Towards a Neurology-Specific Approach to Feedback: A Mixed-Method Analysis of Medical Student Feedback in Neurology Clerkships

Background: Effective feedback is paramount to medical student growth and development. Despite this, the feedback received is often lacking in quality. Objectives: We sought to better understand the optimal design of feedback efforts for neurology students. Methods: We utilized a mixed-method, two-phased study of feedback. In phase 1, a novel self-reflective feedback form was implemented for 3rd-year neurology mid-clerkship feedback. Students were surveyed about the quality and nature of mid-clerkship feedback before and after implementation. Surveys included quantitative and qualitative assessments of the feedback process to examine student perceptions of feedback usefulness, format, and quality pre- and post-implementation. In phase 2, following survey analysis, focus groups were conducted with students, residents, and attendings within the Neurology Department to understand perceptions behind initial results and elucidate important aspects of student feedback in neurology. Results: Twenty-nine out of 174 students completed the survey before implementation (16.6% response), and 17 out of 112 students completed it after implementation (15.1% response). Feedback was perceived similarly pre- and post-implementation, described as “useful and actionable” (86% pre vs. 71% post, P = 0.5) and an “active conversation” (86% vs. 77%, P = 0.5). Students perceived higher quality feedback from residents than attendings (8.0 vs. 6.1/10, P = 0.004) and felt resident feedback was more likely to yield substantive change in performance (7.6 vs. 5.9/10, P = 0.02). Qualitatively, challenges emphasized included time constraints, lack of personal connection, and overly generalized content. Focus groups examined underlying perceptions surrounding these challenges. We also examined concerns specific to neurology education. Analysis highlighted thematic notes to guide the improvement of feedback in the neurology clerkship. Conclusions: This study suggests that the format of medical student feedback in neurology may be less important than a close educational alliance, direct attention, and clear expectations in providing feedback. Given these findings, as well as identified barriers of time to build such a relationship and training to foster this dynamic, it is not surprising that students find resident feedback to be of higher quality and more likely to yield substantive change in performance. The emphasis on a close relationship with persons providing feedback can be fostered through the unique nature of neurologic practice.