Hospitalists Need to Rethink the Way They Evaluate Students

Here are our favorite tips and tricks for delivering effective feedback:

1. Establish a positive learning climate. Educators must partner with learners to generate an atmosphere of mutual trust and respect.1,3,4,8 An example of how to ally with learners is to announce early on, “As a teacher, I really value feedback. As such, I plan on giving feedback throughout the rotation because I want you to be the best doctor you can possibly be.”
2. Require reflection. Effective feedback hinges on learners’ ability to self-assess.2,5,7 One approach is starting each feedback session with a simple open-ended question, such as, “How do you think you are doing?” Alternatively, you could be more specific, such as, “How do you think you did in managing the patient’s electrolytes when he went into diabetic ketoacidosis?”
3. Be prompt. Feedback should be timely.1,4,7,8 An important distinction between feedback and evaluation is that feedback is formative, enabling learners to make needed changes before the end of a course, whereas evaluation is summative and presents a distinct judgment.1,4 If feedback is withheld until the end of the rotation, learners will not have an opportunity to remediate behaviors.
4. Take advantage of different formats. Try a brief, concrete suggestion on the fly. A statement that might occur on bedside rounds is, “Allow me to show you a better technique to measure the liver span.” Or use a teachable event, such as a medical error or a particularly challenging case. Pulling interns aside after they deliver sobering news is a great opportunity to provide feedback in a semiformal fashion. Finally, formal sit-down feedback should be scheduled halfway through each rotation to ensure learners are on track and to address any major issues, such as professionalism or an inadequate clinical performance.2
5. Be specific. Focus on behaviors and examples rather than judgments.1,2,4,7,8 For example, we have all experienced the inattentive student. Instead of framing feedback as, “It seems like you don’t care about medicine because you weren’t paying attention on rounds,” one could say, “I noticed you were fidgeting and looking at your phone during Aaron’s presentation.” Feedback should be based on firsthand observations and should be descriptive, utilizing neutral language.
6. Avoid information overload. Feedback is best consumed in small snacks rather than an all-you-can-eat buffet.1,7 Your goal should not be to completely overhaul a learner but rather to focus on a few observable, correctable behaviors.
7. Be empathetic. To make negative feedback less threatening, take yourself off the pedestal. An example of this could be saying, “As a third-year medical student, I struggled to remember all the right questions to ask, so performing a thorough review of systems helped me to catch the things I would miss.”
8. Confirm understanding. It is important to know the learner has heard the feedback and to conclude the session with an action plan.

Just as hospitals engage in continuous quality improvement, as professionals, we should all strive for continuous self-improvement. Giving and receiving feedback is critical to personal growth. It is our hope that by using these tips, all of us will improve, creating a new generation of providers who give effective and useful feedback.

References

1. Anderson PA. Giving feedback on clinical skills: are we starving our young? J Grad Med Educ. 2012;4(2):154-158. doi:10.4300/JGME-D-11-000295.1.
2. Branch WT, Paranjape A. Feedback and reflection: teaching methods for clinical settings. Acad Med. 2002;77(12 Pt 1):1185-1188.
3. Hewson MG, Little ML. Giving feedback in medical education: verification of recommended techniques. J Gen Intern Med. 1998;13(2):111-116.
4. Ende J. Feedback in clinical medical education. JAMA. 1983;250(6):777-781.
5. Bing-You RG, Trowbridge RL. Why medical educators may be failing at feedback. JAMA. 2009;302(12):1330-1331.
6. Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. JAMA. 2006;296(9):1094-1102.
7. Cantillon P, Sargeant J. Giving feedback in clinical settings. BMJ. 2008;337:a1961.
8. Ramani S, Krackov SK. Twelve tips for giving feedback effectively in the clinical environment. Med Teach. 2012;34(10):787-791.