The active feedback program: bringing medical students out of the shadows

Figures & data

Table 1. Oral instruction to medical students on day 1 when laying out expectations on how to efficiently present stroke patients on inpatient rounds

Limit patient presentations to no more than 2–3 minutes
Short one-liner that includes patient age, sex, stroke type and location
Major overnight events
Blood pressure range over last 24 hours rounded to the nearest 10. Only include other vital signs if abnormal (febrile, tachypneic, etc.)
Exclude mention of the general medical exam unless abnormal (heart murmur detected or rales on chest auscultation, etc.)
Present the neurological exam in the order below, describing only pertinent positives (abnormal exam findings), while leaving out normal neurological systems and findings
-Mental status
-Speech
-Cranial nerves
-Motor
-Sensory
-Reflexes
-Coordination
Gait (which often cannot be tested depending on the severity of the stroke impairment)
Abnormal lab values and drug levels
New results from diagnostic tests
Problem-based assessment and plan as outlined below:
-Repeat one-liner, but this time include major stroke risk factors and other major active problems
-Discuss the stroke as the first major problem, being sure to talk through the suspected stroke etiology
-Discuss other major problems in turn. Do not discuss chronic problems that are not active or applicable to this hospitalization
-Disposition: describe any barriers to the patient transitioning to the next phase of recovery (stepping down from ICU-level care, discharging to home, acute rehabilitation, or nursing facility, etc.)

Figure 1. The active feedback program. this week-long program can be extended for longer rotations by keeping the 1^st individual feedback session halfway through the rotation. medical students at our institution may or may not round on the weekends, which is why this schedule ends on a friday