Direct Observation and Feedback in Medical Education

Looking back on my year of core clerkship, the saying "you learn from your mistakes" has definitely held true. Third year was a time of constantly entering new environments and learning new sets of skills with every new rotation. However, gauging success in a rotation was often quite difficult, since feedback was often received quite infrequently. In addition, the feedback itself often felt quite generic and was difficult to apply in the future (if I had a nickel for each time I was told to "read around my cases"...).

There are a number of different factors at play here, and I will devote a blog post to each issue individually. With the student, barriers include a reluctance to ask for additional feedback from a preceptor, and a lack of familiarity of how to ask. Staff members may be too busy during the day to supervise students at the bedside or in the ambulatory setting in order to give adequate feedback. Likewise, there may be a lack of familiarity of how to give appropriate feedback. Finally, the curriculum itself may lend itself to an inability to obtain appropriate feedback. While there are significant efforts being made to ensure all students are observed once doing a history and physical examination at the bedside during their Internal Medicine rotation, could there be further system-level changes that can foster an environment of more observation and feedback?

My clerkship years have been filled with very diverse experiences. With that, I have had some rotations with a great deal of observation and feedback built into the rotation, while others have very little opportunities. Yet in other rotations I was observed often, but was not receiving appropriate feedback. I firmly believe that a medical student's comfort in being observed and asking for or receiving feedback plays a large role in their perceived performance in a rotation, as well as their perception or enjoyment of that block. Most importantly, I think it causes significant avoidable stress in a medical student's clerkship; it is for this reason that I will be focusing on this topic throughout my CEEP selective. It starts with identifying the issues and barriers, and establishing new practices that make increased observation and feedback the norm.

- Anthony