Does the location of a narrative comment section affect feedback on a lecture evaluation form?

Although the structure and composition of graduate medical education (GME) is evolving with medical and technological advances, didactic lecture format instruction remains a critical component in many training environments internationally. In the US, the Accreditation Council for Graduate Medical Education (ACGME) publishes program requirements outlining educational guidelines for 133 specialties and subspecialties.1 These requirements mandate Emergency Medicine (EM) residency programs must have an average of at least five hours of dedicated instruction per week with 50% of these hours given by faculty members. Trainees therefore often lead a significant portion of didactic sessions. Developing presentation skills is a critical talent to learn, as junior physicians become educators. Additionally, US accreditation bodies require evaluations to measure participation and educational effectiveness of these didactic presentations. Learner evaluations are one mechanism used to meet this requirement. Formative assessment and feedback have been shown to change trainees’ behavior.2-5 Recent literature also supports the notion that trainees do not benefit from feedback in the form of numerical marks but rather from narrative, specific feedback that explicitly states the areas that require improvement.2,3,6 Despite this evidence, there is little data about the components of an effective evaluation tool. One common example, a numerical Likert scale has been shown to be less helpful than narrative or verbal feedback.7 To our knowledge, there is no validated or recommended tool to measure educational effectiveness while also providing meaningful feedback to resident lecturers. The authors sought to test the hypothesis that by relocating a blank space for written comments from the bottom of a lecture evaluation form to the top, it would convey the importance of narrative feedback to the evaluator, motivate the evaluator to provide feedback more frequently, and increase the quality of feedback provided to our resident lecturers. The purpose of this study was to determine if moving the narrative feedback section on a lecture evaluation form from the bottom to the top of the form increases the presence and the quality of written narrative feedback.