Daily Learner Feedback & Assessment
(Penciner R & McPartland K. Daily Learner Feedback & Assessment Tool: A Community Academic Hospital Approach. Presented at the Canadian Conference on Medical Education, Montreal, Quebec, April 2016.)
Teaching medical students and residents (learners) in the clinical setting occurs in diverse and dispersed settings, including hospital wards, clinics, operating rooms and community based offices. On many rotations, teaching and learning experiences are often episodic, with learners encountering different teachers and supervisors throughout their rotation. Although paper daily assessment tools are often used, there are logistical challenges in completion, collection and distribution to the learners’ preceptors. Verifying attendance of learners in these clinical settings is also often challenging.
Most teachers and supervisors are not responsible for providing summative (end of rotation) evaluation to their learners. Current university evaluation systems do not easily allow for daily evaluations of this episodic teaching. The preceptor responsible for evaluating the learner often does not have the entire “picture” from all the clinical teachers/supervisors about the learner’s performance.
Learners often report that they are not receiving adequate feedback on performance in the clinical setting. From the educator’s perspective, learners in difficulty are often not identified until the end of the rotation, when it is too late to provide timely feedback and remediation.
At North York General Hospital, we developed an online solution to provide daily feedback and assessment to our medical trainees. A paper based daily encounter card was first developed by the hospital’s medical education committee based on literature review and existing tools being used by hospital departments. The tool was standardized across all hospital departments based on consensus of the education leads and piloted. Further revisions of the tool were incorporated based on feedback from teachers and learners. A hospital-wide web-based learner feedback and assessment system was developed using SharePoint (Microsoft corp.).
The online tool uses the CanMeds Competency Framework utilizing a 3 point Likert scale for each competency (above-, meets- or below expectations), free text for formative feedback, and a 10 point global rating scale.
After each teaching encounter (shift or day of teaching), the supervising physician completes the online form. Teachers are encouraged to complete the form in real time with the learner immediately after the encounter and to provide feedback about the encounter. Any competency that is rated “below expectations” triggers an automated e-mail to the administrator thereby identifying a potential learner in difficulty in real time. Reports can be generated for individual learners consisting of (1) all the encounter cards submitted or (2) a cumulative report of the encounter cards. Preceptors can receive reports mid-rotation and at the end of the rotation reports.
Anecdotally, the learners are receiving more frequent feedback from their supervising teachers immediately following their encounter. Teachers are more engaged in the feedback process and are becoming familiar with CanMeds Competencies. Learners in difficulty are being identified earlier in their rotation. Preceptors responsible for evaluation can provide mid-rotation feedback and end of rotation evaluation that is informed by all the teachers that have supervised the learner. The reliability of the evaluation is increased. Departments can use the teaching data to track teaching centrally for purposes of practice plans.