Eric Grosch, Letter to Dr. Morgenstern on LOR - Semmelweis ...

serenely <strong>to</strong> apply them in life-altering decisions <strong>to</strong>uching subordinate trainees,[22] such as
recommendation for certifying examinations, and employment, and even in promoting
faculty-members[25].
Albanes[34] suggests that “real life” ratings, presumably of qualified physicians, are objective and
based on outcomes, yet Carey[35] asserts that evaluations of physician-faculty must be subjective.
Codman[36] and his spiritual successors[37-41] have called for outcome-based rating of
performance and, by extension, of competence, but physicians and hospitals have pointed the
deficits of that method and prevented its spread, <strong>to</strong> date, by citing the multiplicity of fac<strong>to</strong>rs,
unrelated <strong>to</strong> institutional or physician-competence, that determine outcome.[42]
The champions of rating attribute two roles <strong>to</strong> it, evaluative or summative (entailing punitive and
deterrent purposes) and formative.[42] Paterson <strong>to</strong>uted the formative purpose:
I. Rating methods have been developed because of a recognition of the educational value of
ratings . . .
a. . . . on those who make the ratings. . . insures the analysis of subordinates in terms of the traits
essential for success in the work.
b. . . . on the employee. . . encourages self-analysis and provides an incentive for
self-improvement in . . . traits in which he is weakest.[35]
As educational feedback, rating fails <strong>to</strong> fulfill Ziegenfuss' proposed criteria for adequacy and
efficacy:
. . . the art of feeding back quality-related data is a critical point of quality improvement work. . .
Feedback is effective when the following conditions are met:
1. Clarity of Purpose. Data can be used for development or for rendering judgment (formative
versus summative . . .). . . for . . . organizational development, . . . the purpose is . . . formative . .
. Learning and change <strong>to</strong> improve processes is the goal. A judgmental purpose (summative) offers
a . . . grade of pass or fail and is designed for accountability. . .[45]
Since “accountability” entails punishment[46], it does not belong in any workplace.[4] In
education, by definition, the only appropriate purpose of feedback is the formative one. The
Likert-rating, in its cus<strong>to</strong>mary application, succeeds in the summative, punitive goal of criterion 1
but fails in its formative goal.
2. Clear and Specific Data. Data . . . must be . . . relevant <strong>to</strong> the . . . recipient.[45]
The vague expression, “general medical knowledge, 3” (or any other number) is unclear and
non-specific, so rating fails criterion 2 and is not relevant <strong>to</strong> the recipient (see criterion 5).