Anonymity, Confidentiality, and Transparency

December 04, 2016

i everyone,

Not long ago, I contacted a resident to explore a peer evaluation he'd written about a colleague. He was shocked that I’d identified him, because peer evaluations in MedHub were labeled "anonymous." He was right- the evaluations have never truly been anonymous, because program leadership could see who wrote them. For this reason, we are going to re-label peer evaluations as "confidential" to signify that residents can’t see the evaluator’s name, although program leadership can.

This re-labeling is needed to accurately reflect the confidential status of peer evaluations, but the truth is I oppose confidential reviews. I presume evaluations were originally made confidential due to an assumption that confidentiality would encourage honest feedback and protect evaluators from retaliation. Personally, I'm skeptical that confidentiality encourages honesty, and I'm even more skeptical about the risk of retaliation. Instead, I believe confidentiality sends a counterproductive and cynical message about the value and safety of candid feedback.

Confidential feedback is problematic for additional reasons. First, to shield evaluators’ names, reviews are withheld until several accumulate, which prevents residents from responding promptly to improve their performance. Second, confidentiality undermines the integrity of face-to-face feedback. If verbal feedback is honest, then evaluations entered into MedHub should reflect what was said, and it should be obvious who said it. In contrast, it's hurtful and counterproductive for residents to read anonymous critiques that contradict the verbal feedback they received.

I’d like to propose scrapping confidential feedback and normalizing open evaluations. To succeed, we'd have to ensure 1) that residents are taught how to provide effective, constructive feedback, 2) that feedback is based on well-defined learning goals, 3) that feedback is bidirectional, 4) that feedback is based on observed behaviors, and 5) that feedback is given respectfully, professionally, and in good faith. When feedback is routine, welcome, and helpful, there should be no need to hide evaluators’ names. Eliminating confidentiality would allow us to make feedback available immediately. On occasion, we may need to preserve confidentiality, for example if residents feel vulnerable reporting certain behaviors. For this reason, we would maintain a pathway for trainees to share information confidentially with program leadership.

For now, although this does not signify a change in practice, we will change the label on peer evaluations from "anonymous" to "confidential." However, I'd like to discuss making our peer evaluations open. No decision has been made yet about this proposal, so let me know your thoughts.

Enjoy your Sunday, everyone,

Mark

PS, on a totally different note, no one guessed which of the second graders was me. I’m the boy sitting cross-legged on the floor with the horizontal stripes. Some of you guessed it was the kid on the top with the tan tie, two away from the teacher. That’s my twin brother, Eddie.

Submitted by Mark David Siegel on April 10, 2017