Review of instruments for peer assessment of physicians

Editor—Evans et al reviewed instruments for peer assessment of physicians.¹ Decades of experience helping healthcare professionals learn how to seek, give, receive, and process feedback has led to several conclusions.² Rigorous psychometric techniques have little place when what is being explored is the impact human beings have on one another when they interact face to face.

The primary form of validity that really matters is face validity, specifically because the judgments are subjective—the “subjects” are human beings. This same fact explains the “poor agreement between observers of the same event” when “humanistic qualities” are of concern. The “observer,” after all, is not the person experiencing the event. Furthermore, even when a person exhibits the same behaviour towards two separate people, he or she can, and, as our own research documents, often does, experience the behaviour differently. As well they should, for they, too, are different human beings.

Perhaps in trying to be “scientifically rigorous” the essential nature of human interactions is being missed. We are not, however, arguing against the use of instruments. Rather, we are emphasising that the most useful instrument will be one that enables two people to get a clear, nonjudgmental, behaviourally specific (versus dealing with crucial but immeasurable and judgmental qualities such as “honesty” and “trust”) picture of the impact they are having on one another. We highlight the word they because our experience has been, and increasing numbers of others are reporting, that the current fad of anonymous aggregated 360 degree assessments is, indeed, iatrogenic. Faceless mechanisms that purport to improve the quality of face-to-face human encounters are an oxymoron.