Teacher Certificate Program 1: Assessment – Breakout Activity

A resident consistently scores just below average on evaluations. Knowledge is adequate, documentation is fine, patients aren’t harmed—but attendings describe them as “slow,” “hesitant,” or “lacking confidence.” No single red flag, but a pervasive sense of concern.

Why it’s challenging :

• • No objective failure
  • Faculty discomfort vs. defensible assessment
  • Risk of implicit bias (gender, accent, introversion, etc)

For discussion:

• • What is “good enough” competence?
  • Is “trust” a valid assessment construct?
  • How long can someone remain borderline before action is required?

A Year 3 medical student aces exams and performs procedures flawlessly butis dismissive to nurses, defensive when corrected, and occasionally sarcasticwith patients.

Why it’s challenging :

• • High cognitive performance obscures professionalism concerns
  • Faculty split: “brilliant but difficult” vs “unsafe long-term”
  • Learner resists feedback

For discussion:

• • Can professionalism deficits alone justify failure?
  • How do you document patterns vs isolated incidents?
  • Is remediation realistic or performative?

A universally liked intern—kind, empathetic, hardworking— repeatedly misses subtle clinical findings and struggles to synthesize information. Errors are caught by others before harm occurs.

Why it’s challenging :

• • Emotional difficulty failing someone who is beloved
  • Halo effect
  • Patient safety vs empathy

For discussion:

• • Does being “nice” bias assessment?
  • How much supervision is too much?
  • When does kindness stop compensating for competence?

A Year 2 medical student discloses severe anxiety/depression/ADHD afterpoor evaluations and requests accommodations. Faculty are unsure what canbe considered in assessment vs accommodation.

Why it’s challenging :

• • Legal, ethical, and emotional complexity
  • Fear of discrimination vs. lowering standards
  • Timing of disclosure (before vs. after problems)

For discussion:

• • What is reasonable accommodation in clinical assessment?
  • How do you separate impairment from competence?
  • Who should be involved in these decisions?

An international medical graduate has strong medical knowledge but receivesfeedback that they are “abrupt,” “unclear,” or “not connecting” with patients. Patient satisfaction scores are lower, but no complaints.

Why it’s challenging :

• • Cultural norms vs. professional standards
  • Accent bias
  • Vague language in evaluations

For discussion:

• • What is assessable vs. culturally biased?
  • How specific must feedback be to justify consequences?
  • Should patient satisfaction be used in summative assessment?

A Year 3 medical student alternates between excellent and poor performance depending on the supervisor, service, or workload. Some attendings rate them in the top quartile; others express serious concern.

Why it’s challenging :

• • Reliability of assessments
  • Context dependence of competence
  • “Which narrative wins?”

For discussion:

• • How do we reconcile conflicting evaluations?
  • Are we assessing the learner or the environment?
  • What data carries the most weight?

A medical student nearing graduation is found to have significant deficiencies (e.g., unprofessional behaviours; inadequate clinical skills) that weren’t previously documented due to leniency and “they’ll grow out of it” thinking.

Why it’s challenging :

• • System failure
  • High stakes (graduation, licensure)
  • Moral distress among faculty

For discussion:

• • Who is responsible for delayed identification?
  • Is it ethical to graduate with “known concerns”?
  • What should remediation look like this late?

A resident disputes evaluations, demands objective proof, records feedback conversations, and escalates concerns to leadership or legal channels.

Why it’s challenging :

• • Fear-driven inflation of evaluations
  • Documentation quality exposed
  • Power dynamics

For discussion:

• • What counts as defensible assessment?
  • How do we support faculty psychologically?
  • Should programs change assessment language or tools?