Difficulty with negative feedback: Face-to-face evaluation of junior medical student clinical performance results in grade inflation

Hypothesis. Direct, face-to-face feedback regarding a medical students' clinical performance will not increase critical, objective analysis of their performance. Methods. A new ward evaluation system (NS) was used concurrently with our standard written ward evaluation system (OS). The two methods were directly compared using a standard t test. The OS is a subjective written evaluation of clinical performance, with a summary grade of 1-6 given as a final grade, with 1 = fail and 6 = honors. The NS retains the 1-6 grading scale; however, students met with individual faculty and residents and received a face-to-face evaluation of their performance, as well as a written summary. Twenty-four third-year medical students rotating on general surgery at the University of Michigan Medical Center participated in the study. Results. There was a significant degree of grade inflation with the NS, particularly for students with poorer performance. The average grade using the OS was 5.11 +/- 0.11; with the NS, the average grade was 5.62 +/- 0.07 (P < 0.001). If students with grades of 5.0 or less in the OS are studied, then the average grade using the OS is 4.24 +/- 0.32, in contrast to 5.47 +/- 0.14 with the NS (P < 0.005). An additional interesting finding was noted: among the students who failed to participate in the face-to-face interviews (n = 4), the average grade using the OS was 4.36 +/- 0.29 (P < 0.05 vs OS total). Conclusions. While students desire more timely, direct feedback on their clinical performance, faculty are poor at giving direct, objective, face-to-face feedback, particularly when it involves negative feedback, with resultant grade inflation. (C) 2000 Academic Press.