Are we optimizing medical students’ preparation for clerkship? A content analysis of narrative comments on clinical skills during preclinical training
DOI :
https://doi.org/10.36834/cmej.78569Résumé
Introduction: The progression from preclinical medical training to clerkship is a pivotal yet steep transition for medical students. Effective feedback on clinical skills during preclinical training can better equip students for clerkship and allows time for them to address difficulties promptly. The goal of this study was to explore whether and how narrative comments at this stage were being leveraged to achieve this transition.
Methods: We conducted a content analysis to categorize narrative comments on the clinical skills of two cohorts of third-year preclinical students at one academic institution.
Results: Teachers made narrative comments for 272 students. Each comment was divided into analysis units (n = 1,314 units). Comments were either general (n = 187) or focused on attitude (n = 628), knowledge and cognitive processes (n = 357), or clinical reasoning (n = 142). They were abundantly positive (n = 1,190) and marginally negative (n = 39). Few (6%) contained suggestions for improvement.
Discussion: In this study, narrative comments on clinical skills before clerkship seemed minimally helpful, as they were overwhelmingly positive and seldom offered suggestions. This could suggest missed opportunities for early interventions. Pre-clerkship narrative comments could potentially be optimized by increasing emphasis on clinical reasoning, addressing challenges early and providing actionable steps for improvement.
Références
1. Prince KJAH, Boshuizen HPA, van der Vleuten CPM, Scherpbier AJJA. Students' opinions about their preparation for clinical practice. Med Educ. 2005;39(7):704-12. https://doi.org/10.1111/j.1365-2929.2005.02207.x
2. Boileau É, Talbot-Lemaire M, Bélanger M, St-Onge C. "Playing in the big leagues now": exploring feedback receptivity during the transition to residency. Health Prof Educ. 2019;5(4):303-12. https://doi.org/10.1016/j.hpe.2018.09.003
3. Young JQ, Ranji SR, Wachter RM, Lee CM, Niehaus B, Auerbach AD. "July effect": impact of the academic year-end changeover on patient outcomes: a systematic review. Annals intern med. 2011;155(5):309-15. https://doi.org/10.7326/0003-4819-155-5-201109060-00354
4. Guerrasio J, Garrity MJ, Aagaard EM. Learner deficits and academic outcomes of medical students, residents, fellows, and attending physicians referred to a remediation program, 2006-2012. Acad Med. 2014;89(2):352-8. https://doi.org/10.1097/ACM.0000000000000122
5. Boud D. Feedback: ensuring that it leads to enhanced learning. Clin Teach. 2015;12(1):3-7. https://doi.org/10.1111/tct.12345
6. Boileau E, St-Onge C, Audétat MC. Is there a way for clinical teachers to assist struggling learners? A synthetic review of the literature. Adv Med Educ Pract. 2017;8:89-97. https://doi.org/10.2147/AMEP.S123410
7. Steinert Y. The "problem" learner: Whose problem is it? AMEE Guide No. 76. Med Teach. 2013;35(4):e1035-45. https://doi.org/10.3109/0142159X.2013.774082
8. Challis AF Gifford Batstone, Maggie. An accident waiting to happen? A case for medical education. Med Teach. 1999;21(6):582-5. https://doi.org/10.1080/01421599979004
9. Coombes I, Donovan P, Bullock B, Mitchell C, Noble C. Can a novel Constructivist theory-informed feedback intervention reduce prescribing errors? A pre-post study. BMC Med Educ. 2023;23(1):150. https://doi.org/10.1186/s12909-023-04095-6
10. Hayes V, Bing-You R, Varaklis K, Trowbridge R, Kemp H, McKelvy D. Is feedback to medical learners associated with characteristics of improved patient care? Perspect Med Educ. 2017;6(5):319-24. https://doi.org/10.1007/S40037-017-0375-8
11. Kluger AN, DeNisi A. The effects of feedback interventions on performance: a historical review, a meta-analysis, and a preliminary feedback intervention theory. Psychol bulletin. 1996;119(2):254. https://doi.org/10.1037/0033-2909.119.2.254
12. van de Ridder JMM, Peters CMM, Stokking KM, de Ru JA, ten Cate OThJ. Framing of feedback impacts student's satisfaction, self-efficacy and performance. Adv Health Sci Ed. 2015;20(3):803-16. https://doi.org/10.1007/s10459-014-9567-8
13. Chakroun M, Dion VR, Ouellet K, et al. Narrative assessments in higher education: a scoping review to identify evidence-based quality indicators. Acad Med. 2022;97(11):1699-1706. https://doi.org/10.1097/ACM.0000000000004755
14. Holmboe ES, Yepes M, Williams F, Huot SJ. Feedback and the mini clinical evaluation exercise. J Gen Inter Med. 2004;19(5 Pt 2):558-61. https://doi.org/10.1111/j.1525-1497.2004.30134.x
15. Dudek N, Cook D. Narrative assessment. In: Yudkowsky R, Park YS, Downing SM, editors. Assessment in health professions education. New York (NY): Routledge; 2019. p. 173-80. https://doi.org/10.4324/9781315166902-11
