Attendings Compare Learners To Each Other, Not To A Fixed Standard

In this elegant and provocative study, investigators asked attending physicians to score videos of residents with “borderline” clinical performance on a mini-CEX under two different circumstances, after seeing several good trainee videos, or after seeing several bad trainee videos. The prior exposure had a large effect on the grades given the “borderline” performances. For example, attendings gave failing grades to 55% borderline trainees after viewing good performances but to only 24% after viewing poor performances. This difference is concerning if these evaluations were to be used for high-stakes decisions. Evaluators in this study were not trained in grading the mini-CEX, but this might improve the results.—Laura Willett, MD

Yeates P et al. Effect of Exposure to Good vs Poor Medical Trainee Performance on Attending Physician Ratings of Subsequent Performances. JAMA. 2012;308(21):2226-2232

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