Reflection on Giving Constructive Feedback to Peers

Description of what I have done in the seminar of giving constructive feedbacks to

peers via history taking on cardinal symptoms of cardiovascular disease:

It is usually done prior to performing Cardiovascular Examination

Presenting complaint:
Chest Pain (11Q)
Site (S) : Can you pinpoint where the pain is coming from exactly?
Onset (O) : (i) May I know how does this pain come about?
(ii) Is it due to exertion?
~If so  Can you quantify the exercise that triggers the pain?
~If no  Does the pain occur at night or at rest?
Character (C) : Can you describe the pain?
`Is it a heavy dull one, a sharp one, a burning one or an aching one?
`Is it a sudden or progressive pain?
`Does it persist or come and go?
Radiation (R) : Does the pain from your chest radiate to other parts of your body?
Association (A) : Do you experience any other symptoms with this pain?
Time (T) : (i) How long have you been having this problem?
(ii) How often does it occur?
(iii) How long does this pain last?
Exacerbating &
Relieving factor (E) : (i) Did you notice anything that worsens the pain?
(ii) Did you do anything to relieve the pain?
Severity (S) : On a scale of 1 to 10, how would you rate the pain?
Breathlessness
O: How does your breathlessness come about? Do you feel breathless after an exertion?
~If so  Can you quantify the exercise you did that made you breathless?
~If no  Does your breathlessness occurs when you’re lying down?
~If so  Does it wake you up at night during your sleep?
A: ~If no  What other symptoms you have while having breathlessness?
T: (i) How long have you been having breathlessness?
(ii) How often/frequent does it occur?
(iii) How long does your breathlessness last?
E: (i) Is there anything you do that worsens your breathlessness?
(ii) Did you do anything to relieve your breathlessness?
S: What is the extend of breathlessness you could tolerate on a scale of 10?

Palpitation
O: (i) When did you feel that your heart beat was abnormal?
(ii) Have you been told by a doctor about the risks of heart disease?
C: (i) Can you describe your abnormal heartbeat?
`Is it beating too fast / too hard / skipping a beat?
(ii) Can you tap out the rhythm of your heartbeat while this symptom is occurring?
A: Do experience any other symptoms while having irregular heartbeat?
T: (i) How long have you been having this symptom?
(ii) How often does it occur?
(iii) How long does it last?

Dizziness and Syncope

O: Does it occur as you change position quickly?
C: Can you describe your dizziness?
` Have you ever fainted or felt like fainting?
` Did you feel like the room is spinning?
` Did you feel like you’re losing consciousness?
Oedema
C: ~If so  Is it occurring on both legs?
E: Does it get worse throughout the day?
T: Do you have any swollen ankles or legs before?

Claudication
Do you experience any leg pain?
O - Does it occur due to exertion?
E - Does it improve at rest?

ICE:
Ideas (I): (i) Do you have any thought about the cause of your current symptom?

Concern(C): (i) You seem pretty worried now, so what worries you the most?
(i) Are you worried about your current condition affecting your daily life?
(ii) What about your close ones, are they affected by your health condition?

Expectation(E): (i) What do you hope to achieve from this consultation?

(ii) What are you going to do to improve your health?

Signposting:
Is there anything else you want me to know before I summarize?

Internal summary:
Name, Age, Presenting Complaint, Concern

Past Medical History (P/S) : Have you been diagnosed with any disease previously?
Have you done any surgery before?
Diabetes? Hypertension? Obesity?

Drug & Allergy (D/A) : Are you currently taking any medication?
Do you have any allergies?
Is it ok if I ask you some sensitive questions?
Family history (F) : Do you have any family member who had a heart disease?

Social history (S):

(i) Smoking / Do you live with any smoker? (iv) Occupation
(ii) Alcohol (v) Stress
(iii) Diet (Fatty Food?) (vi) Coping ability
(vii) Exercise / Sedentary

Systemic reviews
Ok right now, I’m just going to ask you some Yes or No questions:
General:
(i) Fever
(ii) Tiredness
(iii) Unintentional change in appetite and weight

Head: Eyes:
(i) Headache (i) Blurry Vision
(ii) Dizziness

Nose: Mouth:
(i) SOB (i) Cough
(ii) Nausea & Vomiting

GI: Urinary:
(i) Heartburn (i) Urinating problem
(ii) Change in Bowel Habit

Skin: Neuromuscular
(i) Rashes (i) Muscle/Joint Pain
(ii) Lumps
Final summary
Presenting complaint + P D/A F S

Thank you, have a good day!

I have learnt a lot in about the importance of giving constructive feedback to peers.
Humans are not perfect and making minor mistakes while performing history taking upon
the patient is inevitable, let alone this is our first-time taking history from patients. It was
tough for us to remember all the things to ask, however, with the constructive feedback
session right after the history taking is done, it allows us to remind each other on the things
that were omitted while performing history taking. It definitely helps us a lot in building and
reconstructing our flow throughout the process of history taking. As a result, each of us
could get better and better by telling each other on the criteria we could improve.

In retrospect, I should have known better in the ways of providing constructive

feedback in such a way it could motivate the person receiving the feedback in a positive
way. Giving feedback must not be taken light-heartedly as we need to ensure our peers
improve themselves throughout the seminar. Hence, any mistake that is done must be
acknowledged as to prevent them from messing up the process of history taking in the
future. History taking is so important in diagnosing a patient’s disease as it accounts for 90%
of contribution towards the diagnosis made for the patient. Therefore, as a medical student,
it is important to make sure the learning experience provided in each seminar session,
especially those seminars organised for history taking, is maximised via giving constructive
feedback to peers.