title: Simple feedback notes enhance specificity of feedback to learners.
abstract: BACKGROUND
  Learners reported that physician educators give insufficient and general feedback.
  
  
  OBJECTIVE
  This study analyzed faculty's use of 3 x 5-inch feedback notes (preprinted with "well done" or "needs improvement") for quantity and specificity of feedback. Learners evaluated these notes compared with other feedback methods.
  
  
  METHODS
  Seven experienced clinician educators presented the feedback notes to learners during the 10-month trial. A carbonless duplicate was retained for qualitative analysis of content. The specificity of comments was categorized as general (no clarifiers) or detailed if it contained 1 or more clarifiers. Additionally, the learners were surveyed regarding utility of notes on the basis of characteristics of effective feedback.
  
  
  RESULTS
  A total of 770 notes containing 1607 individual comments were presented to learners, with significantly more (P <.001) "well done" comments (69%) than "needs improvement" comments (31%). Eleven content areas emerged. The most frequently coded "well done" content areas were assessment (n = 258), treatment (n = 208), and physical examination (n = 176). The most frequently coded "needs improvement" content areas were documentation (n = 161) and expanding knowledge (n = 102). Eighty-two percent of the comments were specific, and the specificity increased significantly from 24% in the initial 4-month time frame to 46% in the last 3 months (P <.001, Pearson chi-square test). Learners agreed that feedback notes provided more constructive (94%), timely (92%), and concrete (94%) feedback when compared with other feedback methods. Learners preferred feedback given face-to-face (96%) or by written notes (96%) rather than by e-mail (30%).
  
  
  CONCLUSIONS
  Cued feedback notes provided learners with detailed feedback in a format that learners prefer. Over time, simple feedback notes lead to more specific feedback for trainees.
authors.affiliation: Center for Ambulatory Teaching Excellence, Medical College of Wisconsin, Milwaukee 53233, USA. tschum@mew.edu
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Schum
authors.forename: Robert L
authors.initials: RL
authors.lastname: Krippendorf
authors.forename: Kathy A
authors.initials: KA
authors.lastname: Biernat
mesh_terms: D004501:Education, Medical / Q000458:organization & administration*; D005246:Feedback; D006801:Humans; D012680:Sensitivity and Specificity; D013337:Students, Medical