Section 4: Written feedback
Written feedback is appropriate when:
- Performance needs to be documented, either positive or negative aspects; this happens with grading and annual evaluations of employees
- A warning or remediation is being given
- You are summarizing what happened in a meeting to ensure everyone is on the same page
- You want to give the recipient time to digest the information first
- You have provided next steps and the recipient may not remember all of it from the meeting
Issues to keep in mind for written feedback
- Check your tone. Aim for an objective tone and be aware that emotion does not get conveyed easily in an email, and can be misconstrued by the reader. They cannot see your body language while they read the message.
- Don’t pass the buck. Written assessments should be clear, objective, and be reflective of you as their supervisor, rather than blaming preceptors before you or the curriculum. Ask how you can help them.
- Be clear about expectations. Next steps should be well-delineated. For example, what is it that you want them to improve on, and how would that be measured? Are the expectations reasonable? Give positive reinforcement for good behavior/performance.
- Be aware that remedial students do not often understand the “rules” of clinical behavior and protocols. Ask yourself if there are unwritten rules, and whether students who did not grow up in the US healthcare system need extra prep for these “unwritten rules” and knowledge of the healthcare system.
- If writing a message to interns to assign homework to be reviewed the following week, remember that homework is not intended as a punishment or structured only for struggling students. Assignments should target reviewing interesting conditions or clinical findings that were either correctly identified or missed by a student to help connect didactic knowledge to clinical practice. Frame this as a learning opportunity.
Writing Clinical Evaluation Comments
There is an art when it comes down to grading your students and adding the appropriate comments. Below are 5 different styles of grading and comments that might be seen regarding a student’s performance. Remember the goal is to shape knowledgeable, caring and clinicians who continue to strive for improvement.
Sample meditrek grading form
| Score | Criteria | |
|---|---|---|
| Technical Skills | 1-4 | Accurately and effectively performs tests involved in primary eye care; using proper technique, equipment and record keeping. |
| Knowledge Base | 1-4 | Demonstrates knowledge of basic science and clinical concepts used in patient care. Able to distinguish normal from abnormal. |
| Analytical Skills | 1-4 | Integrates knowledge base with clinical findings. Tailors exam testing for specific characteristics and/or complaints for common conditions |
| Diagnostic Skills | 1-4 | Independently makes accurate differential and final diagnoses of common conditions |
| Management and Treatment | 1-4 | Formulates management plans for common diagnoses, including appropriate follow up, treatment and patient education for the majority of patient encounters. |
| Communication Skills | 1-4 | Effectively communicates with patients, preceptor, staff and/or other interns, presents cases and/or demonstrates thought processes. Establishes good doctor-patient rapport. Exhibits cultural sensitivity. |
| Efficiency | 1-4 | Completes routine exams in an appropriate timeframe: including completing charts, referral letters, and eyeglass orders. |
| Attitude | 1-4 | Accepts and benefits from constructive criticism, shows active desire to learn, uses learning resources well, actively seeks new knowledge from a variety of sources. Independently pursues self study. |
| Professionalism | 1-4 | Punctual, ethical, appropriately dressed, respectful, prepared, complies with confidentiality and clinic policies, works effectively with others to optimize patient Demonstrates respectful and compassionate interpersonal behavior. |
| Overall Impression | ||
| Total Score |
In the examples below, a 1 is the lowest score and a 4 is the highest score.
