1. Cherie Jones MD, FRCPC Sheila Pinchin, MEd Sue Fostaty-Young

2. 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 asnapshot letter grade does, and often used to complement letter grades.

3. 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 well- entrenched (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)

4. Links to learning objectives Identifies strengths and weaknesses by providing examples, quotations, etc. Uses constructive and specific language Individualizes feedback Identify each learners areas of strength and build on them, rather than depending on adeficit model of fixing the gaps. Summarizes and provides suggestions for improvement.

5. 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

6. 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?

7. Professionalism Functioning in the team context Links to the learning objectives for the task Skills: Relationship with the Patient Gathering Information (Hx and Px)

8. 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…

9. 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.

10. Unhelpful Feedback ReasonHelpful FeedbackReason Your body language wasnt very good at the start JudgmentalAt the beginning you were looking at the computer screen records and not at the patient as she started to tell her story Descriptive, detailed, behavioural You werent very empathic Non- specific You didnt acknowledge the problems she has dealing with her husbands illness Identifies specific problem Youre very abrupt Personality issue You interrupted a lot. For example… (give specific points in consultation) Behavioural, specific It was really good Non- specific 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 Examples of Helpful and Unhelpful Narrative Feedback

11. Mid-Term SELF AssessmentFinal SELF Assessment Self-Assessment form Global Assessment: Needs Improvement Progressing as expected 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: Self-Assessment form Global Assessment: Needs Improvement Meets expectations 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:

12. Mid-Term PEER AssessmentFinal PEER Assessment Peer Assessment form Global Assessment: I look forward to working with this student for the rest of the term: (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… 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…

13. Mid-Term TUTOR AssessmentFinal TUTOR Assessment Tutors Student Assessment form Global assessment: Mid-term (formative) Needs Improvement Progressing as expected Sentence stems: This students progress in relation to his/her self-defined focus this term has been: My concerns with this students performance are: In order to improve future performance this student should: Tutors Student Assessment form Global assessment: Final Requires remediation Meets expectations Sentence stems: This students progress in relation to his/her self-defined focus this term has been: My concerns with this students performance are: In order to improve future performance this student should:

14. Communication NEEDS Attention PROGRESSIN G AS EXPECTED Tutor Agreement Introduction polite and effective; establishes rapport & explains aims of consultation YesNo Determines reason for visit, obtains basic history of presenting complaintsYesNo Performs a basic review of systems, social and family historyYesNo Avoids use of jargonYesNo Demonstrates the use of techniques including: Open-ended questions, Clarifying statements, Transitional statements, Summarizing to encourage patient to tell their story. YesNo Demonstrates the use of non verbal communicationYesNo 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:

15. Professional behaviours and skills NEEDS Attention PROGRESSIN G AS EXPECTED Tutor Agreement Attends all session and arrives on timeYesNo Demonstrates effective communication within group and with tutorsYesNo Prepares and participates effectively within groupYesNo Dresses according to defined dress codeYesNo Understands and demonstrates what is meant by professional behaviourYesNo Receptive to feedback and interacts politely and positively with tutors.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:

16. 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. Examples of Narrative Assessment Forms or Prompts from across UGME Walsh, 2006, Adapted from the Coaching Feedback Format, Bayer Institute for Health Care communication

17. Narrative feedback requires for each student: Observation Notes on observation Organization of notes over time Many faculty have adopted a variety of strategies to keep notes on students in tutor groups or clerkship groups. These include: 1. A series of file (recipe) cards, one for each student, with dates and comments (Dr. Sylvester) 2. A series of forms or checklists, one for each student with objectives and observations over time (dated) 3. Encounter cards, and other student self-assessments (to be used in conjunction with tutor/preceptor observation)

18. Sue Fostaty-Young is our UGME Assessment and Evaluation Consultant. Reach her at fostatys@queensu.ca fostatys@queensu.ca Sheila Pinchin is our UGME Education Specialist. Reach her at sheila.pinchin@queensu.ca 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 hiscockc@hdh.kari.net