Cherie Jones MD, FRCPC
Sheila Pinchin, MEd
Sue Fostaty-Young
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This is written descriptions of a student's
performance organized in logical order, to
illustrate the "story" or account of a student's
progress and performance, including strengths
and areas for improvement…to guide future
efforts
Often yields richer information than a
“snapshot” letter grade does, and often used to
complement letter grades.
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Physician performance improves significantly more
with feedback than without it (Westberg & Jason, 1991)
Without reinforcement, desirable and helpful
behaviours on the part of learners may be
extinguished, and bad habits may become wellentrenched (Ende 1983; Westberg & Jason, 1991)
Provision of feedback, which identifies learner
strengths and makes recommendations for
improvement, is a key tool in clinical teaching (Irby &
Bowen, 2004).
“Learning without feedback is like learning
archery in a darkened room. “
(Cross, 1996)
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Links to learning objectives
Identifies strengths and weaknesses by
providing examples, quotations, etc.
Uses constructive and specific language
Individualizes feedback
Identify each learner’s areas of strength and
build on them, rather than depending on a
“deficit model” of “fixing the gaps”.
Summarizes and provides suggestions for
improvement.
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Helps the student identify learning goals to
work toward
Assesses how well the student is achieving
learning goals
Reviews student progress over time
Provides suggestions for improvement
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If the student had the next three weeks to work
on improving something, what should it be
and what suggestions do you have for them as
to how to do it?
If you were “handing over” the student to
another tutor, what could you identify as areas
for improvement that your colleague could
focus on?
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Professionalism
Functioning in the team context
Links to the learning objectives for the task
Skills:
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Relationship with the Patient
Gathering Information (Hx and Px)
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“I was very impressed with the degree to which
individuals in this group worked together in terms
of respecting each other, as well as with the ease
in which an animated discussion spontaneously
moved from student to student.” (FSGL 2010)
“Wow! Wonderful person. Will make a great doc!
Keep up the good work!”
“Should develop superior clinical ability. Practice
every opportunity…”
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“Continue with current progress; More
practice.”
“Improving conveying of competence,
increased interaction and verbal
communication in sessions…”
“Expression of confidence and professional
persona in interactions with patients and
colleagues. May benefit from videotape review
of interviews. Role modeling.”
Examples of Helpful and Unhelpful Narrative
Feedback
Unhelpful
Feedback
Reason
Helpful Feedback
Reason
‘Your body
language
wasn’t very
good at the
start’
Judgmental
‘At the beginning you were looking Descriptive,
at the computer screen records and detailed,
not at the patient as she started to
behavioural
tell her story’
‘You weren’t
very empathic’
Nonspecific
‘You didn’t acknowledge the
problems she has dealing with her
husband’s illness’
Identifies
specific
problem
‘You’re very
abrupt’
Personality
issue
‘You interrupted a lot. For
example…’ (give specific points in
consultation)
Behavioural,
specific
‘It was really
good’ ‘
Nonspecific
At the start you asked an open
question and then allowed her to
tell her story. You left silences so
that she continued in her own
words’
Positive,
specific,
descriptive
Mid-Term SELF Assessment
Final SELF Assessment
Self-Assessment form
Global Assessment:
Needs Improvement
Progressing as expected
Self-Assessment form
Global Assessment:
Needs Improvement
Meets expectations
Sentence Stems:
Since beginning this term I have
focused on improving my ability to:
One example of my progress in this
area is:
In addition to continued development
in the area described above, I plan to:
Sentence Stems:
Overall I would describe my progress
this term:
I would like to further develop my
ability to:
Towards this end I plan to:
Mid-Term PEER Assessment
Final PEER Assessment
Peer Assessment form
Global Assessment:
I look forward to working with this
student for the rest of the term: (Agree
/Disagree)
Peer Assessment form
Global assessment:
I welcome the opportunity to work
with this student in the future (Agree
/Disagree)
Sentence stems:
This student made a significant
contribution to the group by…
This student could improve his/her
performance in a group by…
Sentence stems:
This student made a significant
contribution to the group by…
This student could improve his/her
performance in a group by…
Mid-Term TUTOR Assessment
Final TUTOR Assessment
Tutor’s Student Assessment form
Global assessment:
Mid-term (formative)
Needs Improvement
Progressing as expected
Tutor’s Student Assessment form
Global assessment:
Final
Requires remediation
Meets expectations
Sentence stems:
This student’s progress in relation to
his/her self-defined focus this term
has been:
My concerns with this student’s
performance are:
In order to improve future
performance this student should:
Sentence stems:
This student’s progress in relation to
his/her self-defined focus this term
has been:
My concerns with this student’s
performance are:
In order to improve future
performance this student should:
Communication
NEEDS
Attention
PROGRESSIN
G AS
EXPECTED
Tutor
Agreement
Introduction polite and effective; establishes rapport & explains aims of
consultation
Determines reason for visit, obtains basic history of presenting complaints
Performs a basic review of systems, social and family history
YesNo
Avoids use of jargon
Demonstrates the use of techniques including:
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Open-ended questions,
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Clarifying statements,
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Transitional statements,
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Summarizing to encourage patient to tell their story.
