Table 3 Characteristics of Narrative Comments from study of association of Gender and Resident Race and Ethnicity with Narrative Comments from Internal Medicine Resident Performance Assessments
Level & Description | Illustrative Examples |
|---|---|
Valence | |
Very Strong Praise Very strongly positive, very high praise | “In 23 years of working with residents I would place (First Name) in TOP 5% of all residents I have worked with. They are an exceptional physician and young person.” Overall Comment, Man PGY2 resident “Chief Resident material.” Overall Comment, Man PGY1 resident “(First Name) is an outstanding intern. I usually expect such excellent performance in May rather than in November. They have an advanced fund of knowledge. They are thorough, meticulous, has great differentials and plans. They are also very professional and compassionate. (First Name) leads family discussions well beyond their training. It was a pleasure to work with them. They are also helpful to their teammates and shows leadership skills. (First Name) would make a great chief. (Areas for improvement) None. Keep going on your path.” Strength and Areas for Improvement Comment, Woman PGY1 resident “(First Name) is a phenomenal team leader, incorporating every member of the team into the patient’s care plan as well as any educational opportunities. Differential diagnoses were complete and appropriately prioritized.” Strength and Areas for Improvement Comment, Man PGY3 resident “Dr. (Last Name) was an outstanding role model and an excellent team leader. They functioned at the level of an attending and made smart decisions about patient care. They demonstrated their perfect combination of art and science in their care of their patients. they are a compassionate caregiver. I appreciated the opportunity to work with them and to learn from them.” Strength and Areas for Improvement Comment, Woman PGY3 resident “Always the utmost professional.” Competency Specific Comment, Man PGY3 resident “Dr. (Last Name) is an exemplary intern, hard-working, professional, compassionate, and efficient, in the top 10% of interns I have taught. Their case presentations were particularly notable - organized and efficient with a clear logical progression and transparent clinical thinking. They also showed keen sensitivity, asking a patient if they could disclose medical information to the patient’s interested friend. Overall, a real pleasure to have on our team.” Overall Comment, Woman PGY1 resident |
Strong Praise Strongly positive, high praise | “Excellent resident! They prepared the interns very well for daily rounds and H and P presentations. Very knowledgeable and reliable, they knew the census well and always followed up. They were willing to take on extra responsibilities and kept family informed. I would love to work with them again in the future.” Overall Comment, Woman PGY2 resident “(First Name) overall had an extremely good month as an intern on July (rotation). They knew all the patients on the team, not just their own patients. They had a plan for every patient and challenged themself by looking up any answers they did not know. Really they are performing above the level expected. They should continue to work just as hard throughout residency- will be a very, very good resident.” Overall Comment, Man PGY1 resident “(First Name) performed in an excellent fashion during our time together. They were thorough, organized, efficient and always level-headed and committed to doing their best. They are very bright, with an above average fund of knowledge. They made excellent progress in adapting to bedside presentations and making their notes and presentations more concise in response to feedback. They had excellent rapport with the rest of the team and the staff. They are off to a great start! Keep working on efficiency and presentations and notes (these are not problems, just areas they can get better given this is just their second month). Work on confidence and seeking more independence as the year progresses (same comment as above). Don’t be too hard on yourself. You did a great job this month.” Strength and Areas for Improvement, Man PGY1 resident “Excellent job in patient care.” Competency Specific Comment, Woman PGY3 resident |
Praise Fairly positive, mild to moderate praise | “(First Name) is progressing appropriately. They are working on improving their efficiency and their knowledge base. They are a good team player and helps teach the medical students. They completed medical records in a timely fashion, with appropriate detail.” Overall Comment, Woman PGY1 resident “Overall, a very solid resident with good knowledge, judgment and people skills.” Overall Comment, Man PGY3 resident “Dr. (Last Name) is performing at the level expected for their first month on inpatient service. They obtain accurate history and physical. Their medical knowledge is at the level expected for their training. They can continue to expand their medical knowledge through reading and clinical experience. They were reliable to follow-up on patient care during the day. Overall, they did well during this rotation.” Overall Comment, Woman PGY1 resident “Very good fund of knowledge, strong data gathering and communication skills, strong ability to formulate a treatment plan -- all reasonably advanced for a first month PGY2. Took on the mantle of team leader comfortably and with confidence. Interns went out of their way to tell me that they enjoyed working with them, and that they created the right balance of oversight and autonomy. Also, took time out to praise team members when they did things right, a nice thing to do.” Strengths and Areas for Improvement Comment 6048 “(First Name) was a great intern. They have a good fund of knowledge with no deficits. They are also adept at communicating with patients and handling very difficult patients, without compromising appropriate and good care. I enjoyed working with them and they will be a very good resident.” Strengths and Areas for Improvement, Woman PGY1 resident “(First Name) did a nice job coordinating care for their patients and employing the assistance of other health care providers.” Competency Specific Comment, Man PGY2 resident |
