Adam L. Reinhardt,University of Nebraska Medical Center,Omaha,NE,Evin M. Lackore,University of Nebraska Medical Center,Omaha,NE,Nora M. Kovar,University of Nebraska Medical Center,Omaha,NE,Gary L. Beck,University of Nebraska Medical Center,Omaha,NE
Direct observation and focused feedback provide critical components for medical student education yet numerous challenges exist in providing useful comments to students during their clerkships (1,2,3). In an effort to encourage direct observation and feedback, Structured Patient Care Observation forms (SPCOs) were used to evaluate third-year medical students (MS3) during patient encounters.
Investigate the quality of SPCO feedback given to students on their pediatric clerkship rotation.
All MS3 were instructed to solicit feedback using the SPCOs during the clerkship. SPCOs prompted evaluators to provide up to 3 feedback points related to the encounter. Three independent reviewers assessed all comments for quality. Feedback quality was categorized as “actionable” for recommendations that students could use to improve future encounters (e.g., “don’t forget to summarize back to the patient”), “generalized” for responses that could apply to nearly any student (e.g., “continue to practice”), or “reinforcing” for comments of benefit for students but those not easily actionable (e.g., “good empathy and rapport”). Disagreements on comment categorization were resolved through discussion until consensus was achieved.
161 SPCOs were submitted. 8 SPCOs were excluded for lack of accurate observer information. Encounter settings included hospital (70), well child visits (34), sick visits (41), unknown (8). Observers included attending physicians (88) and residents (65).
SPCOs generated 769 points of feedback most commonly related to the interview (25.2%), physical exam (16.9%) or interaction with patient and family (15.7%).
Actionable comments accounted for 12.4% of responses while generalized and reinforcing comments accounted for 22.1% and 65.5% respectively. Less than half of all the SPCOs (43%) included any actionable feedback with 45% of attending physicians and 40% of residents giving at least one actionable comment. 64% of attending physicians and 60% of residents gave at least one generalized feedback statement.
SPCOs allowed MS3s to receive feedback from clinical supervisors; however the usefulness of this feedback was limited by generalized or reinforcing feedback rather than actionable comments which would be specific enough to be useful in shaping future encounters. Adding examples of specific actionable feedback as prompts to future SPCOs may further improve feedback quality.
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Moss HA, Derman PB, Clement RC. 2012. Medical student perspective: working toward specific and actionable clinical clerkship feedback. Med Teach 34: 665-667.
Richards ML, Paukert JL, Downing SM, Bordage G. 2007. Reliability and usefulness of clinical encounter cards for a third-year surgical clerkship. J of Surg Research 140:139-148.