in written documentation, there is also some gender bias and differences in terminology used based on the gender of the student being described. There was a very interesting article published recently in Academic Medicine (Riese et al, 2017) discussing the differences between the way male and female medical students are described, in addition to the differences between the way male and female evaluators grade their students differently.

This year I stopped turning in evaluations about my co-residents and our fellows/attendings and I am not apologizing for it. It has really given me more confidence in giving face-to-face constructive criticism and genuine compliments to the people I work with for up to 80 hours a week at a time, and I would encourage more individuals and programs to consider supporting this approach. It also gives me the feeling of a clean conscience when one of my co-residents receives a negative evaluation – they know it wasn’t from me and they know if there was something I felt I needed to address with them that I would have respected them enough to have done it without hiding behind the internet. I’ve also made the decision to stop reading things that are written about me, with the expectation that the people I work with would have a similar level of respect for me and would help me improve my patient care skills by having meaningful human interaction. (As a bonus, I save a lot of time staring at a computer screen.)

What do you think? How do you handle rude commentary from someone you’re supposed to trust and feel supported by? Do the potential benefits of written performance evaluations truly outweigh the cons of secretive and generic feedback practices?

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