ARCH Model for Guiding Effective Feedback for Medical Learners by:   Conor Walsh, M17

Although feedback is a vital component of medical education and is important to ensure that standards are met, providing effective and appropriate feedback can be difficult for medical students, residents, and practicing physicians. Oftentimes, feedback can be too general (thereby making it difficult to set specific goals), untimely (i.e. given several weeks to months after a rotation), or be given without an explicit plan for improvement.

Characteristics of effective feedback include:

Considering emotions of both learner and teacher be:

  • Partially based on learner’s self-assessment and be well timed and expected
  • Based on direct observation and reliable information
  • Be specific, not general
  • Given in descriptive non-evaluative language
  • Given in a collaborative spirit

The ARCH concept helps provide a model for structured feedback for medical students and residents.

Allow/ask for self-assessment

Reinforce what is being done well (attitudes, skills, and knowledge)

Confirm what needs Correction or improvement

Help the learner with a plan for improvement and coach as needed

Allow/ask for self-assessment-

  • -Ask the learner to self-assess what they did well and what they could work on.

Example: “How do you feel about your interview with Mr. Smith? What do you think went well? What do you think you could continue to improve on?”

Reinforce what is being done well (attitudes, skills, and knowledge)

Example: “I agree that you were able to take a thorough history and that it was well organized.”

Confirm what needs Correction or improvement

Example: “Although you were thorough in your review of systems, it appeared to me that Mr. Smith really wanted to talk more about his joint pain. Did you notice that as well?

Help the learner with a plan for improvement and coach as needed

Example: “Why don’t you write up our discussion today with the goals to work towards this week and email it to me. I’ll make time this week to make sure we discuss your progress towards achieving those goals.

References:

  1. MacLeod L. Making SMART goals smarter. Physician Exec 2012; Mar/Apr:38(2):68-72.
  2. Ericsson KA. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med 2004;79(10 Suppl):S70–81.
  3. Bienstock JL, Katz NT, Cox SM, et al. To the point: medical education reviews—providing feedback. Am J Obstet Gynecol 2007 Jun;196(6):508-13.
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