Cherie Jones MD, FRCPCSheila Pinchin, MEdSue Fostaty-Young

This is written descriptions of a student's performance organized in logical order, to illustrate the "story" or account of a student's progress and performance, including strengths and areas for improvement…to guide future efforts

Often yields richer information than a “snapshot” letter grade does, and often used to complement letter grades.

Physician performance improves significantly more with feedback than without it (Westberg & Jason, 1991)

Without reinforcement, desirable and helpful behaviours on the part of learners may be extinguished, and bad habits may become well-entrenched (Ende 1983; Westberg & Jason, 1991)

Provision of feedback, which identifies learner strengths and makes recommendations for improvement, is a key tool in clinical teaching (Irby & Bowen, 2004).

“Learning without feedback is like learning archery in a darkened room. “

(Cross, 1996)

Links to learning objectives Identifies strengths and weaknesses by

providing examples, quotations, etc. Uses constructive and specific language Individualizes feedback Identify each learner’s areas of strength

and build on them, rather than depending on a “deficit model” of “fixing the gaps”.

Summarizes and provides suggestions for improvement.

Helps the student identify learning goals to work toward

Assesses how well the student is achieving learning goals

Reviews student progress over time Provides suggestions for improvement

If the student had the next three weeks to work on improving something, what should it be and what suggestions do you have for them as to how to do it?

If you were “handing over” the student to another tutor, what could you identify as areas for improvement that your colleague could focus on?

Professionalism Functioning in the team context Links to the learning objectives for the

task Skills:

Relationship with the Patient Gathering Information (Hx and Px)

“I was very impressed with the degree to which individuals in this group worked together in terms of respecting each other, as well as with the ease in which an animated discussion spontaneously moved from student to student.” (FSGL 2010)

“Wow! Wonderful person. Will make a great doc! Keep up the good work!”

“Should develop superior clinical ability. Practice every opportunity…”

“Continue with current progress; More practice.”

“Improving conveying of competence, increased interaction and verbal communication in sessions…”

“Expression of confidence and professional persona in interactions with patients and colleagues. May benefit from videotape review of interviews. Role modeling.”

Unhelpful Feedback

Reason Helpful Feedback Reason

‘Your body language wasn’t very good at the start’

Judgmental

‘At the beginning you were looking at the computer screen records and not at the patient as she started to tell her story’

Descriptive, detailed, behavioural

‘You weren’t very empathic’

Non-specific

‘You didn’t acknowledge the problems she has dealing with her husband’s illness’

Identifies specific problem

‘You’re very abrupt’

Personality issue

‘You interrupted a lot. For example…’ (give specific points in consultation)

Behavioural, specific

‘It was really good’ ‘

Non-specific

At the start you asked an open question and then allowed her to tell her story. You left silences so that she continued in her own words’

Positive, specific, descriptive

Examples of Helpful and Unhelpful Narrative Feedback

Mid-Term SELF Assessment Final SELF Assessment

Self-Assessment formGlobal Assessment: Needs ImprovementProgressing as expected

Sentence Stems:Since beginning this term I have focused on improving my ability to: One example of my progress in this area is:In addition to continued development in the area described above, I plan to:

Self-Assessment formGlobal Assessment: Needs ImprovementMeets expectations

Sentence Stems: Overall I would describe my progress this term: I would like to further develop my ability to:Towards this end I plan to:

Mid-Term PEER Assessment Final PEER Assessment

Peer Assessment formGlobal Assessment: I look forward to working with this student for the rest of the term: (Agree /Disagree)

Sentence stems:This student made a significant contribution to the group by… This student could improve his/her performance in a group by…

Peer Assessment form Global assessment: I welcome the opportunity to work with this student in the future (Agree /Disagree)

Sentence stems:This student made a significant contribution to the group by… This student could improve his/her performance in a group by…

Mid-Term TUTOR Assessment Final TUTOR Assessment

Tutor’s Student Assessment formGlobal assessment: Mid-term (formative) Needs ImprovementProgressing as expected

Sentence stems:This student’s progress in relation to his/her self-defined focus this term has been:My concerns with this student’s performance are: In order to improve future performance this student should:

Tutor’s Student Assessment formGlobal assessment: Final Requires remediation Meets expectations

Sentence stems:This student’s progress in relation to his/her self-defined focus this term has been:My concerns with this student’s performance are: In order to improve future performance this student should:

Communication NEEDS Attention

PROGRESSING AS

EXPECTED

Tutor Agreement

Introduction polite and effective; establishes rapport & explains aims of consultation

YesNo

Determines reason for visit, obtains basic history of presenting complaints YesNoPerforms a basic review of systems, social and family history YesNo

Avoids use of jargon YesNoDemonstrates the use of techniques including:Open-ended questions, Clarifying statements, Transitional statements,Summarizing to encourage patient to tell their story.

YesNo

Demonstrates the use of non verbal communication YesNo

Student Narrative: Since beginning this term, I have focused on improving my ability to:One example of my progress in this area is:One example of a skill I still need to improve is:In order to improve this skill I plan to:

Tutor Narrative:

So far this term, this student has been focusing on improving his/her ability to:

So far this term, this student has demonstrated significant strengths in:

During the remainder of this term, this student should be encouraged to improve his/her ability to:

In order for the student to improve this skill I suggest that s/he:

Professional behaviours and skills NEEDS Attention

PROGRESSING AS

EXPECTED

Tutor Agreement

Attends all session and arrives on time YesNo

Demonstrates effective communication within group and with tutors YesNoPrepares and participates effectively within group YesNo

Dresses according to defined dress code YesNoUnderstands and demonstrates what is meant by professional behaviour YesNoReceptive to feedback and interacts politely and positively with tutors. YesNo

Student Narrative Since beginning this term I have focused on improving my ability to:One example of my progress in this area is:One example of a skill I still need to improve is: In order to improve this skill I plan to:

Tutor Narrative:

So far this term, this student has been focusing on improving his/her ability to:

So far this term, this student has demonstrated significant strengths in:

During the remainder of this term, this student should be encouraged to improve his/her ability to:

In order for the student to improve this skill I suggest that s/he:

Subspecialty Medicine Assessment Form (Clerkship)

Continue… Comment on aspects of performance that were effective. Be specific and describe impact. Highlight things you would like to be done in the future.

Start, or do more…Identify behaviour the student knows how to do, and could do, or do more often.

Consider…Highlight a point of growth for the learner, a “doable” challenge for future interactions.

Stop, or do less Point out actions that were not helpful, or could be harmful. Be specific, and indicate potential impact.

Examples of Narrative Assessment Forms or Prompts from across UGME

Walsh, 2006, Adapted from the Coaching Feedback Format , Bayer Institute for Health Care communication

Narrative feedback requires for each student: Observation Notes on observation Organization of notes over time

Many faculty have adopted a variety of strategies to keep notes on students in tutor groups or clerkship groups. These include:

1. A series of file (recipe) cards, one for each student, with dates and comments (Dr. Sylvester)

2. A series of forms or checklists , one for each student with objectives and observations over time (dated)

3. Encounter cards, and other student self-assessments (to be used in conjunction with tutor/preceptor observation)

Sue Fostaty-Young is our UGME Assessment and Evaluation Consultant. Reach her at fostatys@queensu.ca

Sheila Pinchin is our UGME Education Specialist. Reach her at sheila.pinchin@queensu.ca

Cherie Jones-Hiscock is a psychiatrist working as a Course Director in Clinical and Communication Skills. Reach her at hiscockc@hdh.kari.net