Structured feedback to undergraduate medical students: 3 years’ experience of an assessment tool

Figures & data

Table

Practice points

In a continuous attachment with personal supervisors, summarised formative assessment is a feasible and acceptable strategy. Most students and supervisors are satisfied with the experience of a structured assessment tool. Long-term use of an assessment strategy can increase the proportion of specific feedback to students, supervisors’ stringency of assessment, and their satisfaction with the tool.

Box 1. Competency domains of the assessment form.

Medical interview

History taking

Physical examination

Working diagnoses

Problem solving

Investigations and treatment

Explanation and planning

Relationship with patients; time management

Box 2. Questions to students and supervisors on the feedback sheets.

To students

• Did your supervisor correctly identify your strengths and weaknesses in your consultations? (yes, partially, no)

• Did you get specific advice on how to improve your consultations? (yes, partially, no)

• Did your supervisor supply effective feedback in the second feedback session? (yes, partially, no)

To supervisors

• Did the assessment tool contribute to improved structure in the assessment of your student's performance? (yes, partially, no)

Figure 1. Flow chart of students between first and second feedback sessions.

Table 1.  First feedback session: scores of the assessment form.

	Mean of ratings
Competency domain	Supervisors’ ratings (all students) (n = 458)	Self-ratings (all students) (n = 462)	Self-ratings (male students) (n = 206)	Self-ratings (female students) (n = 256)	Self-ratings (students with work experience) (n = 226)	Self-ratings (students without work experience) (n = 228)
Medical interview	5.4 (SD = 1.0)***	5.0 (SD = 0.8)	4.9 (SD = 0.8)	5.0 (SD = 0.8)	5.0 (SD = 0.8)	4.9 (SD = 0.8)
History taking	5.3 (SD = 1.0)***	4.6 (SD = 0.9)	4.6 (SD = 0.9)	4.6 (SD = 0.9)	4.7 (SD = 0.8)	4.5 (SD = 1.0)
Physical examination	5.3 (SD = 1.0)***	4.5 (SD = 1.0)	4.6 (SD = 1.0)	4.5 (SD = 1.0)	4.6 (SD = 1.0)*	4.4 (SD = 1.0)
Working diagnoses	5.0 (SD = 1.0)***	4.2 (SD = 1.0)	4.3 (SD = 1.0)*	4.1 (SD = 1.0)	4.3 (SD = 0.9)	4.1 (SD = 1.0)
Problem solving	5.2 (SD = 1.1)***	4.5 (SD = 1.0)	4.5 (SD = 1.0)*	4.4 (SD = 0.9)	4.5 (SD = 1.0)*	4.4 (SD = 1.0)
Investigations and treatment	5.1 (SD = 1.1)***	4.1 (SD = 1.0)	4.2 (SD = 1.0)*	4.0 (SD = 1.0)	4.2 (SD = 1.0)**	4.0 (SD = 1.0)
Explanation and planning	5.3 (SD = 1.0)***	4.5 (SD = 1.1)	4.6 (SD = 1.0)	4.5 (SD = 1.1)	4.6 (SD = 1.1)	4.5 (SD = 1.1)
Relationship with patients; time management	5.4 (SD = 1.1)***	4.5 (SD = 1.0)	4.5 (SD = 1.0)	4.5 (SD = 1.1)	4.5 (SD = 1.1)	4.5 (SD = 1.0)
Average score	5.3 (SD = 0.9)***	4.5 (SD = 0.8)	4.5 (SD = 0.7)	4.5 (SD = 0.8)	4.5 (SD = 0.7)*	4.4 (SD = 0.8)

Notes: *p < 0.05, **p < 0.01; ***p < 0.001.

Box 3. Examples of generalised/specific goals (first feedback session) and generalised/specific feedback and ‘feed forward’ (second feedback session).

First feedback session – Generalised goals: examples

• More practical training to increase the ‘flow’ of the consultation (student 113)

• Improved consultation skills and enhanced efficiency (student 193)

• Consult with many patients to gather maximum of experience (student 301)

First feedback session – Specific goals: examples

• Needs to improve in supplying information in a language understandable to the patient, and in suggesting appropriate follow-up (student 9).

