“How Am I Doing?”: Many Problems But Few Solutions Related to Feedback Delivery in Undergraduate Psychiatry Education



Giving performance feedback to students in psychiatry requires particular delicacy and skill since a critique of the subjective artistry of the psychiatric interview may be felt more personally than a critique of an objective skill, such as eliciting a reflex or applying a stethoscope to the chest. Thus, one would expect that psychiatrists 1) are adept at giving feedback and 2) have written about the nuances of feedback delivery in psychiatric education. After a curricular needs assessment in our program revealed that feedback delivery was being neglected at all levels of training, a review of the medical education literature was conducted to find explanations for preceptor difficulty with performance feedback delivery in undergraduate psychiatric education.


A qualitative content-analysis review of the Pub Med and OVID literature on feedback delivery and medical education was conducted.


Several articles were available on feedback delivery in medical education, but only one of the studies was specific to undergraduate psychiatric education. Several articles offered practical tips to address deficiencies in the feedback process, but there was little to no explanation for the reasons behind the deficiencies.


Reasons for the challenges faced by medical students and teachers during feedback conversations have not been fully explored in the literature. In contrast to other areas of medicine, little has been written specifically about feedback to students in undergraduate psychiatric education. Although there are many resources to assist medical educators with feedback delivery skills, an understanding as to why physicians and students struggle with feedback conversations is needed. Reasons for the apparent disconnect between what should be happening and what is actually happening during feedback conversations with undergraduate psychiatry students need to be understood. The authors hypothesize causes for the problems with feedback delivery in undergraduate psychiatric education.

This is a preview of subscription content, log in to check access.


  1. 1.

    Ende J: Feedback in clinical medical education. JAMA 1983; 250(6): 777–781

    CAS  PubMed  Article  Google Scholar 

  2. 2.

    Katz PO: Providing feedback. Gastrointest Endosc Clin N Am 1995; 5(2): 347–355

    CAS  PubMed  Google Scholar 

  3. 3.

    Richardson BK: Feedback. Acad Emerg Med 2004; 11(12): 2383E1–5

    Google Scholar 

  4. 4.

    Morrison E, Rucker L, Boker J, et al: The effect of a 13-hr Curriculum to Improve Residents’ Teaching Skills. Annals of Internal Medicine 2004; 141: 256–263

    Article  Google Scholar 

  5. 5.

    Chur-Hansen A, Koopowitz LF: Formative feedback in teaching undergraduate psychiatry. Acad Psychiatry 2005; 29(1): 66–68

    PubMed  Article  Google Scholar 

  6. 6.

    Wigton RS, Patil KD, Hoellerich VL: The effect of feedback in learning clinical diagnosis. J Med Educ 1986; 61(10): 816–822

    CAS  PubMed  Google Scholar 

  7. 7.

    Berman MF, Simon AE: The effect of a drug and supply cost feedback system on the use of intraoperative resources by anesthesiologists. Anesth Analg 1998; 86(3): 510–515

    CAS  PubMed  Google Scholar 

  8. 8.

    Studnicki J, Bradham DD, Marshburn J, et al: A feedback system for reducing excessive laboratory tests. Arch Pathol Lab Med 1993; 117(1): 35–39

    CAS  PubMed  Google Scholar 

  9. 9.

    Opila DA: The impact of feedback to medical housestaff on chart documentation and quality of care in the outpatient setting. J Gen Intern Med 1997; 12(6): 352–356

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  10. 10.

    Duffield KE, Spencer JA: A survey of medical student’s views about the purposes and fairness of assessment. Med Educ 2002; 36(9): 879–886

    CAS  PubMed  Article  Google Scholar 

  11. 11.

    Functions and Structures of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the M.D. Degree; 2004

  12. 12.

    CAN Meds 2000 Project: Skills for the new millennium: report of the societal needs working group, September 1996. (www.rcpsc.org)

  13. 13.

    Royal College of Physicians and Surgeons of Canada Requirements for Program Accreditation, 2003 (Accessed January 2005 www.rcpsc.org)

  14. 14.

    Gil DH, Heins M, Jones PB: Perceptions of medical school faculty members and students on clinical clerkship feedback. J Med Educ 1984; 259: 856–864

    Google Scholar 

  15. 15.

    Lye P, Bragg D, Simpson D: Improving feedback with a clinical encounter form. Acad Med 1997; 72: 444–445

    CAS  PubMed  Article  Google Scholar 

  16. 16.

    Prystowsky JB, DaRosa DA: A learning prescription permits feedback on feedback. American Journal of Surgery 2003; 185(3): 264–267

    PubMed  Article  Google Scholar 

  17. 17.

    Ringdahl EN, ADelzell JE, Kruse RL: Evaluation of interns by senior residents and faculty: is there a difference? Med Educ 2004; 38(6): 646–651

    PubMed  Article  Google Scholar 

  18. 18.

    Moorehead R, Maguire P, Thoo SL: Giving feedback to learners in the practice. Australian Family Physician 2004; 33(9): 691–695

    Google Scholar 

  19. 19.

    Manusov EG, Carr RJ, Rowane M, et al: Dimensions of happiness: a qualitative study of family practice residents. J Am Board Fam Pract. 1995; 8(5): 367–7520

    CAS  PubMed  Google Scholar 

  20. 20.

