The Evaluation & Feedback of
your Medical Student
Instructor Name
Goal
Residents will improve their feedback
techniques to heighten the students
learning experiences in the clinical
setting.
Objectives
At the end of the session, the learner will
be able to:
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Define feedback and describe its importance
Distinguish between formative & summative
feedback
Distinguish between feedback & evaluation
Describe the characteristics of feedback
Identify barriers to giving feedback
What is Feedback?
“Feedback is when a learner is offered insight
into what he or she actually did, as well as the
consequences of his or her actions. Feedback
highlights the dissonance between the intended
result and the actual result, thereby providing
impetus for change.”
J. Ende
Feedback in clinical medical education. JAMA 250(6): 777-81, 1983
Aug 12.
Why is it important?

Students who receive regular
feedback
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Perform significantly better
Develop better judgment
Learn faster
0ne of the most important qualities
of a good preceptor
Without Feedback
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Mistakes go uncorrected
Good performance is not reinforced
Clinical competence is not achieved
Learners self-validate
Formative Vs. Summative
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Feedback can be both
Formative informs the learner w/ ongoing
feedback
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Giving throughout the rotation
Allows learner the opportunity to correct
Summative verifies attainment of
competency
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Given at the end of rotation
No present opportunity to correct
Feedback Vs. Evaluation
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Feedback
Presents information
Formative
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i.e., guides learner to
goal
Neutral
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i.e., verbs & nouns
Evaluation
Presents a judgment
Typically summative

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i.e., how well learner
met goal
Normative statements
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i.e., adverbs &
adjectives
Feedback Vs. Evaluation
Feedback
Evaluation
Timing
Timely
Scheduled
Setting
Informal
Formal
Observation
Observation
Objective
Objective
Basis
Content
Scope
Specific Action
Purpose
Improvement
Global
Performance
“Grading”
Case 1: What would you do?
You realize the morning after being on call that
your intern did not appropriately evaluate a
patient with ______. Therefore, the patient was
not given ____ and showed signs of significant
_____.

What do you say to the intern? (both
immediately and later)
Essential Characteristics of
Feedback
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Descriptive, not judgmental
Specific, not general
Focus on changeable behaviors
Emphasize consequences
Be Timely
Based on first-hand information (not
hearsay)
Judgmental (not specific)

“You guys are awful. I’m tired of
watching you guys screw up. Try
harder and win. I expect 3 TDs in the
second half! Just do it! I don’t want
to lose my job.”
Specific (not judgmental)
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“We’re getting killed on the blitz.
The offensive line needs to focus on
#40 better.
JPW, drop back…”
Specific things to improve
Changeable Behavior

Provide feedback on performance
discrepancies that are within the control
of the learner
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Consider current skills / knowledge for
learner’s level
Emphasize Consequences
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Provide (or ask learner to provide)
possible outcomes if the behavior is not
changed
Highlight the benefits to changing the
behavior
Be Timely w/ Feedback
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Ensures more accurate recall
Immediate feedback is more
believable
Allows learner to modify behavior
earlier versus letting it continue
(making it more difficult to correct)
Based on Firsthand
Information
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Observe the student
You cannot provide feedback on
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Skills you haven’t observed
Knowledge you haven’t questioned
Reasoning you haven’t heard
Attitudes you haven’t experienced
Giving Feedback
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Describe the performance
Wait for learners comments
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Recommend how to improve
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May provide you insight into the problem
Be specific and be clear
Coach, not judge
Example: Student Too Slow
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Instead of
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Say
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“You took way too long interviewing that
patient. You need to be out of the room in
about 20 minutes with your H&P.”
“I noticed you were in Mrs. Smith’s room
for an hour.”
Then wait
Example: Student Too Slow
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Student replies
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“I know, I just couldn’t get the patient to
stop talking!”
“I didn’t know which questions were most
important to ask”
“I spent 40 minutes doing the physical
exam”
Recommend how to improve
Example: Student Mistake

Instead of
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Say
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“You wanted to give the patient the wrong
antibiotic for their pneumonia”
“Why did you want to give the patient
Keflex for their pneumonia?”
Then wait
Example: Student Mistake
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Student replies
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“You mean Keflex isn’t a good antibiotic for
pneumonia?”
“oops, I meant to click on ceftriaxone
instead.”
“Dr. Attending said to put them on Keflex.
I thought it was a bad idea.”
Example: Student Mistake
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Recommend how to improve
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Read the IDSA’s recommendations for CAP.
You can find them…
Computer order entry can be dangerous if
you don’t pay close attention to what you
are ordering…
I’ll clarify this with Dr. Attending
Example: Disorganized
Student Presentation
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Instead of: “You need to improve your
presentation.” (not specific)
Say: “This morning on rounds, your
presentation was very disorganized. It
was difficult to follow your thought
process.”
Wait – student can tell you what the
problem was from their standpoint
Example: Disorganized
Student Presentation
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Recommend how to improve
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“When you have a complicated patient,
organize your presentation with a problem
list. That way others can follow your
thought process and your presentations
will be more concise and organized.”
“Also, on rounds, listen to how the
stellar interns present and try to model
your presentations like theirs.”
Barriers to Giving Feedback
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“They know how they’re doing.”
“Is this an anomaly?”
“I don’t have time.”
The Awkwardness
Summary
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Effective feedback is essential to both
learning & good teaching
Learners who receive useful feedback
perform better
Without feedback, mistakes go
uncorrected
Feedback is a skill and can be learned &
improved upon
Questions???