(Taken from lecture by Dr. Amy Moy and Dr. Phyllis Andrejko, NECO)
The Generic / I Don’t Really Know You Evaluation:
The preceptor gives high 3’s and 4’s in most sections, but has no comments that support the above average performance. There are no areas provided for the student to work on or feedback provided on techniques or skills that they did well in.
| Competency | Score 1-4 | Comments |
|---|---|---|
| Technical Skills | 3 | |
| Knowledge Base | 4 | |
| Analytical Skills | 3 | |
| Diagnostic Skills | 4 | |
| Management and Treatment | 3 | |
| Communication Skills | 3 | |
| Efficiency | 4 | |
| Attitude | 3 | |
| Professionalism | 3 | |
| Overall Impression | Great job, great clinician | |
| Total Score | 30 |
The “Repeater” Evaluation
Doesn’t provide specific feedback other than rewording of grading criteria.
| Score | Comment | |
|---|---|---|
| Technical Skills | 3 | Uses accurate techniques and has a good command of technical skills required in a primary care examination. |
| Knowledge Base | 3 | Demonstrates knowledge of basic science and clinical concepts used in patient care. Able to distinguish normal from abnormal. |
| Analytical Skills | 3 | |
| Diagnostic Skills | 3 | Independently makes differentials for common conditions and is beginning to attempt differentials for final diagnoses. |
| Management and Treatment | 3 | |
| Communication Skills | 3 | |
| Efficiency | 3 | |
| Attitude | 3 | |
| Professionalism | 3 | Student is always professional |
| Overall Impression | ||
| Total Score | 27 |
The “No Filter” Evaluation
This evaluation is giving unnecessary personal commentary and speaks of other preceptors’ assessments.
In the overall impression section, the preceptor writes the following:
“I am not sure why this student got a remedial at the previous site. I wonder if the previous preceptor was young. Often young preceptors are harsher graders because they feel that they have something to prove.”
This evaluation is giving unnecessary personal commentary and speaks of other preceptors’ assessments. An evaluation should be objective and refrain from personal, unclinical and unprofessional opinions about others.
The “It Takes Time” Evaluation
It is important to provide a frame of reference for where the student’s current skills are, instead of where they will be in the future.
| Score | Comment | |
|---|---|---|
| Technical Skills | 3 | appears to be ok with use of equipment. Some difficulty in recording results and signing charts, but I think this will improve with time |
| Knowledge Base | 3 | I think that with time and exposure to patients, student will continue to improve her clinical detection skills |
| Analytical Skills | 3 | |
| Diagnostic Skills | 3 | I think there is a natural tendency for the student to overreact or over-diagnose normal variations. She often describes the signs of the disorders rather than recording the diagnosis. This is not so bad as long as I can convince her to be brief in her records when appropriate and expand notations when indicated. It takes time. |
| Management and Treatment | 2 | Student will need time and patient exposures but seems to have potential |
| Communication Skills | 2 | This is an Achilles heel for the student. I have sat with her and personally discussed the need to make eye contact with the patients, speak confidently, and make herself better understood. |
| Efficiency | 2 | Again, I feel that time management should improve with experience. |
| Attitude | 3 | |
| Professionalism | 3 | |
| Overall Impression | ||
| Total Score | 24 | Remedial grade |
The “I am Paying Attention” Evaluation: A Good Scenario
This scenario provides feedback specifically in most categories, providing more individual areas that the student did well and areas that they can still improve.
