In my new position I am required to ask doctors, who work for a university health care system (that includes hospitals), to fill out evaluations on students working to become doctors. In the most recent eight week period (which ended three weeks ago) this amounted to 307 evaluations sent to 117 different doctors; some sent as many as nine weeks ago. I have followed this (so far) with 654 reminders and I am still missing over 100 evaluations; (107). Overall, this is more than 1 in 3 evaluations so far unreturned.

From the other side I have students expressing frustration over the apparent double standard within a system that requires prompt responses from them yet allows doctors they finished working with 8 or 9 weeks ago to continue their boycott of evaluations. The most vocal complaint I have heard from students is that the lack of timely feedback makes it more difficult for them to focus on areas needing improvement.

Though I suppose I am complaining and I definitely would like to see improvement, I believe this to be the norm; typical prioritization for busy and harried professionals. So with that in mind I would like to think my written thought is less frustration and more seeking understanding so we may improve the process.

I understand it often is a matter of perceived priorities and I know that some of the doctors who are guilty of this heedless procrastination are literally making life-altering and life-saving decisions on a daily basis. But I am also quite certain that they are not doing so every moment of every day. When will a 10 minute block of time to fill out an evaluation become a priority? When the Clerkship Director asks? Or the Faculty Director? Or the Dean? Or the University President? If any of these apply, then why not when I ask?

I believe that for a physician to accept a position in a teaching hospital or health care system is to accept a responsibility to the future of medicine. I understand that in a given moment an evaluation may appear to be a small thing, but it speaks to a much larger mindset, and it has a much greater influence on morale and energy and outlook than what it may appear to, in a given moment.

Finally, and certainly of least importance, I am told I should not take this consistent lack of response personally. And I do not take it home with me or lose sleep over it; (at least not much). I consider it a particularly challenging (and at times a particularly frustrating) aspect of the job, but then I have also always been energized by a difficult challenge. When I see more expedient responses from a Director's request though, it is difficult to not realize that there is less respect for my position, and I am in my position because I am me; and being human, “me” is personal. How can it not be? Still, I agree it is the least important aspect of this plea for more expedient evaluations.

I truly am extremely energized by all of the organizational aspects of this new position, but most particularly I am personally challenged by the not-uncommon and contradictory disregard I see for a responsibility that I am confident every physician in our system takes seriously. I am not going away. I will continue to send reminders, (however many it takes), and I am sure that I will continue to be challenged. I have a great deal of respect for doctors and their profession. They are (from my perspective) performing miracles; but when they are doing so in a teaching environment, (like it or not) that involves filling out student evaluations. Please.

And Thank You.

I originally wrote the above as a template for a slightly more personalized “impassioned and heartfelt plea regarding student evaluations” that I intended to share with the Director, in the active hope that we could then share this with 117 physicians and that my perspective might help us to improve. But when I verbally presented a condensed version of this thought, (focusing mostly on the stats), I received a lukewarm (at best) reaction. After this discussion the Director sent out her standard “ATTENTION NEEDED” email to the 15 or 20 seriously delinquent doctors, and this missive will accomplish what is intended and it will keep me in my place and we will do it all over again in another eight weeks.

The paragraph above reflects my immediate reaction which (because of its immediacy) I am sure is an overreaction. Perhaps the Director will think things through and determine that my perspective and my thoughts are valid and worth sharing. I do believe that our doctors take their responsibility for the future of medicine very seriously, and I am pleased to be in a position to support this endeavor. And yes, I am in my position because I am me, and I do struggle with what I perceive as (perhaps not exactly a lack of respect, but certainly) a recognition and active acknowledgement of my place vs. their place. In this circumstance, in this moment, it feels like we have simply maintained. Whether, (from our varying perspectives), we see it as thinking things through, or prioritizing, or (because I am new to this position) giving it some more time, or avoiding confrontation, or making excuses, or protecting fragile egos, regarding student evaluations it feels like we are merely staying afloat. Long live the Status Quo!

I am confident we will improve. I believe we could (and should) work to improve more quickly.

The other aspect of this circumstance I want to examine is the apparent contradiction between responsibilities taken seriously and tasks not completed. The most obvious (to me) explanation is that some physicians need urgency to act. I could analogize my requests and reminders to the common cold, and the Director's requests to pneumonia, and the doctor's resulting response to their efforts to avoid further complications, and by doing so it lessens the personal sting for me, but it does not optimize student learning. It is apparently difficult for some to see the urgency in evaluation because by the time they are asked for this formal feedback, they have moved on to new students and they have nobody in their face demanding attention.

Assessment and evaluation is a critical piece of every effective teaching-learning model utilized at every level of education. After dealing with an urgency some physicians hand patients off for continued care and follow-up. This is not an option in teaching. The process is not complete without the evaluation, and the physician cannot hand the evaluation off to someone else. The urgency can be found in the future of medicine, and this (teaching – evaluation process) mirrors the earlier contradiction between responsibilities taken seriously and tasks not completed in that “now” is far more urgent than the future. So how do we instill a sense of urgency into our actions for the future, as represented (in this circumstance) by student evaluations? This question reaches far beyond this circumstance.

Phrasing the question as applicable to our current challenges worldwide, with the past on our backs and the present slapping us silly, how do we instill a sense of urgency into our actions for the future?

As a clerkship coordinator unable to obtain a few student evaluations from a few heedless procrastinators without the intervention of a Director, when I consider worldwide challenges, I am discouraged; and more than a bit overwhelmed.

Unless we find a way to disarm the nostalgic yearning for days gone by and to demobilize the crippling bureaucracy and the polarizing politics that dominate today, tomorrow will simply become a more dysfunctional extension of today.

In my personal circumstance, we will improve because I will continue to pound the drum and (though faint right now) it will ultimately become a part of the rhythm and flow of our small community.

In the worldwide circumstance, even though my drum is not the only drum, those with the wealth and power either cannot or will not hear the drums. Regardless, we must continue to pound the drums until they too become a part of the rhythm and flow of our larger community.

But this week, I am the one that feels beaten. This week I am sad. This week I am discouraged. This week I am disappointed. This week I am seeking understanding, and I am asking for understanding.

Please.

And Thank You.