A learning prescription permits feedback on feedback.

BACKGROUND: Students consistently identified inadequate feedback as a deficiency in our third-year clerkship. METHODS: We asked students to solicit one faculty and one resident every 2 weeks for written feedback on a "feedback prescription pad." Each prescription requested four comments: two things the student did well and two things the student needs to improve. Students rated feedback using a five-point scale. A three-point categorization scheme was employed to assess the quality of feedback. RESULTS: Students' rating of feedback improved significantly compared with a previous time period (3.5 +/- 1.2 versus 2.6 +/- 1.2, P <0.01). Interrater reliability of our categorization scheme was high (kappa > or =0.75, P <0.01) and demonstrated that only 10% of comments were specific enough to qualify as effective feedback. CONCLUSIONS: Feedback prescription pads were a simple method to facilitate feedback. Although students appreciated feedback, most feedback was inadequate. Faculty development programs to enhance student feedback should be a priority of clinical medical education.