‘This is just not their world’: Clinical faculty members appear SET for a re-imagined teaching effectiveness evaluation system

INTRODUCTION: Despite longstanding critiques of the appropriateness of student evaluations of teaching (SETs) as measures of teaching effectiveness, many departments of medicine continue to rely on SETs for high-stakes decisions that impact clinical faculty. METHODS: Using a reflexive thematic analysis approach, the authors conducted 1-on-1 semi-structured interviews with key informants in leadership roles and frontline clinical teachers across multiple subspecialties. The authors used principles of reflexive thematic analysis, guided by Bandura's model of triadic reciprocality, to examine the interplay between personal, behavioral, and environmental factors influencing faculty experiences. RESULTS: Participants included 10 faculty in leadership roles, and 15 clinical teachers. Findings revealed that contextual factors (e.g. clinical workload) and personal dynamics (e.g. relationships with learners) significantly impacted participants' experiences with SETs. Participants expressed dissatisfaction with the perceived disconnect between departmental decision-making and the realities of clinical teaching environments. They described a lack of reciprocity in how departments respond to faculty concerns, contributing to feelings of isolation, undervaluation, and disengagement. Many questioned the fairness and utility of SETs, especially when used without safeguards or complementary data sources. DISCUSSION: Our findings support others who have called for disrupting the dominance of SETs in academic medicine. Participants proposed alternatives to SETs, including peer evaluations, third-party observations, and prioritizing teaching contributions such as mentorship and curriculum development. These suggestions reflect a desire for systems that better capture the complexity and value of clinical teaching. The present findings contribute to ongoing debates about SETs in academic medicine by centering faculty voices and highlighting the relational and systemic tensions inherent in current assessment practices. The authors advocate for a re-visioning of teaching assessment systems that prioritize bidirectional engagement, contextual relevance, and holistic measures of teaching effectiveness.