16. Kelleher M, Kinnear B, Sall DR, et al. Warnings in early narrative assessment that might predict performance in residency: signal from an internal medicine residency program. Perspect Medl Educ. 2021;10(6):334-40. https://doi.org/10.1007/S40037-021-00681-W
17. Ginsburg S, Gold W, Cavalcanti RB, Kurabi B, McDonald-Blumer H. Competencies "plus": the nature of written comments on internal medicine residents' evaluation forms. Acad Med. 2011;86(10):S30-4. https://doi.org/10.1097/ACM.0b013e31822a6d92
18. Jackson JL, Kay C, Jackson WC, Frank M. The quality of written feedback by attendings of internal medicine residents. J Gen Intern Med 2015;30(7):973-8. https://doi.org/10.1007/s11606-015-3237-2
19. White JS, Sharma N. "Who writes what?" Using written comments in team-based assessment to better understand medical student performance: a mixed-methods study. BMC Med Ed. 2012;12(1):123. https://doi.org/10.1186/1472-6920-12-123
20. Chakroun M, Dion VR, Ouellet K, et al. Quality of narratives in assessment: piloting a list of evidence-based quality indicators. Perspect Med Educ. 2023;12(1):XX. https://doi.org/10.5334/pme.925
21. Hodges B. Assessment in the post-psychometric era: Learning to love the subjective and collective. Med Teach. 2013;35(7):564-8. https://doi.org/10.3109/0142159X.2013.789134
22. Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107-15. https://doi.org/10.1111/j.1365-2648.2007.04569.x
23. Pintoi AJ, Zeitz HJ. Concept mapping: a strategy for promoting meaningful learning in medical education. Med Teach. 1997;19(2):114-21. https://doi.org/10.3109/01421599709019363
24. Boileau E, Audétat MC, St-Onge C. Just-in-time faculty development: a mobile application helps clinical teachers verify and describe clinical reasoning difficulties. BMC Med Educ. 2019;19(1):120. https://doi.org/10.1186/s12909-019-1558-2
25. Evans DE, Alstead EM, Brown J. Applying your clinical skills to students and trainees in academic difficulty. Clinic Teach. 2010;7(4):230-5. https://doi.org/10.1111/j.1743-498X.2010.00411.x
26. Hauer KE, Ciccone A, Henzel TR, et al. Remediation of the deficiencies of physicians across the continuum from medical school to practice: a thematic review of the literature. Acad Med. 2009;84(12):1822-32. https://doi.org/10.1097/ACM.0b013e3181bf3170
27. 27. Torre DM, Treat R, Durning S, Elnicki DM. Comparing PDA- and paper-based evaluation of the clinical skills of third-year students. WMJ. 2011;110(1):9-13. https://wmjonline.org/wp-content/uploads/2011/110/1/9.pdf
28. Murdoch‐Eaton D, Sargeant J. Maturational differences in undergraduate medical students' perceptions about feedback. Med Educ. 2012;46(7):711-21. https://doi.org/10.1111/j.1365-2923.2012.04291.x
29. Tekian A, Borhani M, Tilton S, Abasolo E, Park YS. What do quantitative ratings and qualitative comments tell us about general surgery residents' progress toward independent practice? Evidence from a 5-year longitudinal cohort. Amer J Surg. 2019;217(2):288-95. https://doi.org/10.1016/j.amjsurg.2018.09.031
30. Hatala R, Sawatsky AP, Dudek N, Ginsburg S, Cook DA. Using In-Training Evaluation Report (ITER) qualitative comments to assess medical students and residents: a systematic review. Acad Med. 2017;92(6):868-79. https://doi.org/10.1097/ACM.0000000000001506
Téléchargements
Publié-e
Comment citer
Numéro
Rubrique
Licence
© Linda Bergeron, Patricia Blanchette, Molk Chakroun, Élisabeth Boileau, Isabelle Boulais, Martine Chamberland, Christina St-Onge 2025
Cette œuvre est sous licence Creative Commons Attribution - Pas d'Utilisation Commerciale - Pas de Modification 4.0 International.
La soumission d’un manuscrit original à la revue constitue une indication qu’il s’agit d’un travail original, qu’il n’a jamais été publié et qu’il n’est pas envisagé pour publication dans une autre revue. S’il est accepté, il sera publié en ligne et ne pourra l’être ailleurs sous la même forme, à des fins commerciales, dans quelque langue que ce soit, sans l’accord de l’éditeur.
La publication d’une recherche scientifique a pour but la diffusion de connaissances et, sous un régime sans but lucratif, ne profite financièrement ni à l’éditeur ni à l’auteur.
Les auteurs qui publient dans la Revue canadienne d’éducation médicale acceptent de publier leurs articles sous la licence Creative Commons Paternité - Pas d’utilisation commerciale, Pas de modification 4.0 Canada. Cette licence permet à quiconque de télécharger et de partager l’article à des fins non commerciales, à condition d’en attribuer le crédit aux auteurs. Pour plus de détails sur les droits que les auteurs accordent aux utilisateurs de leur travail, veuillez consulter le résumé de la licence et la licence complète.