| Score | Comment | |
|---|---|---|
| Technical Skills | 3 | Student…sometimes forgets to record findings as discussed/viewed. Continue to work on writing assessments as clinical fact and plan accordingly. Continue to work on acceptable refractive shortcuts and use of refractive binocular techniques. Record keeping should include last exam, A+O x 3, ethnicity, etc. Student has done a nice job with gonioscopy. Continue to enhance 90D and BIO |
| Knowledge Base | 3 | He can sometimes be disconnected from his cases but is capable of showing sufficient knowledge base… |
| Analytical Skills | 3 | Needs to be more consistent with tailoring his exams accordingly. Continue to work on cases anterior to posterior, common to rare… |
| Diagnostic Skills | 3 | Mostly consistent, however needs to work on being more independent in decision making |
| Management and Treatment | 3 | Continue to work on recording process; assessment is clinical fact and plan is what you do about it. |
| Communication Skills | 3 | Continue to enhance verbal independent decision making by sharing thoughts and speaking optometry on regular basis |
| Efficiency | 2 | Needs to work in lab to practice skills; review cases independently and in group prior to and after patient’s exam |
| Attitude | 3 | |
| Professionalism | 3 | |
| Overall Impression | Overall, the student has improved and grown in clinical care. He needs to embrace being proactive in clinic and approaching clinic as not only his chosen career, but a plan should be in place to study and practice for clinic and have follow-up learning issues from clinic. I think the student would benefit from tutoring sessions to practice verbal and written commitment to a case to enhance independent decision-making. | |
| Total Score | 26 | Pass |
Example of Thoughtful Written Feedback from a Preceptor
Technical Skills Rating: 3
The student demonstrates developing technical proficiency and has shown clear improvement, particularly in procedures such as gonioscopy, where technique has become more confident and consistent. The student should continue to work on accurately recording all clinical findings as they are observed, ensuring documentation includes key elements such as last exam date, A+Ox3 status, and demographic information including ethnicity. Refractive technique is improving but would benefit from additional practice in binocular balancing and refractive shortcuts. Continued refinement of 90D and BIO skills is recommended, practicing on every appropriate patient.
Knowledge Base Rating: 3
The student possesses a solid foundational knowledge base and can demonstrate appropriate understanding when prompted. At times, the student appears somewhat disconnected from details of the cases, which may affect the ability to integrate knowledge independently. With more deliberate pre- and post-encounter case review, the student will continue to strengthen clinical reasoning and confidence.
Analytical Skills Rating: 3
The student is able to analyze most clinical findings appropriately, though the approach is not always consistent. The student should continue working on structuring examinations from anterior to posterior and using a “common to rare” approach when forming differential diagnoses. Analytical accuracy improves when the student pauses to reflect on findings, and additional repetition and intentional case review will help solidify this skill.
Diagnostic Skills Rating: 3
The student is developing reliable diagnostic skills and can typically arrive at an appropriate diagnosis with some guidance. Greater independence in decision-making will help the student transition from seeking frequent confirmation to feeling confident in clinical conclusions. The student is encouraged to formulate a top differential before seeking preceptor input and to verbalize diagnostic reasoning clearly.
Management and Treatment Rating: 3
The student generally selects appropriate management strategies but should continue working on clearly distinguishing the assessment (clinical fact) from the plan (action steps). Strengthening the recording process will help the student develop more structured, actionable treatment plans. Continued review of standard-of-care management guidelines will help the student write concise, confident, and complete plans.
Communication Skills Rating: 3
The student communicates respectfully and professionally with patients and staff. Continued development of verbal clinical reasoning and independent decision-making through clear explanation of thought processes is recommended. Regular practice “speaking optometry” using clinical terminology, differentials, and rationale will strengthen both confidence and clarity.
Efficiency Rating: 2
The student is improving in efficiency but still has room to streamline workflow. Additional hands-on practice in the lab will help reinforce technical skills so they become more automatic during patient care. Reviewing cases independently and with peers both before and after exams will help the student better anticipate required tests and manage time more effectively during patient encounters.
Attitude Rating: 3
The student maintains a positive and receptive attitude in clinic and remains willing to learn and adjust based on feedback. This openness will support ongoing clinical growth. Continued curiosity and readiness to improve are encouraged.
Professionalism Rating: 3
The student demonstrates appropriate professionalism, interacting respectfully with patients, staff, and preceptors. The student is punctual, prepared, and receptive to guidance. Continued development of a proactive professional identity through patient ownership and preparation is recommended.
Overall Impression
Overall, the student has demonstrated progress and meaningful growth in clinical care. There remains an opportunity for the student to become more proactive in clinic—approaching responsibilities with the mindset of an emerging clinician rather than solely a learner. Establishing a structured plan for studying, practicing skills, and following up on learning issues will support continued development. The student may benefit from targeted tutoring or coaching sessions focusing on verbal and written clinical communication to strengthen independent decision-making and case ownership.
