The Evaluation & Feedback of your Medical Student

Instructor Name

Goal

Residents will improve their feedback techniques to heighten the students learning experiences in the clinical setting.

Objectives

At the end of the session, the learner will be able to:

Define feedback and describe its importance

Distinguish between formative & summative feedback

Distinguish between feedback & evaluation

Describe the characteristics of feedback

Identify barriers to giving feedback

What is Feedback?

“Feedback is when a learner is offered insight into what he or she actually did, as well as the consequences of his or her actions. Feedback highlights the dissonance between the intended result and the actual result, thereby providing impetus for change.”

J. Ende

Feedback in clinical medical education. JAMA 250(6): 777-81, 1983 Aug 12.

Why is it important?

Students who receive regular feedback Perform significantly better Develop better judgment Learn faster

0ne of the most important qualities of a good preceptor

Without Feedback

Mistakes go uncorrected Good performance is not

reinforced Clinical competence is not

achieved Learners self-validate

Formative Vs. Summative Feedback can be both Formative informs the learner w/

ongoing feedback Giving throughout the rotation Allows learner the opportunity to correct

Summative verifies attainment of competency Given at the end of rotation No present opportunity to correct

Feedback Vs. Evaluation

Feedback Presents

information Formative

i.e., guides learner to goal

Neutral i.e., verbs & nouns

Evaluation Presents a judgment Typically summative

i.e., how well learner met goal

Normative statements i.e., adverbs &

adjectives

Feedback Vs. Evaluation

Feedback Evaluation

Timing Timely Scheduled

Setting Informal Formal

Basis Observation Observation

Content

Objective Objective

Scope Specific ActionGlobal

Performance

Purpose

Improvement “Grading”

Case 1: What would you do?

You realize the morning after being on call that your intern did not appropriately evaluate a patient with ______. Therefore, the patient was not given ____ and showed signs of significant _____.

What do you say to the intern? (both immediately and later)

Essential Characteristics of Feedback

Descriptive, not judgmental Specific, not general Focus on changeable behaviors Emphasize consequences Be Timely Based on first-hand information

(not hearsay)

Judgmental (not specific) “You guys are awful. I’m tired of

watching you guys screw up. Try harder and win. I expect 3 TDs in the second half! Just do it! I don’t want to lose my job.”

Specific (not judgmental) “We’re getting killed on the

blitz. The offensive line needs to

focus on #40 better. JPW, drop back…” Specific things to improve

Changeable Behavior

Provide feedback on performance discrepancies that are within the control of the learner Consider current skills / knowledge for

learner’s level

Emphasize Consequences

Provide (or ask learner to provide) possible outcomes if the behavior is not changed

Highlight the benefits to changing the behavior

Be Timely w/ Feedback

Ensures more accurate recall Immediate feedback is more

believable Allows learner to modify behavior

earlier versus letting it continue (making it more difficult to correct)

Based on Firsthand Information

Observe the student You cannot provide feedback on

Skills you haven’t observed Knowledge you haven’t questioned Reasoning you haven’t heard Attitudes you haven’t experienced

Giving Feedback

Describe the performance Wait for learners comments

May provide you insight into the problem

Recommend how to improve Be specific and be clear

Coach, not judge

Example: Student Too Slow

Instead of “You took way too long interviewing that

patient. You need to be out of the room in about 20 minutes with your H&P.”

Say “I noticed you were in Mrs. Smith’s room

for an hour.” Then wait

Example: Student Too Slow

Student replies “I know, I just couldn’t get the patient

to stop talking!” “I didn’t know which questions were

most important to ask” “I spent 40 minutes doing the

physical exam” Recommend how to improve

Example: Student Mistake

Instead of “You wanted to give the patient the

wrong antibiotic for their pneumonia” Say

“Why did you want to give the patient Keflex for their pneumonia?”

Then wait

Example: Student Mistake

Student replies “You mean Keflex isn’t a good

antibiotic for pneumonia?” “oops, I meant to click on ceftriaxone

instead.” “Dr. Attending said to put them on

Keflex. I thought it was a bad idea.”

Example: Student Mistake

Recommend how to improve Read the IDSA’s recommendations for

CAP. You can find them… Computer order entry can be

dangerous if you don’t pay close attention to what you are ordering…

I’ll clarify this with Dr. Attending

Example: Disorganized Student Presentation

Instead of: “You need to improve your presentation.” (not specific)

Say: “This morning on rounds, your presentation was very disorganized. It was difficult to follow your thought process.”

Wait – student can tell you what the problem was from their standpoint

Example: Disorganized Student Presentation

Recommend how to improve “When you have a complicated patient,

organize your presentation with a problem list. That way others can follow your thought process and your presentations will be more concise and organized.”

“Also, on rounds, listen to how the stellar interns present and try to model your presentations like theirs.”

Barriers to Giving Feedback

“They know how they’re doing.” “Is this an anomaly?” “I don’t have time.” The Awkwardness

Summary

Effective feedback is essential to both learning & good teaching

Learners who receive useful feedback perform better

Without feedback, mistakes go uncorrected

Feedback is a skill and can be learned & improved upon

Questions???