title: Effects of structured written feedback by cards on medical students' performance at Mini Clinical Evaluation Exercise (Mini-CEX) in an outpatient clinic.
abstract: BACKGROUND
  Feedback cards are recommended as a feasible tool for structured written feedback delivery in clinical education while effectiveness of this tool on the medical students' performance is still questionable.  The purpose of this study was to compare the effects of structured written feedback by cards as well as verbal feedback versus verbal feedback alone on the clinical performance of medical students at the Mini Clinical Evaluation Exercise (Mini-CEX) test in an outpatient clinic.
  
  
  METHODS
  This is a quasi-experimental study with pre- and post-test comprising four groups in two terms of medical students' externship. The students' performance was assessed through the Mini-Clinical Evaluation Exercise (Mini-CEX) as a clinical performance evaluation tool. Structured written feedbacks were given to two experimental groups by designed feedback cards as well as verbal feedback, while in the two control groups feedback was delivered verbally as a routine approach in clinical education.
  
  
  RESULTS
  By consecutive sampling method, 62 externship students were enrolled in this study and seven students were excluded from the final analysis due to their absence for three days. According to the ANOVA analysis and Post Hoc Tukey test,  no statistically significant difference was observed among the four groups at the pre-test, whereas a statistically significant difference was observed between the experimental and control groups at the post-test  (F = 4.023, p =0.012). The effect size of the structured written feedbacks on clinical performance was 0.19.
  
  
  CONCLUSIONS
  Structured written feedback by cards could improve the performance of medical students in a statistical sense. Further studies must be conducted in other clinical courses with longer durations.
authors.affiliation: Department of Medical Education, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran;
authors.forename: Fariba
authors.initials: F
authors.lastname: Haghani
authors.affiliation: Department of Urology, Isfahan University of Medical Sciences, Isfahan, Iran;
authors.forename: Mohammad
authors.initials: M
authors.lastname: Hatef Khorami
authors.affiliation: Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Fakhari
keywords: Ambulatory care; Feedback; Medical education; Outpatient clinics