Authors: Zhang XC, Abrams M, Papanagnou D, Thomas Jefferson University, on behalf of the Advising Students Committee in Emergency Medicine

Providing timely feedback is a critical component in medical education in promoting learning and learner self-reflection as they acquire new skills and knowledge in the ever-changing field of medicine. Feedback should be provided in a safe space, be based on direct observation, with specific suggestions for future improvement. While there are innumerable publications on how to provide appropriate, receptive feedback, many instructors and faculty members receive little training on writing a constructive and explorative student evaluation as part of a formative assessment process. Abbreviated commentaries such as ‘good job’ or ‘read more,’ provide little insight into the mindset and behavior of the student and can result in unexplained discrepancies between the students’ objective scores and their written narrative evaluations. 

As a food enthusiast and Yelp (www.yelp.com) reviewer, I am met with many similar challenges shared by my academic colleagues in writing a constructive summary (or evaluations) of a memorable experience. While the stakeholders of a restaurant review and student evaluation may differ, both pieces share common literary constructs and conceptual frameworks for a review that accurately and eloquently portrays every aspect of the encounter.

In order to guide evaluators in writing formative and constructive student evaluations, we have collected, reviewed and revised five lessons that transcends both culinary and pedagogical dimensions.  

Lessons

1.       Take a [mental] picture

Just as how food enthusiasts photograph their culinary adventures as a keepsake, clinician evaluators can also take mental pictures of the students’ performance, simply by empowering the learners to recall their own clinical experience for you. While many patients may invoke powerful memories recall with the near superhuman ability to remember specific nuances of their encounter, remembering the details of a student’s performance after a hectic day is trying and unreliable. As an evaluator, you can ask the student to send a formal evaluation request with the following information: 1) the student’s professional photo, 2) his/her patient encounters of the day, 3) learning points, 4) areas of strength, and 5) ways to improve for the next day. This simple act allows the learner to actively recap their clinical experience while invoking the evaluator’s memory of the day’s events.

2.       Document every detail

As each description from the impeccable selection of the avant-garde décor, to the artistically plated legumes, to the amicable staff transport the reader into the reviewer’s culinary experience, clear and detailed documentation is as crucial in recording medical events as student behavior and evaluation. Each specific recording of the students’ behavior provides a formative marker to track their specific growth as students and in some cases, mark concerning habits for the program leadership that should be addressed during their training.

3.       Use a rubric

Similar to a food critic’s reviews, medical students in the United States are also evaluated based on a set rubrics or criteria. The Association of American Medical Colleges (AAMC) lists 15 core competencies before medical school graduation; the Accreditation Council for Graduate Medical Education (ACGME) uses a similar set of six core competencies. Depending on the learner and institution, the evaluator should adhere to the strict phrasing for the level of competence within each gradable competencies to minimize subjective grading and ensure fair comparison between the student and his or her peers.

4.       Leave room for improvement

Even the best restaurant reviews have flaws, and it falls upon the reviewer to illustrate areas of improvement to make the dining experience even more memorable with each visit. In medicine, students are held to a high-stake and an even higher pressure where misinformed actions or unidentified knowledge gaps may cause inadvertent harm to patients. As such, clinical evaluators must strive to provide active, constructive feedback based on direct observation after every student encounter, as well as documenting these elements on formal evaluations to be later reviewed by the program leader stakeholders, such as clerkship directors or program directors. These documented areas of improvement can be instrumental in providing targeted remediation and mentorship.

5.       Check-in before you check out

While many commercialized review apps enable end-users and reviewers to ‘check-in’ to the restaurant and with periodic reminders to seek out personal opinions and evaluations of their experience, the formal medical evaluation process often requires learners to send out individualized evaluation requests on a password-protected hospital server, making it difficult for evaluators to input their reviews without student-prompts. While there is a limited market for a commercialized smartphone apps to check-in for an evaluation, evaluators can circumnavigate this by requesting the student to send an evaluation request at the beginning of the shift as a ‘check-in’ reminder. This check-in serves as a reminder for both the evaluator to complete the evaluation, and for the student to acknowledge that his/her performance will be critically assessed during the shift.

In conclusion, constructive, narrative, written feedback is an integral part of formative and summative evaluation in health professions education. We hope the insights from the food blogging world may prove helpful for these individuals. The five-step guide to develop a 5-star review will support evaluators as they aim to provide written, constructive feedback to their students.