Factors Influencing Evaluation Completion During Emergency Medicine Sub-internships: A Multi-site Observational Study

Clinical rotation assessments are essential for evaluating student competencies, guiding feedback, and determining readiness for residency. Equitable sub-internship evaluations rely on complete and representative input from supervising attending physicians and senior residents. However, it remains unclear whether evaluation completion varies based on evaluator or student characteristics. This study examined completion rates of on-shift evaluations during emergency medicine (EM) sub-internships at two affiliated academic sites and assessed whether evaluator and student factors were associated with differences in evaluation completion.

A retrospective observational study was conducted across two level 1 trauma centers affiliated with a single EM residency program during the 2023-2024 academic year. All sub-internship students (n = 56) were included. After each shift, students invited supervisors to complete an online evaluation. Variables included evaluator gender, professional rank, clinical sites, and student gender. The primary outcome was evaluation completion rate. Descriptive statistics and 95% confidence intervals (Wilson method) were reported. Group differences were analyzed using Pearson's chi-square and Fisher's exact tests.

A total of 56 students distributed 1,038 evaluation invitations, of which 658 (63.4%) were completed. Completion rates differed significantly by evaluator type, with residents completing 187 (74.5%) of 251 evaluations and advanced practice providers completing 10 (55.6%) of 18 evaluations (χ² = 21.65, p = 0.003). Evaluator gender was also associated with response rate: female evaluators completed 272 (67.5%) of 403 evaluations, compared to male evaluators who completed 386 (60.8%) of 635 (χ² = 4.49, p = 0.034). Completion rates were higher at the university-based site, with 392 (67.8%) of 578 evaluations completed, compared to 266 (57.8%) of 460 at the community-based site (χ² = 10.60, p = 0.001). No significant differences were observed by student gender: 262 (64.5%) of 406 evaluations were completed for women, and 393 (62.7%) of 632 for men (χ² = 0.30, p = 0.585).

Evaluation completion during EM sub-internships varied by evaluator type, evaluator gender, rotation site, student degree type, and rotation month, but not by student gender or specialty interest. These findings identify practical targets for improving equitable and representative evaluation practices. Generalizability is limited by single-program design, and multi-institutional studies are warranted to further explore these trends.