YesNo
Demonstrates the use of non verbal communication
YesNo
YesNo
YesNo
YesNo
Student Narrative:
Since beginning this term, I have focused on improving my ability to:
One example of my progress in this area is:
One example of a skill I still need to improve is:
In order to improve this skill I plan to:
Tutor Narrative:
So far this term, this student has been focusing on improving his/her ability to:
So far this term, this student has demonstrated significant strengths in:
During the remainder of this term, this student should be encouraged to improve
his/her ability to:
In order for the student to improve this skill I suggest that s/he:
Professional behaviours and skills
NEEDS
Attention
PROGRESSIN
G AS
EXPECTED
Tutor
Agreement
Attends all session and arrives on time
YesNo
Demonstrates effective communication within group and with tutors
Prepares and participates effectively within group
YesNo
YesNo
Dresses according to defined dress code
Understands and demonstrates what is meant by professional behaviour
Receptive to feedback and interacts politely and positively with tutors.
YesNo
YesNo
YesNo
Student Narrative
Since beginning this term I have focused on improving my ability to:
One example of my progress in this area is:
One example of a skill I still need to improve is:
In order to improve this skill I plan to:
Tutor Narrative:
So far this term, this student has been focusing on improving his/her ability to:
So far this term, this student has demonstrated significant strengths in:
During the remainder of this term, this student should be encouraged to improve his/her
ability to:
In order for the student to improve this skill I suggest that s/he:
Examples of Narrative Assessment
Forms or Prompts from across UGME
Subspecialty Medicine Assessment Form (Clerkship)
Continue…
Comment on aspects of performance
that were effective. Be specific and
describe impact. Highlight things you
would like to be done in the future.
Start, or do more…
Identify behaviour the student knows
how to do, and could do, or do more
often.
Consider…
Highlight a point of growth for the
learner, a “doable” challenge for
future interactions.
Stop, or do less
Point out actions that were not
helpful, or could be harmful. Be
specific, and indicate potential impact.
Walsh, 2006, Adapted from the Coaching Feedback Format , Bayer
Institute for Health Care communication
Narrative feedback requires for each student:
 Observation
 Notes on observation
 Organization of notes over time
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Many faculty have adopted a variety of strategies to
keep notes on students in tutor groups or clerkship
groups. These include:
A series of file (recipe) cards, one for each student,
with dates and comments (Dr. Sylvester)
A series of forms or checklists , one for each student
with objectives and observations over time (dated)
Encounter cards, and other student self-assessments
(to be used in conjunction with tutor/preceptor
observation)
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Sue Fostaty-Young is our UGME Assessment
and Evaluation Consultant. Reach her at
fostatys@queensu.ca
Sheila Pinchin is our UGME Education
Specialist. Reach her at
sheila.pinchin@queensu.ca
Cherie Jones-Hiscock is a psychiatrist working
as a Course Director in Clinical and
Communication Skills. Reach her at
hiscockc@hdh.kari.net