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Narrative comments in internal medicine clerkship evaluations: room to grow.

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Title: Narrative comments in internal medicine clerkship evaluations: room to grow.
Authors: Crumbley C; Department of Family & Community Medicine, Baylor College of Medicine, Houston, TX, USA., Szauter K; Educational Affairs, John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA.; Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA., Karnath B; Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA., Sonstein L; Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA., Belalcazar LM; Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA., Qureshi S; Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.
Source: Medical education online [Med Educ Online] 2025 Dec; Vol. 30 (1), pp. 2471434. Date of Electronic Publication: 2025 Feb 25.
Publication Type: Journal Article
Language: English
Journal Info: Publisher: Taylor & Francis Country of Publication: United States NLM ID: 9806550 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1087-2981 (Electronic) Linking ISSN: 10872981 NLM ISO Abbreviation: Med Educ Online Subsets: MEDLINE
Imprint Name(s): Publication: 2016- : Philadelphia, PA : Taylor & Francis
Original Publication: [E. Lansing, MI] : Medical Education Online, [1996-
MeSH Terms: Clinical Clerkship*/standards , Internal Medicine*/education , Narration* , Educational Measurement*/methods , Formative Feedback*, Humans ; Clinical Competence ; Students, Medical/psychology
Abstract: The use of narrative comments in medical education poses a unique challenge: comments are intended to provide formative feedback to learners while also being used for summative grades. Given student and internal medicine (IM) grading committee concerns about narrative comment quality, we offered an interactive IM Grand Rounds (GR) session aimed at improving comment quality. We undertook this study to determine the quality of comments submitted by faculty and post-graduate trainees on students' IM Clerkship clinical assessments, and to explore the potential impact of our IM-GR. Archived comments from clerkship cohorts prior to and immediately following IM-GR were reviewed. Clinical clerkship assessment comments include three sections: Medical Student Performance Assessment (MSPE), Areas of Strength, and Areas for Improvement. We adapted a previously published comment assessment tool and identified the performance domain(s) discussed, inclusion of specific examples of student performance, evidence that the comment was based on direct observations, and, when applicable, the inclusion of actionable recommendations. Scoring was based on the number of domains represented and whether an example within that domain was provided (maximum score = 10). Analysis included descriptive statistics, t-test, and Pearson correlation coefficients. We scored 697 comments. Overall, section ratings were MSPE 2.51 (SD 1.52, range 0-9), Areas of Strength 1.53 (SD 1.09, range 0-6), and Areas for Improvement 1.27 (SD 1.06, range 0-8). Significant differences were noted after Grand Rounds only in the MSPE mean scores. Within domains, trends toward increased use of specific examples in the post-GR narratives were noted. Assessment of both the breadth and depth of the included comments revealed low-quality narratives offered by our faculty and resident instructors. A focused session on best practices in writing narratives offered minimal change in the overall narrative quality, although we did notice a trend toward the inclusion of explanative examples.
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Contributed Indexing: Keywords: Narrative comments; clerkship clinical assessment; educational assessment; internal medicine; medical student
Entry Date(s): Date Created: 20250225 Date Completed: 20250509 Latest Revision: 20250509
Update Code: 20250510
PubMed Central ID: PMC11864032
DOI: 10.1080/10872981.2025.2471434
PMID: 39998485
Database: MEDLINE
Description
Abstract:The use of narrative comments in medical education poses a unique challenge: comments are intended to provide formative feedback to learners while also being used for summative grades. Given student and internal medicine (IM) grading committee concerns about narrative comment quality, we offered an interactive IM Grand Rounds (GR) session aimed at improving comment quality. We undertook this study to determine the quality of comments submitted by faculty and post-graduate trainees on students' IM Clerkship clinical assessments, and to explore the potential impact of our IM-GR. Archived comments from clerkship cohorts prior to and immediately following IM-GR were reviewed. Clinical clerkship assessment comments include three sections: Medical Student Performance Assessment (MSPE), Areas of Strength, and Areas for Improvement. We adapted a previously published comment assessment tool and identified the performance domain(s) discussed, inclusion of specific examples of student performance, evidence that the comment was based on direct observations, and, when applicable, the inclusion of actionable recommendations. Scoring was based on the number of domains represented and whether an example within that domain was provided (maximum score = 10). Analysis included descriptive statistics, t-test, and Pearson correlation coefficients. We scored 697 comments. Overall, section ratings were MSPE 2.51 (SD 1.52, range 0-9), Areas of Strength 1.53 (SD 1.09, range 0-6), and Areas for Improvement 1.27 (SD 1.06, range 0-8). Significant differences were noted after Grand Rounds only in the MSPE mean scores. Within domains, trends toward increased use of specific examples in the post-GR narratives were noted. Assessment of both the breadth and depth of the included comments revealed low-quality narratives offered by our faculty and resident instructors. A focused session on best practices in writing narratives offered minimal change in the overall narrative quality, although we did notice a trend toward the inclusion of explanative examples.
ISSN:1087-2981
DOI:10.1080/10872981.2025.2471434