As I may have mentioned, I mentor a diverse group of students and residents.

Sometimes they get a Single Oddball Bad Evaluation (SOBE) and it is due to racism.

Now that I have your attention I will add some nuance because Twitter is Where the Nuance Magic Happens.

“Racism” is an oversimplification. A better way to describe it is “cultural mismatch.”

Which is to say that a common fixture at an academic medical center is a white, suburban, overachieving, public/private high school university direct path straight arrow middle aged doctor who grew up meeting their parents professional friends (people like me)...

... for whom a student or resident who grew up with a different language, culture, religion, peer group, educational path, exposure to people/experiences/situations might just seem... somehow off.

The cultural mismatch goes both ways. The quirky weird dinosaur doctor seems somehow off as well. But the power dynamic and the writing of evaluations and grades means it’s the student who is left holding the Single Oddball Bad Evaluation.

I have offered Career Guidance for a number of learners I have mentored as they pass through this ugly chapter in their medical education.

Maybe counterintuitively, this thread is not for them and others who have suffered the (and yes it is) injustice of a SOBE.

This thread is for all the good-hearted middle aged white liberal arts undergraduate fancy medical school academic attendings like me.

When you go to deliver a Single Oddball Bad Evaluation, I would ask for you to pause.

Consider the possibility that culture, not proficiency, is to blame for your perception of poor performance.

Is it possible that expectations of cultural norms in the way this student asks questions of takes coaching are coming in to play?

The way they talk, learn, respond and recover?

Is it possible that your definition of Things Everyone Should Know By This Age are not universally available to all people attending this medical school or residency?

Also ask yourself is you were concrete and clear with regard to your expectations and the criteria by which you would differentiate good performance from bad?

Or did you base that on cultural assumptions with which you were raised and by which you have succeeded?

In summary, racism is performed by racists.

Single Oddball Bad Evaluations can be produced by people not deserving of that title but whom still succumb to writing evaluations based on a bad feeling inside that comes as a result of having a cultural mismatch with the learner.

Don’t start by asking yourself how you feel about different ethnicities, religions, cultures and languages.

Start when you sit down to write a bad evaluation. Start with the SOBE.

Then work backward from there to ask yourself if your unfamiliarity with this learner’s background, culture, religion, language or ethnicity may somehow be coloring your perception of their knowledge, skill, interest or enthusiasm.

Don’t feel bad if a cultural mismatch has biased your evaluation. It happens to all of us. Your learner probably felt it too.

Just pause and soften your evaluation. Point out what the student did well and in what ways this resident improved while you were together.

Notice when you have “stars” how they might more commonly come from a background similar to yours. Or have a similar educational pedigree. These biases are easiest to notice when we REALLY LOVED a learner or REALLY DIDN’T GET ALONG with them.

I don’t know maybe plain old white students and residents occasionally get a bad evaluation out of nowhere.

I don’t know because I don’t mentor many of them.

I only hear about these SOBEs from the students and residents I mentor.

And I’ve come to believe they aren’t just due to a tough grader or getting off on the wrong foot.

Especially when the SOBE is so different than all the other evaluations they have gotten in their training.