Student Empowered Longitudinal Feedback (SELF) Framework: Reframing Learner Handover Free

In traditional medical school clerkships, sharing student performance between rotations (also known as “learner handover” or “forward feeding”) is controversial. Those in favor describe multiple benefits, including the early identification of struggling students, more accurate assessments, better quality feedback, and individualized teaching on the basis of identified weaknesses.^1–6  Others counter that the benefits may not be worth the significant drawbacks, including: possible introduction of bias and stigmatization, influence on performance ratings, threats to student confidentiality, and risk of legal repercussions.^1,3,4,6–9  Despite the potential downsides, there is increasing recognition that longitudinal assessment is critical to support medical student progression, particularly in the movement toward Competency-Based Medical Education.¹⁰ 

Current literature regarding attitudes around learner handover is largely focused on the voices of clerkship directors and medical educators, with a lack of discussion on the role of medical students themselves. In this Council on Medical Student Education in Pediatrics perspective, we provide a student-centered model of learner handover to empower medical students to have more agency over their learning.

A learner handover takes place at the conclusion of a relationship between preceptor and student. To ensure accurate and meaningful handover at this summative phase, it is crucial to start planning from the beginning and offering input regarding the student’s progress throughout the rotation. An outline of the key considerations for orientation and continuous feedback to support a meaningful handover are provided in Table 1.

A proper orientation begins with introductions and establishing a safe learning environment.^11,12  Preceptors should approach the initial meeting with students as a shared conversation, with a plan for follow-up discussions throughout a rotation to ensure that individual learning goals are being addressed. To set the stage for the handover, the preceptor should adjust the standard orientation by determining the students’ goals and their learning and feedback preferences.

Formative feedback throughout a rotation offers medical students the opportunity to gauge their performance, adjust, and make improvements over time. Substantial literature has been devoted to optimal feedback practices.¹³  However, for the purpose of supporting the development of an optimal learner handover, it is most imperative to ensure that feedback occurs regularly so that the preceptor is able to offer the most effective transition for the next rotation.

After a successful orientation and continuous feedback, the preceptor is now ready to provide the learner with a plan for continuing their development on the next rotation. In Table 2, we offer a proposed framework (SELF) that can be used to guide conversations near the end of a rotation. This framework requires the learner to reflect on their strengths (“S” – strengths), provide examples (“E” – examples), identify targeted learning goals (“L” – learning goals), and determine how future preceptors can advance their progression (“F” – future).

The framework may be used as either a self-directed worksheet or a verbal conversation. If the framework is used as a worksheet, we suggest that students save a copy of the form to share during their next clinical experience. If the framework is used to structure a verbal conversation, we recommend allowing the student to lead this discussion to support their self-directed learning. Regardless, it is crucial the student maintains ownership in the learner handover process while simultaneously practicing self-reflection throughout their rotation experiences.

Amanda is a 24-year-old medical student. Despite being “book smart,” Amanda has had several issues around professionalism in the clinical setting, namely inappropriately casual language with patients. During the initial student-preceptor orientation, Amanda identified “patient communication” as a learning goal with her preceptor. In this example, the student follows the framework previously described to identify strengths and areas for improvement with their preceptor. The preceptor then provides a summary of the student’s progress at the conclusion of the rotation.

The SELF framework allows for the reframing of the traditional supervisor-to-supervisor concept of learner handover by incorporating learner input in reflection on their performance and growth over the rotation. This places the ownership of learning in the hands of the learner, allowing the learner to be an active participant in the dialogue, and reducing student concerns of biased handover.

This approach requires little more than a reframing of the beginning-of-rotation orientation, ensuring continuous feedback and then providing a student-centered end-of-rotation assessment. Reframing the traditional “beginning-of-rotation orientation,” longitudinal student learning goals are identified and addressed. Throughout the rotation, preceptors will aim to regularly address and reevaluate these learning goals with the student through continuous feedback. At the end of the rotation, completing the SELF worksheet (either verbally or written), in conjunction with a discussion, allows the student to practice self-reflection and identify areas of development in anticipation for the following rotation. Having completed this worksheet or reflective practice, students should consider sharing it, or feeding forward its contents, with the following rotation’s preceptor. New preceptors, in turn, may ask the student to forward feed and consider using previous SELF worksheets or reflections as a springboard for discussion around learning goals.

Learner handover is ultimately a shared responsibility between educators and students, with the common goal of developing physicians who are reflective and seek to improve their performance in an iterative and supportive way. By putting students at its center, the SELF framework can facilitate a culture of student self-regulated learning,¹⁴  with students better equipped to identify learning needs, and work toward reaching their personal learning goals. The implementation of student-led handover encourages students to practice self-reflection and bring forward longitudinal learning objectives through different clerkship rotations.

Thank you to Dr Michael Ryan and Dr Alanna Higgins Joyce for their support throughout the editing process and thoughtful review of this manuscript. Thank you to the Council on Medical Student Education in Pediatrics for the opportunity to contribute to the Pediatrics Monthly Feature.