• Keith Baker, Bishr Haydar, and Shawn Mankad.
• From the Harvard Medical School, Boston, Massachusetts; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts (K.B.); Division of Pediatric Anesthesia, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan (B.H.); and Samuel Curtis Johnson Graduate School of Management, Cornell University, Ithaca, New York (S.M.).
• Anesthesiology. 2017 Feb 1; 126 (2): 327-337.

BackgroundGrade inflation is pervasive in educational settings in the United States. One driver of grade inflation may be faculty concern that assigning lower clinical performance scores to trainees will cause them to retaliate and assign lower teaching scores to the faculty member. The finding of near-zero retaliation would be important to faculty members who evaluate trainees.MethodsThe authors used a bidirectional confidential evaluation and feedback system to test the hypothesis that faculty members who assign lower clinical performance scores to residents subsequently receive lower clinical teaching scores. From September 1, 2008, to February 15, 2013, 177 faculty members evaluated 188 anesthesia residents (n = 27,561 evaluations), and 188 anesthesia residents evaluated 204 faculty members (n = 25,058 evaluations). The authors analyzed the relationship between clinical performance scores assigned by faculty members and the clinical teaching scores received using linear regression. The authors used complete dyads between faculty members and resident pairs to conduct a mixed effects model analysis. All analyses were repeated for three different epochs, each with different administrative attributes that might influence retaliation.ResultsThere was no relationship between mean clinical performance scores assigned by faculty members and mean clinical teaching scores received in any epoch (P ≥ 0.45). Using only complete dyads, the authors' mixed effects model analysis demonstrated a very small retaliation effect in each epoch (effect sizes of 0.10, 0.06, and 0.12; P ≤ 0.01).ConclusionsThese results imply that faculty members can provide confidential evaluations and written feedback to trainees with near-zero impact on their mean teaching scores.

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