Contextual Influences on Feedback Practices: An Ecological Perspective

A qualitative exploration of feedback experience among final-year physiotherapy students using activity theory

BACKGROUND

Feedback is an important part of learning, however, it often does not have the desired effect. Much work has been done exploring students' engagement with feedback and factors which may impact engagement. Mutual understanding of feedback and feedback practice on the part of the student and educator is essential.

METHODS

This study explored the perceptions of feedback of final-year physiotherapy students at Stellenbosch University (South Africa). Twelve semi-structured interviews were conducted to generate data. Cultural-historical activity theory was used as an analytic lens in the data analysis.

RESULTS

Students understood feedback to be a continuous, bidirectional conversation in which they were actively involved. Students recognised their agency in feedback practice. Despite their understanding, their agency was often undermined by factors such as the environment, context and most notably the perceived positioning and relationships between students and educators. Educators who were perceived as credible and created a safe psychosocial space had a positive influence on the students' perception of feedback.

CONCLUSIONS

Students' perceptions of feedback and their engagement was the product of a complex and dynamic interplay of factors. While students recognise their agency, this may be hindered by relationships and the design of feedback in the curriculum. As educators, one must consider how we contribute to this and enable students to activate and use their agency in feedback practice.

Establishing the measurement and psychometrics of medical student feedback literacy (IMPROVE-FL): A research protocol

Current feedback models advocate learner autonomy in seeking, processing, and responding to feedback so that medical students can become feedback-literate. Feedback literacy improves learners' motivation, engagement, and satisfaction, which in turn enhance their competencies. However, there is a lack of an objective method of measuring medical student feedback literacy in the empirical literature. Such an instrument is required to determine the level of feedback literacy amongst medical students and whether they would benefit from an intervention. Therefore, this research protocol addresses the methodology aimed at the development of a comprehensive instrument for medical student feedback literacy, which is divided into three phases, beginning with a systematic review. Available instruments in health profession education will be examined to create an interview protocol to define medical students' feedback literacy from the perspectives of medical students, educators, and patients. A thematic analysis will form the basis for item generation, which will subsequently undergo expert validation and cognitive interviews to establish content validity. Next, we will conduct a national survey to gather evidence of construct validity, internal consistency, hypothesis testing, and test-retest reliability. In the final phase, we will distribute the instrument to other countries in an international survey to assess its cross-cultural validity. This protocol will help develop an instrument that can assist educators in assessing student feedback literacy and evaluating their behavior in terms of managing feedback. Ultimately, educators can identify strengths, and improve communication with students, as well as feedback literacy and the feedback process. In conclusion, this study protocol outlined a systematic, evidence-based methodology to develop a medical student feedback literacy instrument. This study protocol will not only apply to medical and local cultural contexts, but it has the potential for application in other educational disciplines and cross-cultural studies.

Students' perceptions of post-exam feedback in oral radiology-A comparative study from two dental hygienist educational settings

INTRODUCTION

The aim of this study was to investigate how students perceive the benefit of participating in a teacher-organised session providing feedback on exams, termed post-exam feedback, in two dental hygienist programmes.

METHODS

The study was based on interviews with 22 participants, including 18 students and 4 faculty teachers. The data were approached on the basis of thematic analysis, allowing us to generate insights on how the participants reflected on their participation in the post-exam feedback sessions and how they perceived this arrangement as learners.

RESULTS

The findings from the study suggest that motivated students consider post-exam feedback to be beneficial in clearing up uncertainties and deepening their understanding of issues not fully understood during the exam, as well as supporting their further learning. Less motivated students mainly consider post-exam feedback to be relevant for students who do not pass the exams.

CONCLUSIONS

Organised in a student-centred way and with attentiveness to student learning preferences, the results suggest that post-exam feedback can be valuable for enhancing assessment and supporting student learning related to exams.

