Point-of-Encounter Assessment: Using Health Belief Model Constructs to Change Grading Behaviors

Abstract

Objective: Fourth-year medical students need feedback to improve. Even during 1-month rotations, there needs to be a formal mid-clerkship feedback session. Better feedback involves multiple surgical evaluators at multiple levels. Constructs from the Health Belief Model of behavior change were used to assess faculty and resident grading behaviors to create a more usable evaluation system. A point-of-encounter (POE) system was created. The objective of this study was to review the efficacy of a POE clinical evaluation card (CEC) system which was initiated to increase evaluator’s participation in grading and formative feedback prior to mid-clerkship evaluation. Design: The study was a 1-year retrospective cohort study reviewing the CECs for level of evaluator, content, and student compliance. A Likert-type scale survey regarding the usage of the clinical cards was also completed by evaluators. Setting: Texas Tech University Health Sciences Center at El Paso, during 2 fourth-year medical student rotations, Subinternship (Sub-I), and Surgical Intensive Care Unit (SICU). Participants: 34 fourth-year medical students and 20 evaluators. Results: Students turned in a mean of 10 cards, 75% in SICU and 65% in Sub-I turned in all 10 cards. There were significantly greater advanced residents evaluating during Sub-I vs SICU: mean evals by PGY3 were 1.9 vs 0.75 ( p = .01) and mean evals by PGY5 were 1.4 vs 0.1 ( p < .0001). There were significantly more faculty completing evaluations during SICU vs Sub-I: 2.5 faculty evals/student vs 1.4 faculty evals/student ( p = .023). Evaluator ratings were high on a 5-point Likert-type scale, with most responses near the “strongly agree” rating of 4.7 to 4.8. Conclusions: Use of POE CECs met goals of having at least 7 CECs turned in by mid-clerkship and 10 at end-clerkships. Formative evaluations by mid-clerkship went from 0 to 7 evaluations. Evaluator surveys highlighted clarity and efficiency as reasons for using CECs.