title: Repaying in Kind: Examination of the Reciprocity Effect in Faculty and Resident Evaluations.
abstract: BACKGROUND
  Although the reciprocity hypothesis (that trainees have a tendency to modify evaluations based on the grades they receive from instructors) has been documented in other fields, very little work has examined this phenomenon in the surgical residency environment. The purpose of this study was to investigate the extent to which lenient-grading faculty receive higher evaluations from surgery residents.
  
  
  METHODS
  Evaluation data from 2 consecutive academic years were collected retrospectively at a large university-based General Surgery residency program. Monthly faculty evaluations of residents (15 items) and resident evaluations of faculty (8 items; 1 = never demonstrates, 10 = always demonstrates) were included. Correlation and regression analyses were conducted with SPSS version 22 (IBM; Chicago, IL).
  
  
  RESULTS
  A total of 2274 faculty assessments and 1480 resident assessments were included in this study, representing 2 years of evaluations for 32 core faculty members responsible for completing all resident evaluations and 68 PGY1-5 general surgery residents. Faculty (63% men, 13.5 ± 9.8 years out of training) represented 5 different divisions (general surgery, surgical oncology, transplant, trauma critical care, and vascular) within the general surgery department. Faculty received an average of 71.1 ± 33.9 evaluations from residents over the course of 2 years. The average rating of faculty teaching by residents was 9.5 ± 0.4. Residents received an average of 21.8 ± 0.5 evaluations with average ratings of 4.2 ± 0.4. Correlation analyses indicated a positive relationship between the average rating received from residents and the number of years since faculty completed training (r = 0.44, p = 0.01). Additionally, a significant relationship emerged between ratings received from residents and ratings given to residents (r = 0.40, p = 0.04). Regression analyses indicated that when both variables (years since training, ratings given to residents) were included in the model, only ratings given to residents remained a significant predictor of evaluation ratings received from residents (F(1,32)= 4.40, p = 0.04), with an R2of 0.16. Sex or division affiliation did not account for any unique variance.
  
  
  CONCLUSIONS
  These findings suggest that a reciprocity effect exists between surgery faculty and resident evaluations. This effect warrants further exploration, such that efforts to mitigate the risks of providing inaccurate assessments may be developed. Providing trainees with accurate assessments is particularly important given the high-stakes use of these data for milestones, promotion, and graduation purposes, which currently do not account for this reciprocity effect.
  
  
  CONCLUSIONS
  Results suggest that there is a reciprocity effect in the faculty and resident evaluation process.
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center Dallas, Dallas, Texas. Electronic address: aimee.gardner@utsouthwestern.edu.
authors.forename: Aimee K
authors.initials: AK
authors.lastname: Gardner
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center Dallas, Dallas, Texas.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Scott
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D002983:Clinical Competence; D003162:Competency-Based Education / Q000379:methods; D004503:Education, Medical, Graduate / Q000458:organization & administration; D005180:Faculty, Medical / Q000592:standards* / Q000639:trends; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D007400:Interprofessional Relations; D008297:Male; D012044:Regression Analysis; D012189:Retrospective Studies; D012647:Self-Assessment; D012680:Sensitivity and Specificity; D013781:Texas
keywords: Practice-Based Learning and Improvement; Systems-Based Practice; assessment; evaluation; reciprocity; residency