Leadership & professional development: Mitigating assessment bias as a hospitalist

Visual Abstract

“The eye only sees what the mind is prepared to comprehend.” – Robertson Davies.

INTRODUCTION

Hospitalists routinely assess trainees, yet these evaluations may be influenced by implicit bias—unconscious stereotypes that shape interpretation of performance. ¹ Trainees underrepresented in medicine, women, and those with disabilities may be disproportionately affected; even small differences among assessments in performance can affect one's grades, opportunities, and career trajectories. ¹ We describe common assessment biases encountered by hospitalists and practical strategies to reduce them.

TYPES OF ASSESSMENT BIAS

Reviewing common biases can prompt self‐reflection and more deliberate feedback. ² Consider how each scenario could distort an end‐of‐rotation rating, even with good intentions.

Case 1: On a resident's final day, he makes an error that delays a patient's discharge. Recalling a tense conversation with an angry parent, you rate him “below average” despite an otherwise strong performance.

Bias: Availability bias, the tendency to rely heavily on recent information or on information that elicits strong emotion.

Case 2: A student demonstrates exceptional communication skills but otherwise performs at the expected level. You assign an overall “exceeds expectations” rating, citing their bedside manner.

Bias: Halo (or horns) effect, in which one's global impression is driven by one standout strength or weakness, disproportionately shaping the overall evaluation.

Case 3: During sign‐out, a hospitalist says that an intern struggled with efficiency and performed “below average.” Over the week, you observe steady improvement in task triage and follow‐through, yet you give them a “below average” rating, largely reflecting the initial impression.

Bias: Anchoring bias, relying too heavily on early information, and insufficiently updating judgments with new observations.

Case 4: A resident is from your hometown. They demonstrated an average performance, but your shared background leads you to rate them “above average.”

Bias: This is an example of affinity bias, the tendency to favor trainees with shared experiences or backgrounds.

MITIGATING ASSESSMENT BIAS

Bias mitigation can be thoughtfully integrated into the evaluation process. Criterion‐based assessment tools, such as entrustable professional activities (EPAs), reduce subjectivity in evaluation. We can adapt frameworks like SKAIR to provide thoughtful assessments. ²

• 1. Slow down.
• 2. Know your bias.
• 3.Consider the Alternative.
• 4.Get more Information.
• 5. Reflect.

We can apply this to Case 3 above. You begin your service week having heard from a colleague about efficiency concerns.

S: Pause before submitting the evaluation and complete it when you are not rushed or frustrated.

K: Actively make a plan at the beginning of the week to avoid anchoring bias.

A: Ask yourself, “what evidence would lead me to rate this differently?”

I: You note that earlier in the week, the intern initially required prompting to triage tasks and complete notes on time. By the end of the week, their notes were signed before noon, and they independently followed up on tasks without delays.

R: Thoughtfully consider your observations and the trajectory of the resident's efficiency throughout the week.

CONCLUSION

Assessments shape opportunities. By naming common biases and developing standardized evaluation tools, hospitalists can produce fairer evaluations and more actionable feedback to trainees from diverse backgrounds. Our assessments carry power that can impact trainees, and we must consider our feedback carefully.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

DATA AVAILABILITY STATEMENT

Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.