Improving feedback with a clinical encounter form

Verbal interaction analysis: viewing feedback through a different lens

BACKGROUND

Verbal interaction analysis, though seldom applied to the feedback-giving process, can be used to assess feedback dimensions not easily assessed by other means.

DESCRIPTION

The purpose of this study was to explore verbal interaction analysis as a method to assess feedback interactions between senior medical students trained as teachers and their sophomore learners. We randomly selected 14 videotaped encounters of senior teachers giving feedback to sophomore learners and classified 417 utterances to address (a) verbal dominance, (b) feedback balance, and (c) cognitive level.

EVALUATION

Teachers did most of the talking (65.2%). Although some feedback was corrective (20.6%), teacher utterances were mostly positive (33.5%) or neutral (45.9%). Cognitively, the teacher utterances occurred largely at the factual (lowest) level (74.3%).

CONCLUSIONS

Interaction analysis enabled us to describe 3 dimensions of teacher-learner feedback not easily assessed by other means: verbal dominance, positive-corrective balance, and cognitive level. Assessing these dimensions provides information about two theoretically important indices of feedback-giving effectiveness: learner involvement and feedback balance. Future study of verbal interaction analysis in this and other populations is warranted to further evaluate its usefulness.

Improving medical student feedback with a clinical encounter card

OBJECTIVE

We previously developed a Clinical Encounter Card (CEC) for use in medical student feedback. However, no prior studies have investigated the effectiveness of the CEC. The objective of our study was to determine whether use of the CEC would increase medical students' perception of the feedback they received.

METHODS

We conducted a time-series repeated-measures experimental study at a pediatric clerkship site. The study included a crossover design with experimental and control arms. Third-year medical students on the ambulatory rotations were the experimental arm, and inpatient students were the control arm. Students and faculty in the experimental arm received the CEC, which listed 7 feedback domains: history and interviewing, physical examination, oral presentation, written notes, patient assessment, management plan, and professionalism. We used a 10-point Likert-type scale to record responses of students weekly regarding their perceptions of having received feedback in the 7 domains. Multivariate analysis of variance for repeat measures tested mean differences in continuous variables, and Mann-Whitney U rank order sum tested ordinal rank differences.

RESULTS

We received 504 reports from students regarding the feedback they received. We found statistically significant improvements in 6 feedback domains for experimental subjects: history/interviewing, physical examination, oral presentation, written notes, patient assessment, and management plan. There was no improvement in feedback received about professionalism.

CONCLUSIONS

Use of the CEC resulted in students' perceiving increased feedback as evidenced by significant improvements in several medical student feedback domains.

Can a computerized tracking system improve faculty compliance with medical student evaluations?

AIM

We examined whether using a new personal digital assistant (PDA)-based computerized tracking system (PDAT) improved the rate of faculty evaluation of students compared to using written clinical encounter cards. Also, we examined whether the addition of e-mail reminders to PDAT affected the evaluation rate.

METHODS

Retrospective review of collected data on evaluation rates before and after implementation of the computerized tracking system, with and without e-mail reminders. Written encounter cards were available during all phases of the study. The study was conducted at Wake Forest University School of Medicine.

RESULTS

Evaluation rates between three separate 3-month periods were compared: (1) written cards alone, (2) PDAT alone and (3) PDAT plus e-mail reminders to the faculty (PDAT-e). The odds ratio (OR) for faculty completion of evaluations was 2.97 when electronic and paper submission were available compared to paper-only evaluations (95% CI: 2.10-4.22, p-value <0.0001). With the addition of e-mail reminders, the OR was 4.19 (95% CI: 2.98-5.88, p-value <0.0001).

CONCLUSION

PDAT significantly improved faculty compliance with medical student evaluations when compared with written cards alone. The addition of e-mail reminders further improved faculty compliance, but this was not statistically significant. The use of a PDAT appears to be an effective way to improve faculty compliance with medical student evaluations.

A randomized-controlled study of encounter cards to improve oral case presentation skills of medical students

OBJECTIVE

To determine the feasibility of oral case presentation (OCP) encounter cards as a tool for formative evaluation, to estimate the reliability and validity of the ratings when used in a medicine clerkship, and to examine whether the use of OCP encounter cards improves students' OCP skills.

DESIGN

Randomized controlled study.

SETTING

Medicine core clerkship at a U.S. medical school.

PARTICIPANTS/INTERVENTION

Students enrolled in the medicine core clerkship (n=164) from January to December of 2003 were randomly assigned to receive weekly feedback using OCP encounter cards rating nine presentation compentencies or receive usual feedback. Mean OCP ratings were correlated with multiple summative assessments. Performance on an end-of-clerkship OCP was compared between intervention and control groups.

MAIN RESULTS

Eighty percent of cards were completed. The mean OCP rating averaged over 9 competencies was 7.7 (SD=0.8) on a 9-point scale. Standard error of ratings was 0.3. OCP ratings were correlated with inpatient evaluations (r=.58), inpatient ratings of presentation skills (r=.43), and final grades (r=.40). Final OCP performance was similar for the intervention and control groups (7.0 vs 7.2, P=.09).

CONCLUSION

OCP encounter cards are a novel and feasible tool to assess clerkship students' oral case presentation skills. OCP card ratings are reproducible, and validity is suggested by their correlation with multiple markers of performance. However, encounter cards did not improve performance on summative oral presentations.

Medical Students’ Perceptions of Feedback in a Busy Ambulatory Setting: A Descriptive Study Using a Clinical Encounter Card

BACKGROUND

Residents and medical students have expressed repeated concerns over the years about the inadequate amounts and quality of feedback in the clinical setting. Despite innovative ways to teach the skill of giving feedback, the problem has not been fixed.

METHODS

In this study, the author introduced the clinical encounter card to the ambulatory setting for faculty to use as a cue to provide feedback to students. At the end of the 4-week rotation, students anonymously reported on the amount, frequency, and quality of feedback they received.

RESULTS

Students reported that the learning climate for giving/receiving feedback was very good to excellent. They rated the quality and amount of feedback they received from faculty as high on the Likert scale and the frequency just above the mean. Most of the feedback was directed toward knowledge and skills, and there were few reports of demeaning behavior. Feedback was timely, and students reported using the feedback to improve their performance. The clinical encounter card improved feedback to students in a busy ambulatory setting. Whereas the author did not monitor how often the clinical encounter card was used, there were ample cards on each student to provide mid-rotation feedback and summative evaluations. The students rated the process as the best of any clerkship rotation.

CONCLUSIONS

The clinical encounter card is an effective tool to enhance feedback in a busy pediatric ambulatory setting. It is not known if these results are generalizable, but readers are encouraged to repeat the study in other settings.