of the Soul. Each module includes a brief facultypresentation and a guided reflection on personalexperiences. Students then work in small groups of4–5 students and 1 faculty doctor to share andexamine what was discovered in the reflection.Students and faculty share as equals. Small groupsagree on guidelines of interaction and confidentialitythat allow each group member to feel heard,respected and safe.

The Healer’s Art is based on 4 educationalconcepts:

1 medical education is a moral trajectory, and thecurriculum not only informs but also transformslearners;

2 meaning and values are antecedent of profes-sionalism and professional commitment;

3 values learning requires content to be engagedexperientially using an interactive discoverymodel; and

4 learners already know more than they realiseabout healing and the doctor)patient relation-ship.

In sharing their stories, students and faculty directlyexperience basic principles of service and the healingrelationship: safety, authentic listening and presence;intimacy, respect and trust; compassion and empathy;community, and commitment.Evaluation of results and impact The Healer’s Art hasattracted an average of 44% of the UCSF Year 1 classannually since 1992. The course is now offered at 33medical schools in the USA and Canada. In 2003–04,standardised evaluations were collected from 23 ofthe 25 schools participating at the time, with 489 of680 students (72.0%) and 88 of 174 faculty (50.1%)responding. Students rated the quality of the coursehighly (4.47 on a 5-point scale). Both students andfaculty reported that the course provided importantcontent not available elsewhere in the curriculum(4.59 and 4.76, respectively). Students and facultyreported using content from the course both pro-fessionally (65.7% and 75.0%, respectively) andpersonally (73.3% and 79.5%, respectively). Therewere no statistically significant differences in evalua-tions of either the uniqueness or utility of the coursebased on student age, year in school, gender ormedical school. Further evaluation of the course’sshort- and longterm impact is ongoing.

Correspondence: Michael W Rabow MD, Associate Professor of ClinicalMedicine, UCSF ⁄ Mount Zion, 1701 Divisadero Street 500, SanFrancisco, California 94115, USA. Tel: 00 1 415 353 7918;Fax: 00 1 415 353 7932; E-mail: mrabow@medicine.ucsf.edu.

doi: 10.1111/j.1365-2929.2005.02296.x

An effective tool for feedback on a problem-basedlearning (PBL) course

Isaac D Gukas & Samuel J Leinster

Context and setting After a 10-week problem-basedlearning (PBL) course unit, medical students at theUniversity of East Anglia usually receive a report bytheir tutor. This report usually reflects their profes-sional behaviour and overall contribution to the workof the group. The student’s performance is rated assatisfactory, unsatisfactory or exceptional. The reportis discussed with the student at a 1-to-1 meeting withthe tutor. The meeting is expected to address issuesraised in the report. The student is expected to signand indicate whether he ⁄ she agrees or disagrees withthe report. A copy is then sent to the schooladministration and kept in the student’s record.Why the idea was necessary The 1-to-1 meeting is anexcellent opportunity for giving thorough feedbackto the student. After 10 weeks, some details essentialfor adequate feedback may have been forgotten bythe tutor and student. More importantly, trends inperformance which may suggest significant interrup-tions in the learning process may be missed alto-gether.What was done An ‘objective performance index’ wasintroduced during the 10-week period. For each ofthe 20 meetings within the 10-week period, eachstudent was given a mark on a scale of 1–10. Thismark was for depth of knowledge on discussiontopics, enthusiasm shown in the course, team spirit,professional attitude, personal composure and gen-eral attitude to learning. One was considered to beunacceptably low performance, 5 was considered asaverage performance, while 10 was exceptional per-formance. The average mark for each week wasentered on an excel spread sheet and used to plot agraph of ‘performance’ against time for each student.The graphic display was designed to indicate when/ifto intervene before the 10-week report meeting.Evaluation of results and impact A downward trend,a persistently low ‘threshold’ or a swinging fluctu-ation in ‘performance’ as indicated by the pattern ofthe graph were used as intervention points. The finalgraph was also used at the 1-to-1 meeting as afeedback tool. All the students found the graph avery useful aid to deliver the feedback. They wereable to associate specific events with the pattern ofthe graph.

Correspondence: Isaac Gukas, School of Medicine, Health Policy andPractice, University of East Anglia, Norwich NR4 7TJ, UK.Fax: + 4 1603 593752; E-mail: I.gukas@uea.ac.uk

doi: 10.1111/j.1365-2929.2005.02279.x

really good stuff1168

� Blackwell Publishing Ltd 2005. MEDICAL EDUCATION 2005; 39: 1143–1172