Background: Attending evaluations by medical students have many implications including promotion, teaching opportunities, job satisfaction and reputation both for individuals and for groups. In addition to teaching on traditional ward teams with housestaff and students, hospitalists are more commonly teaching in an apprenticeship model, where an attending, often carrying a full census, directly supervises and teaches one or more medical students without housestaff. Little is known about whether the structure of the medicine clerkship rotation affects attending evaluations. We sought to determine whether teaching evaluations from third year medical students (MS3) is influenced by clerkship structure.

Methods: Attending evaluation data from third year medical students was extracted from the UTSW School of Medicine database for the 2016-2017 academic year. Hospital Medicine faculty who attended on both traditional ward and direct with MS3 clerkship rotations were identified. Means and medians were determined for the 17 measures on which attendings are evaluated. The students t-test was used to determine p-values.

Results: There were 23 direct with MS3 evaluations and 39 traditional ward team MS3 evaluations of hospital medicine faculty who attended in both clerkship structures. Mean scores for all measures except for facilitating duty hour adherence (no difference) was worse for the same faculty when teaching MS3s directly (Table). While differences in most measures did not reach statistical significance, teaching of resource utilization was statistically significant (p=0.03) and there was a clear towards statistical significance in most measures. The median score for all measures for both team structures was 8.

Conclusions: These data suggest that hospital medicine faculty receive worse evaluations when on direct with MS3s clerkships. Despite the limited number of evaluations in this analysis, with one measure reaching statistical significance and many others approaching statistical significance, larger samples should be studied to confirm or refute these results. Medians did not demonstrate differences amongst clerkship structures, suggesting outlier effects. Medians may be a better measure of central tendency.

Clerkship structure should be taken into account when compiling and comparing individual attending evaluations. Likewise, when comparing groups of faculty, proportion of evaluations with traditional as compared to direct with MS3 clerkships should be considered. Understanding the reasons for these discrepancies and evolving the direct with MS3 clerkship rotation to reduce or eliminate structural disadvantages in teaching and evaluation are also indicated.

IMAGE 1: Table. Attending Evaluations in Traditional Ward Teams Compared to Direct with MS3 Rotations