Comparing formal and informal modes of clinical clerkship feedback: a content analysis of student perspectives

Clinical clerkships rely on student feedback to evaluate learning environments and guide curricular improvement. However, concerns regarding anonymity and potential repercussions may influence the content of feedback submitted through formal evaluation systems, potentially limiting the range of experiences captured. Students have increasingly utilized informal, peer-driven feedback systems to share clerkship experiences. This study compared the thematic content of qualitative feedback submitted through formal evaluations with feedback shared through an informal, student-managed system. This retrospective qualitative study analyzed comments from Internal Medicine and Surgery clerkships at the Perelman School of Medicine from the 2023 and 2024 clerkship years. Formal feedback consisted of optional free-text comments submitted in site-specific evaluations. Informal feedback was obtained from an anonymous spreadsheet used to share clerkship experiences among students. Comments underwent content analysis using a predefined framework encompassing Teaching Quality and Engagement, Clinical Exposure and Variety, Hands-on Experience, Autonomy, Workload/Hours, Site Culture and Environment, Logistics, and Expectations. Frequencies and percentages were calculated, separated by clerkship (Internal Medicine and Surgery). Theme frequencies were compared between formal and informal comments using Fisher’s exact tests, with Benjamini-Hochberg adjustment for multiple comparisons. A total of 995 comments were analyzed, including 841 formal and 154 informal comments. Among Internal Medicine comments ( n = 291; 241 formal, 50 informal), informal feedback more frequently emphasized Clinical Exposure and Variety (66.0% vs. 26.1%, p < 0.001) and Workload and Hours (26.0% vs. 3.7%, p < 0.001). Among Surgery comments ( n = 704; 600 formal, 104 informal), informal feedback more frequently emphasized Clinical Exposure and Variety (44.2% vs. 30.0%, p = 0.016), Hands-on Experience (32.7% vs. 19.8%, p = 0.016), Workload and Hours (66.3% vs. 4.0%, p < 0.001), and Site Culture and Environment (17.3% vs. 8.7%, p = 0.020). In Surgery comments, formal comments more frequently mentioned Logistics (22.0% vs. 11.5%, p = 0.020). Informal student feedback more frequently emphasized learning-environment aspects of clerkships—including Clinical Exposure, Workload and Hours, Site Culture and Environment, and Hands-on Experience—whereas formal evaluations more frequently addressed Logistics in the Surgery clerkship. Formal and informal feedback appeared to emphasize different aspects of students’ clerkship experiences, suggesting that each may provide information not fully captured by the other. Incorporating insights from both sources may provide a more comprehensive understanding of the students’ experiences and identify opportunities to improve clerkship quality.