Misperceptions and Missed Opportunities: A Qualitative Analysis of Barriers to Evaluating Surgical Teachers

Teaching skills can be improved with written evaluations from learners. In addition to this primary purpose, teaching assessments are used in other aspects of faculty development including appointments, advancement and in some cases, compensation. Surgical trainees' willingness to provide meaningful assessments of their teachers is variable but the reasons for this are ill-defined. This study aims to elucidate surgical residents' perceptions regarding barriers to providing useful feedback to their teachers.

A qualitative, semi-structured confidential interview approach was used. A demographically diverse cohort of surgical residents in an urban university-based program was invited to participate. Interviews explored experiences and perceptions of teaching assessments. Specific attention was paid to understand perceptions of barriers; topics including utility, anonymity, time burden, and others were explored. Interviews were transcribed verbatim with identifiers removed from transcripts before analysis. All data was double coded to ensure accuracy with the development of a codebook until thematic exhaustion was reached.

Yale New Haven Hospital is an academic, university-based medical center with approximately 70 residents in the general surgery program and approximately 170 surgical faculty.

A total of 21 residents completed individual or small group interviews. A theoretically driven sampling technique was used to recruit participants and maximize diversity. Individuals with varying backgrounds including PGY year, gender, age, IMG status, race, academic rank, research background and surgical division were asked to participate.

A total of 21 residents completed individual or small group interviews. Coding and analysis revealed 4 principal motifs: (1). Process- The process to complete assessment instruments is time-consuming and cumbersome to complete during the busy and acute surgical workday while failing to accurately address important aspects of surgical teaching. (2). Utility- Respondents reported uncertainty as to the downstream utility of the assessments, and a lack of confidence that the assessments would be used for faculty growth and improvement. (3). Resident Standing- Respondents described a lack of training, knowledge, skills, and empowerment to assess their teachers. (4). Perceived Consequences- Residents noted concern for identification, future autonomy, and other potential negative career consequences due to small resident sample sizes, recognizable experiences with attendings, and perceived power dynamics.

This study elucidates the perceptions of surgical trainees regarding barriers to providing feedback and assessments of their faculty. Although limited to a single-institution study, residents observed the current system does not allow for honest and accurate evaluations of surgical teachers. The extensive overlap between motifs highlights the need for a holistic approach to address these interconnected themes before teaching evaluations can be honest and productive. Importantly, it is also the first to identify residents' perceived lack of skill and sense of disempowerment to provide constructive faculty assessment. Due to the limited scope of the single-institution study, further verification and studies are needed to improve the quality of faculty feedback and assessment of surgical teachers.