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Giving Medical Students a Voice in Their Evaluations From One Rotation to the Next

November 4, 2022

Editor’s Note: Elizabeth Zeichner is a former high school teacher and third-year medical student at Emory University School of Medicine, where, as co-chair of the Student Curriculum Committee, she has worked on implementing student-led initiatives within the curriculum.

-Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics

For medical students, the sheer amount of information to learn can sometimes feel overwhelming. Not only is there always new medical knowledge, but during the clinical years, the frequent mind shifts required for different clinical clerkships and working with numerous different attendings and residents, can make many days feel like “the first day of work.” It can be disorienting, confusing, and stressful. While ideally there are opportunities for students to be oriented to new rotations or for new preceptors to discuss, then address, their learning goals, this sometimes gets lost amidst busy clinical services.

This week, Pediatrics is early releasing, “Student Empowered Longitudinal Feedback (SELF) Framework: Reframing Learner Handover,” by Anna Chen, MD, Nirit Bernhard, MD, and Angela Punnett, MD from the Hospital for Sick Children at the University of Toronto. This article presents a more structured way to involve learners in the feedback process, such that the preceptor and learner co-create plans for learning, and longitudinal feedback is incorporated throughout clinical clerkships (10.1542/peds.2022-060083).

The authors present an approach for providing learner feedback throughout a clinical rotation, leading up to a learner handover that includes a plan for continued development in the next clinical rotation. This model consists of a learner orientation at the beginning of a rotation, regular feedback throughout the rotation, and a proposed framework, Student Empowered Longitudinal Feedback (SELF), which guides end-of-rotation conversations. SELF asks the learner to describe “S” – Strengths, “E” – Examples of these strengths, “L” – Learning goals, and “F” – ways that Future preceptors can help the student meet these learning goals. This provides an opportunity for the learner to self-reflect and set goals for the next rotation, and these goals can then be shared with the next rotation’s preceptor. The article clearly lays this framework out; check out the tables that outline this framework in action, as well as tips that could contribute to a meaningful learner handover.

While the authors acknowledge that sharing student performance between rotations through a “learner handover” can be controversial and introduce potential bias or influence on student evaluations, they also make the important point that “longitudinal assessment is critical to support medical student progression, particularly in the movement toward Competency-Based Medical Education.” Furthermore, while it may be challenging at first for attendings to adapt to this new learner-centered framework, receiving prior feedback from learners’ prior rotations may also make it easier, as it can help inform early conversations as a “springboard for discussion around learning goals.”

As a learner, it can feel intimidating to envision an environment in which feedback about one’s performance is shared between clinical clerkships. However, in an ideal learning environment where learner input is central to the process, as laid out in this article, it is possible that this structure would establish “a student-centered model of learner handover to empower medical students to have more agency over their learning.” This could potentially empower students to better identify their own learning needs, and subsequently be better supported as they longitudinally work towards their learning goals.

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