'Every Human Interaction Requires a Bit of Give and Take': Medical Students' Approaches to Pursuing Feedback in the Clinical Setting

PhenomenonStudents, alongside teachers, play a key role in feedback. Student behavior in feedback processes may impact feedback outcomes. Student feedback behavior includes recognizing, seeking, evaluating, and utilizing feedback. Student feedback behavior is influenced by numerous student attributes and environmental factors. ApproachWe aimed to explore influences on medical student feedback behavior during clinical attachments. We adopted a subjective inductive qualitative approach. We conducted 7 focus groups with 46 medical students undertaking pediatric hospital-based attachments. We based our discussion framework on existing characterizations of student feedback behavior and the educational alliance model with its focus on the relationship between learners and teachers, and the active role played by both. During initial data analysis, we identified that our results exhibited aspects of Bandura's model of Triadic Reciprocal Causation within Social Cognitive Theory. In line with our subjective inductive approach, we adopted Triadic Reciprocal Causation at this point for further analysis and interpretation. This allowed us to conceptualize the emerging interactions between influences on feedback behavior. Findings We identified three key determinants of student feedback behavior: Environmental influences, Student attributes and Relationships between teachers and students. Environmental influences encompassed factors external to the student, including Teacher attributes and behaviors and The clinical learning context. Through the lens of Triadic Reciprocal Causation, the interrelationships between the determinants of feedback behavior gave rise to five key themes: Interactions between student feedback behavior and environmental influences of the clinical learning context, Interactions between student feedback behavior and environmental influences of teacher attributes and behaviors, Interactions between student attributes and student feedback behavior, Interactions between student attributes and environmental influences of teacher attributes and behaviors, and Relationships and the determinants of student feedback behavior. Insights: We apply the Triadic Reciprocal Causation model of Social Cognitive Theory to understand the influences on student feedback behavior and the interactions between them. We extend the model by situating relationships between students and teachers as a central factor. Future interventions to facilitate students' role in feedback will need to address student attributes, environmental factors, and student-teacher relationships, appreciating the codependent nature of these influences.

Understanding Feedback for Learners in Interprofessional Settings: A Scoping Review

BACKGROUND

Interprofessional feedback is becoming increasingly emphasized within health professions' training programs. The objective of this scoping review is to determine what is known about how learners perceive and interact with feedback in an interprofessional context for learning.

METHODS

A search strategy was developed and conducted in Ovid MEDLINE. Title and abstract screening were performed by two reviewers independently. Next, full texts of selected articles were reviewed by one reviewer to determine the articles included in the review. Data extraction was performed to determine the articles' study population, methodologies and outcomes relevant to the research objective.

RESULTS

Our analysis of the relevant outcomes yielded four key concepts: (1) issues with the feedback process and the need for training; (2) the perception of feedback providers, affecting how the feedback is utilized; (3) professions of the feedback providers, affecting the feedback process; and (4) learners' own attitude toward feedback, affecting the feedback process.

CONCLUSIONS

The learner's perception of interprofessional feedback can be an obstacle in the feedback process. Training around interprofessional feedback should be included as part of interprofessional programs. Research is needed to explore how to address barriers in feedback interaction that stem from misguided perceptions of feedback providers' professions.

Viewing interprofessional collaboration through the lens of networked ecological systems theory

Interprofessional collaboration (IPC) is key to ensuring safe quality care for patients. However, IPC intervention outcomes are variable, leading to calls for systems theories to understand complex interactions in healthcare. Using networked ecological systems theory (NEST), we aimed to uncover facilitators and barriers impacting the interactions between nurses and physicians in a specialty healthcare center. A qualitative study involving 55 non-participant observations and 17 individual semi-structured interviews was conducted at the National Neuroscience Institute of Singapore from April 2019 to March 2021. Template analysis was used to analyze the data. The most important IPC facilitators were exosystemic institutional support and physicians' willingness to engage in IPC in the microsystems that together enabled the establishment of disease-based outpatient programs fostering patient-centered interactions among different healthcare professionals (HCP). We also found that patient-, disease-, and systems-related knowledge played an important role in facilitating IPC. Macrosystemic entrenchments such as intraprofessional composition of ward rounds emerged as a significant barrier. However, microsystemic efforts such as chat groups connecting all HCP involved in the care of the patients in the wards have fostered IPC. Although still preliminary, these findings suggest NEST can be useful to inform systematic interventions to improve IPC.

