Evaluation of medical education programs is necessary to provide adequate and relevant knowledge and skills to healthcare professionals. For this purpose, various approaches and assessment models are used, which are aimed at understanding the quality of programs and their goals. However, since the assessment is carried out by people who express their opinions and pursue interests, the process can be associated with various ethical violations. The most likely ethical violations in the evaluation of medical education programs can be a distortion of results in favor of one stakeholder, disclosure of confidential information, and bias toward respondents.
The first ethical violation can arise from the influence on the evaluators of personal interests or external factors. For example, institutions are usually interested in programs to receive positive evaluations because they have to meet the requirements of different accreditation and funding organizations (Frye & Hemmer, 2012). Consequently, the management of institutions may interest evaluators, especially if they are employees of institutions, to give a more positive assessment of the programs. Moreover, this ethical violation can be legal if the evaluator chooses an approach that is appropriate for the institution or interprets the data in this way.
For example, one of the methods and elements of evaluation is to test and score students who have completed the program; therefore, if the results are satisfactory, the program can be considered effective (Tatum, 2019). However, as Freeman (2019) points out, some students perform worse on tests but have high clinical skills, which the evaluator can use as an argument if the grades are low. Thus, evaluators can commit an ethical violation in favor of their institutions, which can affect the skills and knowledge of students.
The second violation can be the disclosure of confidential information. Stratton (1977) noted in his work that confidentiality could be inadvertently violated if the results and details of the assessment are reported to one responsible person, for example, the head of the school. This person can understand who gave particular feedback if few people took part in the evaluation. At the same time, according to the Kirkpatrick Model, which is commonly used in the assessment of educational programs, one of the elements is student and teacher satisfaction, which is most often expressed in interviews or written feedback (Shih-Chieh & Shih-Yun, 2019). Therefore, if a new educational program with a small number of clerks and residents is being evaluated, then the head of the institution may understand that one of them gave negative feedback. This fact can also affect the further working relationship and the attitude of the head towards this clerk.
Moreover, since assessments include feedback from program participants, the evaluator may commit an ethical violation by discriminating against respondents based on their age, gender, or race. For example, if a large number of residents are satisfied with the program, but a few minority participants express dissatisfaction, the evaluator may misidentify the problem due to racial stereotypes. Besides, minority students are more likely to show low marks on standardized tests, even with sufficient practical skills and knowledge (Freeman, 2019). Consequently, the evaluator may associate dissatisfaction with the program with the inability of the participants to cope with the training rather than actual organizational or management problems. This behavior is a clear ethical violation that can also affect the assessment of the quality of the educational program.
However, these violations can be prevented by choosing the right approach and method of evaluation. First, as noted by Ragsdale et al. (2020), the effectiveness of programs should be assessed from different perspectives, for example, by residents, faculties, patients, clinical and administrative staff. Vassar et al. (2010) also suggest using a utilization-focused approach to evaluation; in other words, to focus on the usefulness and application of knowledge and skills acquired by residents in practice for patients. Thus, such an organization will create an environment in which the assessment’s final results will be difficult to interpret differently without blatant falsification, reducing the risk of ethical violation.
The problem of confidentiality of information can be prevented by involving an objective third party in assessing the results and interpreting the answers in the final reports. For example, after analyzing the responses, the evaluator can rephrase direct quotes or present them in the form of general explanations and conclusions to avoid the manifestation of individual characteristics in the answers. This solution also helps prevent bias against any residents if the evaluator analyses responses without knowing the demographic characteristics of the respondents. In addition, the evaluation process should include more people to ensure their confidentiality and improve the accuracy of the results.
In conclusion, the evaluation of educational programs is an essential process for ensuring the quality of health care. However, some ethical violations can occur due to inappropriate organization of evaluation and its core processes. Such violations can include misjudgment in favor of one of the parties, disclosure of confidential information, and bias towards respondents. Preventive measures to avoid these violations are the use of methods and approaches that provide a multilateral view of the quality of programs and their applicability. In addition, the involvement of objective evaluators who are not involved in the activities of the organization in the assessment process and can draw conclusions from the facts is also a method of avoiding ethical violations.
References
Freeman, J. (2019). Evaluating evaluation: What, how, and why?. Family Medicine, 51(10), 801-802. Web.
Frye, A.W., & Hemmer, P.A. (2012). Program evaluation models and related theories: AMEE Guide No. 67. Medical Teacher, 34(5), e288-e299. Web.
Ragsdale, J. W., Berry, A., Gibson, J. W., Herber-Valdez, C. R., Germain, L. J., & Engle, D. L. (2020). Evaluating the effectiveness of undergraduate clinical education programs. Medical Education Online, 25(1). Web.
Shih-Chieh, L., & Shih-Yun, H. (2019). Evaluating a continuing medical education Program: New world Kirkpatrick model approach. International Journal of Management, Economics and Social Sciences, 8(4), 266-279. Web.
Staton, R. G. (1977). Ethical issues in evaluating educational programs. Studies in Educational Evaluation, 3(1), 57-66. Web.
Tatum, C.B. (2019). Developing and evaluating educational programs. In B. Nchindila, & T. Corrigan (Eds.), The essence of academic performance [eBook edition]. IntechOpen. Web.
Vassar, M., Wheeler, D. L., Davison, M., & Franklin, J. (2010). Program evaluation in medical education: An overview of the utilization-focused approach. Journal of Educational Evaluation for Health Professions, 7(1), 1-3. Web.