Feedback Notes

Abstract

Objective: Trainees actively request effective feedback that is timely and specific about behaviors that can be changed. Faculty claim they give feedback but also state that time constraints limit their ability to provide timely, specific feedback, especially in the ambulatory setting. We sought to develop a simplified, efficient feedback system that could be easily used in the ambulatory setting, provide frequent, high-quality feedback, and be accepted by both faculty and trainees. Description: As part of an advanced faculty development program at the Medical College of Wisconsin, in 1999 we developed a simple feedback system. The goal of the system was to provide an easy and efficient tool—feedback notes—that could be quickly completed by the faculty while providing formative information for the trainee. The 3″ × 5″ carbonless feedback note was developed. It contained the trainee's name and a reference to the encounter (patient problem); two general areas of feedback were sought, including a “well done” section and a “to improve” section; and the final portion of the form called for the faculty member's signature, the date, and the trainee's level. After sessions on feedback in the faculty development program, the notes were distributed. Faculty could use them for medical students (third or fourth year), residents, or fellows in the ambulatory or inpatient setting. As an introduction for the trainees, faculty were advised to inform them that feedback would be given using a feedback note and would include strengths as well as areas to improve. These notes were completed at the time of the encounter or within the following 48 hours; the faculty members should give feedback with additional verbal input, if possible. Duplicate copies of the notes (without the trainees' names or patient information) were collected and used for data analysis. Discussion: Participants in an advanced faculty development program for general internal medicine and general pediatrics used the notes. The time needed for completing each note was one to two minutes. Over the initial five months, seven faculty completed 393 feedback notes. The notes were used in both ambulatory and inpatient settings. The trainees' reactions to the notes ranged from very favorable (the majority of trainees) to angry (with one resident asking whether she could have time for rebuttal). Preliminary feedback from faculty showed general acceptance of this system and a far greater use of explicit feedback than with prior feedback systems. Faculty also indicated that these notes helped them to give focused feedback in a timely manner, even when the trainees were no longer physically present. The convenience of being able to complete these notes after rather than during a busy clinic appeals to faculty members pressured for time. In summary, the use of these simple feedback notes led to more feedback, more specific feedback, and favorable reviews from both faculty and trainees. Formal evaluation will include a content analysis of these notes and a survey of trainees on the effectiveness of this method. After this pilot program, we anticipate expanded use of these notes in our institution.