Beyond the Grade: Exploring Written Feedback in a Pediatric Clerkship

The narrative feedback medical students receive during their clerkships plays a critical role in developing clinical skills and professional identity. Most existing research on feedback focuses on undergraduate medical education within the civilian sector. The Uniformed Services University (USU) School of Medicine provides a unique environment for training uniformed service members, necessitating the integration of clinical skill development with the professional standards and cultural norms inherent within military medicine. This study aims to examine themes and characteristics in written feedback that military medical students receive during their pediatric clerkship within the Military Health System.

This is a qualitative, retrospective analysis of written feedback comments (N = 953) provided to military medical students during their pediatric clerkship. An online survey tool prompted preceptors to comment on performance in line with the domains of Professionalism, Reporting, Interpreting, Managing, and Educating (PRIME) and provide one area for growth. De-identified comments underwent thematic and summary content analysis.

Five themes were identified: (1) Evaluating the student as a learner, (2) Evaluating the student as an emerging physician, (3) Cultivating professional characteristics and identity, (4) Praise and encouragement, (5) Scope of evaluation. Comments on performance were longer (mean = 1,013 characters) and more frequently used third person (68.21%). Comments on growth were shorter (mean = 167 characters) and more frequently omitted the subject (62.33%). Only 26.65% of comments applied the PRIME schema.

The language within the feedback comments showed partial alignment to best practices for feedback, particularly with a focus on observable physician and learner behaviors. In addition to the professional characteristics, knowledge, and skills all doctors must develop, this study's themes also suggested a process of expected acculturation to the military system and ethos. Less productive comments regarding personal traits, general praise, and depersonalized critical feedback were still prevalent. The apparent ineffectiveness of current strategies suggests exploration of novel approaches, such as artificial intelligence (AI), to enhance the language used in feedback.