Oral versus written feedback in medical clinic

Abstract

OBJECTIVE:To determine whether residents perceived oral, face-to-face feedback about their continuity clinic performance as better than a similar, written version. DESIGN:Single-blind, randomized controlled trial. SETTING:Two university-based, internal medicine residency clinics.PARTICIPANTS: All 68 internal medicine and combined program (medicine-pediatrics, medicine-psychiatry, medicineneurology, and preliminary year) residents and their clinic preceptors. MEASUREMENTS AND MAIN RESULTS:Residents at each program were separately randomized to oral or written feedback sessions with their clinic preceptors. The oral and written sessions followed similar, structured formats. Both groups were later sent questionnaires about aspects of the clinic. Sixty-five (96%) of the residents completed the questionnaire. Eight of the 19 questions dealt with aspects of feedback. A feedback scale was developed from the survey responses to those eight questions ( ␣ ‫؍‬ .86). There were no significant differences in the responses to individual questions or in scale means ( p Ͼ .20) between the two feedback groups. When each university was analyzed separately, one had a higher scale mean (3.10 vs 3.57, p ‫؍‬ .047), but within each university, there were no differences between the oral and written feedback groups ( p Ͼ .20). CONCLUSIONS:No differences were observed between the oral and written feedback groups. In attempting to provide better feedback to their residents, medical educators may better apply their efforts to other aspects, such as the frequency of their feedback, rather than the form of its delivery.KEY WORDS: feedback; medical education; internal medicine; ambulatory care; residents. J GEN INTERN MED 1998;13:155-158.F eedback consists of information provided to learners for the purpose of reinforcing appropriate and correcting inappropriate efforts. It is an essential, but often neglected part of the educational process. Surveys reveal that students consider receiving constructive feedback to be a crucial component of the learning environment. 1 Although they identify certain aspects of feedback as highly important, these are frequently lacking in students' educational experiences. 2 In his observations of excellent teachers of clinical medicine, Irby emphasizes that his subjects universally devoted considerable time and effort to providing quality feedback, and he lists it as a crucial component in quality teaching. 3,4 Clinical educators vary greatly, however, in the style and structure of their feedback sessions, 5 and it is unclear which methods are preferable.Despite agreement on the importance of giving feedback, little information is available regarding practical methods of providing feedback to residents in ambulatory settings. One recent study demonstrated that written feedback could improve residents' teaching skills. 6 Another found that oral feedback improved the documentation in clinic charts, but not other aspects of clinic performance. 7 Previous to this study, the internal medicine residency programs at W...

Gender and Feedback in Medical Education

“…The differences we found in the preference for written versus oral feedback between women and men needs to be further explored, but feedback may be better received if given in the preferred mode for the learner, as there is not clear evidence that one is superior to the other (Bing-You, Greenberg, Wiederman, & Smith, 1997;Elnicki, Layne, Ogden, & Morris, 1998;Veloski, Boex, Grasberger, Evans, & Wolfson, 2006). Knowing and acknowledging this may help with faculty development in encouraging a variety of modes of feedback or even asking the preference of the learner.…”

Feedback by simulated patients in undergraduate medical education: a systematic review of the literature

“…Elnicki et al. 26 found that learners perceived verbal, face‐to‐face feedback as equally valuable compared with written feedback. However, Kluger and DeNisi 23 found that verbal feedback was less effective.…”

Coaching in emergency medicine

“…Finally, neither written nor oral feedback have been demonstrated to be superior. 15 In some circumstances, written comments may be too generic or insufficiently prescriptive to effect change. 16 The foundational elements of high-quality feedback include observation, a detailed description of the encounter, and reflecting back to the learner good, adequate and inadequate aspects of their performance.…”