Role of faculty characteristics in failing to fail in clinical clerkships

Abstract

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 (LPEs). Method The authors analysed individual faculty evaluations of medical students who completed the third‐year clerkships over 15 years using a generalised mixed regression model to assess the association of evaluator academic rank with likelihood of an 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 with the final (1.6%), evaluation (odds ratio [OR] = 4.004, 95% confidence interval [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 an 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.

Dutch dismissal practices: characteristics, consequences, and contrasts in residents’ case law in community-based practice versus hospital-based specialties

“…Presumably, at least some of these residents’ supervisors and programme directors may struggle as well, for example to recognize or acknowledge the resident’s problematic performance, to provide appropriate guidance and remediation [ 17 ], and, as an ultimum refugium, to restrain the practice of residents unapt for their specialty if improvement does not occur. This struggle is referred to as the “failure to fail” problem [ 18 ], mainly described related to regular assessment moments by supervisors of medical school undergraduates [ 19 , 20 ]. Reluctance to address poor resident performance and to act on demerit could ultimately lead to “failing to fail” residents subsequently compromising health care quality [ 21 ].…”

Failure to fail: Fear of retribution or a response to neglecting the learner?

“…In this issue Swails et al 1 give another angle on the ‘failure to fail’ debate. ‘Failure to fail’ has been well documented through a systematic review 2 and is characterised by educators feeling unwilling and/or unprepared to report unsatisfactory trainee performance.…”