Student-written patient notes improved in quality while using CPR. The program uses approaches valued in medicine (accurate peer review and self-reflection) to enhance performance.

The feedback sandwich technique-make positive comments; provide critique; end with positive comments-is commonly recommended to feedback givers despite scant evidence of its efficacy. These two studies (N = 20; N = 350) of written peer feedback with third-year medical students on clinical patient note-writing assignments indicate that students think feedback sandwiches positively impact subsequent performance when there is no evidence that they do. The effort necessary to produce feedback sandwiches and students' unwarranted confidence in their performance impact have implications for teaching about how to give feedback.

Years of training accounted for most of the variation in DPR and CDI performance. As a rule, students at higher training levels performed better on both tests, though the expected larger gains during the third year of medical school did not materialize.