• She has to express more verbal empathy, be sensitive to the patient's non-verbal cues, and ask about the patient's concerns and expectations.  Improved disposition of time during the consultation is also required (student 88)

• Summarise the patient's history and negotiate agenda with the patient! (student 328)

Second feedback session – Generalised feedback: examples

• Has made progress (student 105)

• She is a very bright and ambitious student (student 395)

• Very active, independent and positive student (student 425)

Second feedback session – Specific feedback: examples

• He has considerably improved in his problem solving, now adequately applying his theoretical knowledge. The structure of the medical interview  and his management suggestions have developed (student 173)

• She has focused on the three agreed areas for training: disposition of the available time, medical decision making (investigations and treatment),  and examination technique. The results are satisfying (student 243)

• She has improved in her rapport with patients and in her ability to structure the medical interview (student 359)

Second feedback session – Feed forward: examples

• He has improved, but has to consider the structure of the medical interview, and to summarise for the benefit of himself and the patient (student 50)

• She needs to work more on how to elicit the patient's ideas, concerns and expectations (student 62)

• I could confirm his excellent communication skills, and encouraged him to further improve his examination technique (student 292)

Table 2.  First feedback session: range of scores of the assessment form.

No. of scores	Supervisors (%) (n = 458)	Students (%) (n = 462)
1 score	61 (13)	18 (4)
2 scores	258 (56)	159 (34)
3 scores	123 (27)	218 (47)
4–5 scores	16 (4)	67 (13)

Table 3.  First feedback session: specific goals; second feedback session: specific feedback.

Competency domains	First feedback session: No. of specific goals (% of students) (n = 407)	Second feedback session: No. of specific feedback comments (% of students) (n = 256)
Medical interview	188 (46)	141 (55)
History taking	83 (20)	46 (18)
Physical examination	116 (29)	61 (24)
Working diagnoses	137 (34)	92 (36)
Problem solving	126 (31)	85 (33)
Investigations and treatment	153 (38)	103 (40)
Explanation and planning	164 (40)	111 (43)
Relationship with patients; time management	117 (29)	90 (35)

Table

Medical interview	1	2	3	4	5	6	7
Welcomes patient, introduces him/herself to patient
Demonstrates interest and respect towards patient
Starts with an open question; encourages patient to continue
Listens attentively to patient's opening statement, without interrupting or directing patient's response
Uses pauses and silence appropriately
Seeks clarification of words used by patient, if needed
Recognises patient's verbal and non-verbal cues
Phrases questions simply and clearly
Expresses verbal empathy and support; appropriate non-verbal behaviour
Elicits patients’ ideas, concerns and expectations
Summarises periodically and at the end to establish patient's reasons for consultation
Negotiates agenda with patient, taking both patient's and doctor's needs into account
History taking	1	2	3	4	5	6	7
Elicits relevant and specific information from patients
Considers physical, social and psychological factors as appropriate
Physical examination	1	2	3	4	5	6	7
Performs physical examination sensitively, with respect for patients’ integrity
Uses accurate examination technique
Elicits physical signs correctly
Working diagnoses	1	2	3	4	5	6	7
Generates appropriate working diagnoses or identifies patient's problems after history taking
Seeks relevant and discriminating physical signs in examination to help confirm or refute working diagnoses
Problem solving	1	2	3	4	5	6	7
Correctly interprets and applies information, obtained from patient's records, history, physical examination and investigation
Is capable of applying knowledge of basic behavioural and clinical sciences to the identification and management of patient's problems
Is capable of recognising limits of personal competence and acting accordingly
Investigations and treatment	1	2	3	4	5	6	7
Suggests investigations and/or treatment appropriate to findings and in collaboration with patients, taking into consideration discriminating use of resources
Explanation and planning	1	2	3	4	5	6	7
Supplies patient with correct and clear information
Relates explanations to patient's perspective, aiming to achieve shared understanding
Uses clear and understandable language, avoiding medical jargon
Checks patient's understanding
Arranges appropriate follow-up in dialogue with patient
Relationship with patients; time management	1	2	3	4	5	6	7
Maintains friendly but professional relationship with patient
Is capable of reflecting on common ethical issues in medical care
Uses the available time for the consultation appropriately