# Abstract

 

## Introduction: Evaluation of students' learning in clinical education system is one of the most important and challenging issues that facilities in this field have been facing. The present study aimed to evaluate the role of feedback during evaluation in increasing emergency medicine residents' clinical skills. 

## Method: The present experimental study was performed on all second year emergency medicine residents of two educational hospitals, Tehran, Iran, with switching replications design and before-after method. They were randomly allocated to two groups (with or without feedback) and evaluated three times regarding chest ultrasonography for trauma patients, using direct observation of procedural skills (DOPS) and valid and reliable checklist. Data were analyzed using SPSS 20. 

## Results: 30 emergency medicine residents with the mean age of 36.63 ± 30.30 years were allocated to two equal groups (56.7% male). Studied groups were similar regarding the baseline characteristics. In both groups, obtained scores showed a significant increase from the first to the third evaluation (p < 0.001). Mean scores of first and second evaluations were 10.24 ± 0.77, 17.73 ± 0.46 in feedback receivers and 9.73 ± 0.77 and 12.13 ± 0.47 in others (p < 0.001). Mean third score after switching groups were 18.53 ± 0.22 in feedback receivers and 18.99 ± 0.22 in others (p = 0.213). 

## Conclusion: Based on the findings of the present study, giving feedback after evaluating the second year emergency medicine residents regarding chest ultrasonography for trauma patients, led to a significant improvement in their scores in future evaluations and consequently their skill. # Results ***Baseline characteristics*** 30 emergency medicine residents with the mean age of 36.63 ± 30.30 (29 - 47) years participated (56.7% male). They were randomly allocated to either Loghman Hakim (group 1) or Imam Hossein hospitals (group 2). [Table 1](#) shows the baseline characteristics of the participants. The two studied groups were similar regarding the baseline characteristics. 25 (83.4%) residents performed chest ultrasonography more than five times (56.7% more than 10 times) and 25 (83.3%) residents believed that chest ultrasonography for trauma patients had medium to high difficulty level. ***Outcomes*** Mean scores of the residents in the first, second, and third evaluations were 10.00 ± 0.54, 14.93 ± 0.32, and 18.72 ± 0.15, respectively. [Figure 1](#) shows the scores obtained by the residents for the 3 evaluations done based on the hospital. In both groups, obtained scores showed a significant increase from the first to the third evaluation (p < 0.001) according to Greenhouse-Geisser Correction test. Mean score obtained for preparation, scan and post-scan items among all residents were 3.34 ± 0.91, 9.48 ± 3.16, and 1.72 ± 0.97, respectively. [Tables 2](#) and [3](#) compare the scores obtained by each group in the 3 tests qualitatively and quantitatively. Mean scores of first and second evaluations were 10.24 ± 0.77, 17.73 ± 0.46 in feedback receivers and 9.73 ± 0.77 and 12.13 ± 0.47 in others (p < 0.001). Mean third score after switching groups were 18.53 ± 0.22 in feedback receivers and 18.99 ± 0.22 in others (p = 0.213). As can be seen, residents in Loghman Hakim Hospital were significantly better in the second exam both quantitatively and qualitatively. ::::table-wrap

::: caption
Baseline characteristics of participants
:::

**Variable** **Loghman Hakim** **Imam Hossein** **P**

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**Mean age (year)** 34.93 ± 5.40 38.33 ± 5.23 0.091
**Sex**\
Male 9 (60) 8 (53.3) 0.71
Female 6 (40) 7 (46.7)\
**Background experience1(time)**\
1 -4 3 (20) 2 (13.3) 0.879
5- 9 4 (26.7) 4 (26.7)\
≥ 10 8 (53.3) 9 (60)\
**Background attitude** ^2^ **(difficulty)**\
Low 4 (26.7) 1 (6.7) 0.241
Medium 10 (66.7) 11 (73.3)\
High 1 (6.7) 3 (20)\
**Mean promotion exam score**^3^ 81.06 ± 6.29 82.42 ± 6.27 0.565

Data were presented as mean ± standard deviation or frequency
(percentage);

1: Previous experience of chest ultrasonography;

2: Attitude of the resident regarding the difficulty of the procedure;

3: Score in exam taken for promotion from year 1 to year 2 of the
residency program (out of 100).:::: <figure> <p><img src="" /></p> <figcaption>Trend of scores (minimum 0 and maximum 20) in three evaluations of studied groups (p < 0.001, based on Greenhouse-Geisser Correction</figcaption> </figure> ::::table-wrap
::: caption
Comparison of mean evaluation scores between groups
:::

**Evaluation** **Loghman Hakim** **Imam Hossein** **P-value**

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**Preparation (0 -- 4)**\
First 3.00 ± 0.75 2.1 ± 0.92 0.009
Second 4.00 ± 0.00 3.00 ± 0.85 < 0.0001
Third 3.93 ± 0.26 4.00 ± 0.00 0.326
**Scan (0 -- 13)**\
First 6.87 ± 2.39 6.27 ± 2.43 0.501
Second 11.60 ± 0.99 7.33 ± 1.95 < 0.001
Third 12.53 ± 0.74 12.26 ± 0.59 0.287
**Post scan (0 -- 3)**\
First 0.40 ± 0.63 1.20 ± 0.67 0.002
Second 2.13 ± 0.35 1.80 ± 0.86 0.176
Third 2.53 ± 0.64 2.27 ± 0.71 0.287
**Total (0 - 20)**\
First 10.26 ± 2.99 9.73 ± 2.94 0.626
Second 17.73 ± 1.09 12.13 ± 2.29 \<0.001
Third 18.93 ± 0.96 18.53 ± 0.74 0.213

Data were presented as mean ± standard deviation.::::


Extracted trial result:
Outcome: Second test results (continuous)
Intervention: Evaluation with feedback
Comparator: Evaluation without feedback
Intervention group size: 15
Intervention mean: 17.73
Intervention standard deviation: 0.46
Comparator group size: 15
Comparator mean: 12.13
Comparator standard deviation: 0.47