Neutral Neutral, mix praise and criticism | “Cheerful July Intern who will improve as they gain confidence and clinical knowledge bolstered by intensive study.” Overall Comment, Man PGY1 resident “(First Name) is a warm, earnest, and hard-working intern. I very much enjoyed getting to know and work with them. They have a flare for language and is funny. They are kind at the bedside and always willing to take on tasks. They are an eager learner and engages easily. (First Name)’s work-ups and presentations remain somewhat disorganized and their presentations still lack a flow and cohesiveness that would help the listeners understand their thinking process. They took feedback well about these issues. I think with some further directed and focused work in this area, they will catch up quickly.” Overall Comment, Man PGY1 resident “Dr. (Last Name) did well for it being only their second month of residency and being on a difficult service. I am certain with time, they will become an excellent independent physician. Dr. Last Name could expand on their fund on knowledge - particularly in regards to recognizing when patients worsen rather than improving. Also on that note, they could work to be proactive rather than reactive in patient care.” Strength and Areas for Improvement, Man PGY2 resident “Efficient, pleasant to work with. Would benefit from more exposure to patients as expected at this stage of career development.” Strength and Areas for Improvement, Man PGY1 resident “(First Name) was open to feedback which I provided but did not necessarily solicit my feedback. I did not observe them soliciting feedback from the interdisciplinary team with whom they worked, so I cannot comment on that aspect of their commitment to improve through feedback.” Competency Specific Comment, Man PGY2 resident |
Critical Negative tone, criticism, may include red flag(s) about performance | “Can handle straight forward problems; when there are complicating factors sometimes doesn’t use all the data available and concentrates on the data that reinforce their ideas and does not account for conflicting info.” Competency specific comment, Man PGY2 resident |
Specificity | |
Non- specific References 0 core competencies | “(First Name) is ready to be a resident. As a resident they will have the opportunity to teach more and lead teams, and they are ready for that next step.” Overall Comment, Woman PGY1 resident “Only needs continued experience - is doing everything well for their level.” Strengths and Areas for Improvement, Man PGY1 resident |
Weakly Specific References 1 core competency | “Overall (First Name) did a great job collecting information, analyzing information, and coming up and implementing the plan.” Overall Comment, Woman PGY1 resident “This is my second time working with (First Name) on the inpatient setting. They are a very strong intern who is transitioning nicely in taking more responsibility for their patients and will be a great senior resident. They are also very organized, efficient, and again takes ownership of their patients.” Strengths and Areas for Improvement Comment, Woman PGY1 “(First Name) did a great job as team leader during our week together. They are an incredibly hard worker who clearly cares deeply about their patients. They could always be relied upon to follow through and do what needed to make sure their patients got their best care possible. (First Name) will clearly continue to do well in their field of choice.” Strengths and Areas for Improvement Comment, Woman PGY3 resident “Excellent work with multidisciplinary team.” Competency Specific comment, Woman PGY1 resident |
Moderately Specific References 2 to 3 core competencies OR includes 1 specific examples of something done well, an area to improve, or action plan for improvement | “Thinks critically about patients and practices evidence-based medicine. Elicits feedback about decision-making for diagnostic and therapeutic plans.” Strength and Areas for Improvement Comment, Man PGY1 resident “Dr. (Last Name) has deep and thorough knowledge of complex medical care. They are also a trustworthy person who relates to team members in an entirely constructive way. They maintain a posture of respect and care for all the people they work with, including their patients.” Strength and Areas for Improvement, Man PGY3 resident |
“(First Name) was wonderful to work with on (rotation). They are thoughtful, patient, kind and a great team player. They connect strongly with patients, is committed to seeing their care through and spending time with them at the bedside. As swing one day they spent most of the morning with a very sick patient on the floor, stepping up to do an ABG and interfacing with ICU several times. (First Name) puts their patients first and is always willing to learn.” Overall Comments, Woman PGY1 resident “Very capable resident who provided good care to patients and families. They did struggle with phone communication with support staff such as nurses and clerks though in person communication with staff was fine.” Overall Comment, Woman PGY1 resident “(First Name) is a strong intern and could easily finish the year with (receiving) minimal constructive feedback. I encouraged them to get around this by being specific about asking for feedback in real time. For example, when staffing an admission, asking “would you recommend I do that differently next time?” or “if I could have done that even better, what would you recommend?” Overall Comments, Woman PGY1 resident | |
Highly Specific References 4 or more core competencies OR includes 2 specific examples of something done well, an area to improve, or action plan for improvement | “Dr. (Last Name) is a highly knowledgeable and efficient intern. They effectively prioritize tasks and navigates the (institution) system to provide the best care for their patients. They promptly complete their clinical notes, which are concise yet always include the key details. They are dedicated to patient care, staying late when necessary, and taking time to communicate effectively with their patients. They were diligent in addressing clinical questions that arose regarding their patients. At the bedside, they always maintain their composure and positive regard for the patient, even in difficult situations.” Overall Comment, Woman PGY1 resident “(First Name) did a great job coordinating care for complex patients and assuring appropriate transitions between the hospital and other settings (outpatient, transfer to outside hospital, etc.). Their diagnostic and management plans are appropriate and complete. They do a great job paying attention to details and making sure everything is follow-up on appropriate. They developed excellent rapport with patients and their families and was always thoughtful and considerate.” Strength and Areas for Improvement Comment, Woman PGY1 resident “Dr. (Last Name) has an excellent fund of knowledge and is able to manage a broad range of clinical issues independently. They identified infectious disease and antibiotic management as a particular area where they need to improve. They have a highly effective approach to learning, systematically addressing clinical questions using point-of-care resources and the medical literature. They went out of their way to teach the medical students, and taught the team about clinical topics almost every day on rounds. Their bedside manner really communicates concern for the patient. They usually sit on the bed, which helps them establish rapport, and allows for long pauses when patients are dealing with strong emotions. Their notes and oral presentations were concise and complete, demonstrating a thorough understanding of the active clinical issues.” Overall Comments, Woman PGY1 resident |