DMAIC-ing a Difference: Improving Formative Feedback in Clinical Clerkships

Formative feedback is integral to the educational process. We recognised the need to improve our formative feedback due to variable quality, timeliness and depth. Our objective was to improve the quantity and quality of formative feedback given to medical students during clinical rotations using the Define-Measure-Analyse-Improve-Control (DMAIC) problem-solving method.

Based on initial assessment of 50% of students receiving completed formative feedback forms within 72 h after request, we created a task force with representatives from each rotation that met biweekly for 1 year. High-quality feedback was that achieving a Quality of Assessment for Learning score ≥ 4. We identified stakeholders and conducted focus groups to determine barriers; solutions were implemented asynchronously with task force input and iteration as necessary. Formal data were collected upon task force implementation and periodically for a year. Three key deficiencies emerged: faculty education regarding formative feedback, time for completion and proximity of receiving forms to the encounter. Three methods for improvement were implemented at representative discretion: QR codes to access forms, shortened forms with modified verbiage and increased small-group faculty education.

Although formally collected baseline data indicated a 73.4% completion rate for formative feedback forms (higher than anticipated), which remained unchanged over the course of a year, the interventions significantly increased the frequency of high-quality feedback (37.5%-59.4%, p = 0.01), with improvement in all rotations.

Implementation of a task force combined with increased education and potentially simplifying form completion and wording improved formative feedback quality while maintaining quantity.