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Narrative FEEDBACK. Cherie Jones MD, FRCPC Sheila Pinchin, MEd Sue Fostaty-Young. Narrative Feedback: Definition.

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Narrative FEEDBACK

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narrative feedback

Narrative FEEDBACK

Cherie Jones MD, FRCPC

Sheila Pinchin, MEd

Sue Fostaty-Young

narrative feedback definition
Narrative Feedback: Definition
  • This is written descriptions of a student's performance organized in logical order, to illustrate the "story" or account of a student's progress and performance, including strengths and areas for improvement…to guide future efforts
  • Often yields richer information than a “snapshot” letter grade does, and often used to complement letter grades.
does narrative feedback work
Does narrative feedback work?
  • Physician performance improves significantly more with feedback than without it (Westberg & Jason, 1991)
  • Without reinforcement, desirable and helpful behaviours on the part of learners may be extinguished, and bad habits may become well-entrenched (Ende 1983; Westberg & Jason, 1991)
  • Provision of feedback, which identifies learner strengths and makes recommendations for improvement, is a key tool in clinical teaching (Irby & Bowen, 2004).
  • “Learning without feedback is like learning archery in a darkened room. “
  • (Cross, 1996)
effective narrative feedback
Effective Narrative Feedback
  • Links to learning objectives
  • Identifies strengths and weaknesses by providing examples, quotations, etc.
  • Uses constructive and specific language
  • Individualizes feedback
  • Identify each learner’s areas of strength and build on them, rather than depending on a “deficit model” of “fixing the gaps”.
  • Summarizes and provides suggestions for improvement.
goals of narrative feedback
Goals of Narrative Feedback:
  • Helps the student identify learning goals to work toward
  • Assesses how well the student is achieving learning goals
  • Reviews student progress over time
  • Provides suggestions for improvement
what will you say
What will you say?
  • If the student had the next three weeks to work on improving something, what should it be and what suggestions do you have for them as to how to do it?
  • If you were “handing over” the student to another tutor, what could you identify as areas for improvement that your colleague could focus on?
areas for comment
Areas for comment
  • Professionalism
  • Functioning in the team context
  • Links to the learning objectives for the task
  • Skills:
    • Relationship with the Patient
    • Gathering Information (Hx and Px)
effective ineffective
Effective? Ineffective?
  • “I was very impressed with the degree to which individuals in this group worked together in terms of respecting each other, as well as with the ease in which an animated discussion spontaneously moved from student to student.” (FSGL 2010)
  • “Wow! Wonderful person. Will make a great doc! Keep up the good work!”
  • “Should develop superior clinical ability. Practice every opportunity…”
narrative feedback examples
Narrative feedback examples
  • “Continue with current progress; More practice.”
  • “Improving conveying of competence, increased interaction and verbal communication in sessions…”
  • “Expression of confidence and professional persona in interactions with patients and colleagues. May benefit from videotape review of interviews. Role modeling.”

Examples of Narrative Assessment Forms or Prompts from across UGME

Walsh, 2006, Adapted from the Coaching Feedback Format , Bayer Institute for Health Care communication

how to
How to…

Narrative feedback requires for each student:

  • Observation
  • Notes on observation
  • Organization of notes over time
  • Many faculty have adopted a variety of strategies to keep notes on students in tutor groups or clerkship groups. These include:
  • A series of file (recipe) cards, one for each student, with dates and comments (Dr. Sylvester)
  • A series of forms or checklists , one for each student with objectives and observations over time (dated)
  • Encounter cards, and other student self-assessments (to be used in conjunction with tutor/preceptor observation)
help with narrative feedback
Help with narrative feedback
  • Sue Fostaty-Young is our UGME Assessment and Evaluation Consultant. Reach her at
  • Sheila Pinchin is our UGME Education Specialist. Reach her at
  • Cherie Jones-Hiscock is a psychiatrist working as a Course Director in Clinical and Communication Skills. Reach her at