    Houston TK, Ferenchick GS, Clark JM, et al: Faculty development needs. J Gen Intern Med 2004; 19(4): 375–379

    PubMed Central  PubMed  Article  Google Scholar 

  21. 21.

    Barratt MS, Moyer VA: Effect of a teaching skills program on faculty skills and confidence. Ambul Pediatr 2004; 4(1 Suppl): 117–120

    PubMed  Article  Google Scholar 

  22. 22.

    Rotenberg BW, Woodhouse RA, Gilbart M, et al: A needs assessment of surgical residents as teachers. Can J Surg 2000; 43(4): 295–300

    CAS  PubMed Central  PubMed  Google Scholar 

  23. 23.

    Mohanna, K: Teaching Made Easy: A Manual for Health Professionals, 2nd edition, Lange Medical Books/McGraw Hill, 2004

  24. 24.

    Dolmans DH, Wolfhagen HA, Gerver WJ, et al.: Providing physicians with feedback on how they supervise students during patient contacts. Medical Teacher 2004; 26(5): 409–414

    CAS  PubMed  Article  Google Scholar 

  25. 25.

    Greenberg LW: Medical students’ perceptions of feedback in a busy ambulatory setting: a descriptive study using a clinical encounter card. South Med J 2004; 97(12): 1174–1118

    PubMed  Article  Google Scholar 

  26. 26.

    Salerno SM, Jackson JL, O’Malley PG: Interactive faculty development seminars improve the quality of written feedback in ambulatory teaching. J Gen Intern Med 2003; 18(10): 831–834

    PubMed Central  PubMed  Article  Google Scholar 

  27. 27.

    Schum TR, Krippendorf RL, Biernat KA: Simple feedback notes enhance specificity of feedback to learners. Ambul Pediatr 2003; 3(1): 9–11

    PubMed  Article  Google Scholar 

  28. 28.

    Battistone MJ, Milne C, Sande MA, et al: The feasibility and acceptability of implementing formal evaluation sessions and using descriptive vocabulary to assess student performance on a clinical clerkship. Teaching Learn Med 2002; 14(1): 5–10

    Article  Google Scholar 

  29. 29.

    Paukert JL, Richards ML, Olney C: An encounter card system for increasing feedback to students. Am J Surg 2002; 183(3): 300–304

    PubMed  Article  Google Scholar 

  30. 30.

    Salerno SM, O’Malley PG, Pangaro LN, et al: Faculty development seminars based on the 1-minute preceptor improve feedback in the ambulatory setting. J Gen Intern Med 2002; 17(10): 779–787

    PubMed Central  PubMed  Article  Google Scholar 

  31. 31.

    Pituch K, Harris M, Bogdewic S: The brief structured observation: a tool for focused feedback. Acad Med 1999; 74: 599

    CAS  PubMed  Article  Google Scholar 

  32. 32.

    Hewson MG, Little ML: Giving feedback in medical education: verification of recommended techniques. J Gen Intern Med 1998; 13(2): 111–116

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  33. 33.

    Colletti LM: Difficulty with negative feedback: face-to-face evaluations of junior medical student clinical performance results in grade inflation. J Surg Res 2000; 90(1): 82–87

    CAS  PubMed  Article  Google Scholar 

  34. 34.

    Lempp H, Seale C: The hidden curriculum in undergraduate medical education: qualitative study of medical students’ perceptions of teaching. BMJ 2004; 329(7469): 770–335

    PubMed  Article  Google Scholar 

  35. 35.

    Pekkanen J: M.D. Doctors Talk About Themselves. Delacorte Press, 1988

  36. 36.

    Takakuwa KM, Rubashkin N, Herzig KE: What I Learned in Medical School—Personal Stories of Young Doctors, University of California Press, 2004

  37. 37.

    Metcalfe DH, Matharu M: Students’ perception of good and bad teaching: report of a critical incident study. Med Educ 1995; 29: 193–197

    CAS  PubMed  Article  Google Scholar 

  38. 38.

    McKee MD, Steiner-Grossman P, Burton W, Mulvihill M: Quality of student learning and preceptor productivity in urban community health centers. Fam Med 1998; 30(2): 108–112

    CAS  PubMed  Google Scholar 

  39. 39.

    Palepu A, Friedman RH, Barnett RC, et al: Junior faculty members’ mentoring relationships and their professional development in U.S. medical schools. Acad Med 1998; 73(3): 318–323

    CAS  PubMed  Article  Google Scholar 

  40. 40.

    Niedowski E. Marking a new era, Hopkins drops grades. The Baltimore Sun

  41. 41.

    Bing-You RG, Bertsch T, Thompson JA: Coaching medical students in receiving effective feedback. Teach Learn Med 1998; 10: 228–231

    Article  Google Scholar 

  42. 42.

    Speck, M: Best practice in professional development for sustained educational change. ERS Spect 1996; 33–41

Download references

Author information



Corresponding author

Correspondence to Dr. Joann McIlwrick M.D., F.R.C.P.C..

Rights and permissions

Reprints and Permissions

About this article

Cite this article

McIlwrick, J., Nair, B. & Montgomery, G. “How Am I Doing?”: Many Problems But Few Solutions Related to Feedback Delivery in Undergraduate Psychiatry Education. Acad Psychiatry 30, 130–135 (2006). https://doi.org/10.1176/appi.ap.30.2.130

Download citation


  • Medical Student
  • Academic Psychiatry
  • Performance Feedback
  • Hide Curriculum
  • Junior Resident