"It's yours to take": generating learner feedback literacy in the workplace

Feedback can improve students' learning and performance on clinical placements, yet students are often dissatisfied with the process. Attempts to improve feedback frequently focus on faculty development programs without addressing learners' capabilities to engage with feedback. For feedback to be effective, students need to understand its processes and to translate this into practice. Developing student feedback literacy may enhance feedback engagement and, therefore, learning outcomes. This qualitative interview study aimed to problematise student feedback literacy in the healthcare setting, from the learner's perspective. Before commencing placements, 105 healthcare students at an Australian teaching hospital participated in a feedback literacy program. After their placements, 27 students engaged in semi-structured interviews to explore their feedback experiences. Informed by workplace learning theory, interview transcripts were analysed using the framework method of qualitative analysis. Students reported reframing feedback as a process they could initiate and engage in, rather one they were subjected to. When they took an intentional stance, students noted that feedback conversations generated plans for improvement which they were enacting. However, students had to work hard against orthodox feedback expectations and habits in healthcare. They privileged intraprofessional supervisor feedback over interprofessional practitioners, patients, or peers. Findings suggest that student engagement with feedback can be augmented with focussed retraining. However, further research examining the structural and cultural influences on students' capacity to be active in workplace feedback is warranted.

Challenging feedback myths: Values, learner involvement and promoting effects beyond the immediate task

CONTEXT

Research suggests that feedback in the health professions is less useful than we would like. In this paper, we argue that feedback has become reliant on myths that perpetuate unproductive rituals. Feedback often resembles a discrete episode of an educator "telling," rather than an active and iterative involvement of the learner in a future-facing process. With this orientation towards past events, it is not surprising that learners become defensive or disengaged when they are reminded of their deficits.

METHODS

We tackle three myths of feedback: (a) feedback needs praise-criticism balancing rules; (b) feedback is a skill residing within the teacher; and (c) feedback is an input only. For each myth we provide a reframing with supporting examples from the literature.

CONCLUSIONS

Equipping learners to engage in feedback processes may reduce the emotional burden on both parties, rendering techniques such as the feedback sandwich redundant. We also highlight the benefits for learners and teachers of conceptualising feedback as a relational activity, and of tracing the effects of information exchanges. These effects may be immediate or latent, and may manifest in different forms such as changes in learner evaluative judgement or professional identity.

Exploring the influence of context on feedback at medical school: a video-ethnography study

Feedback in medical education is complicated by the multiple contexts within which learning occurs. However, feedback research in medical education has typically focused on information provided by tutors to students with limited exploration of the influence of context. This research seeks to address this gap by exploring the influence of multiple contexts upon feedback processes. Employing video-ethnography methodology we explored feedback in two common contexts for medical student learning: the simulated clinical environment and the medical workplace. Learning and teaching sessions were filmed in each of these contexts, capturing diverse feedback processes. Data were analysed for key themes using a Framework Analysis approach and similarities and differences between the two contexts identified. In total 239 distinct feedback episodes across 28 different teaching and learning sessions were captured, with feedback processes relating to the patient, practice, educational and institutional contexts observed. In this paper, we concentrate on key similarities and differences in feedback processes between the two contexts with respect to six themes: feedback interlocutors, interlocutor positioning, feedback types, feedback foci, feedback styles and feedback milieu. We argue that feedback is inextricably linked to the multiple contexts in which feedback is enacted. It is only by exploring these contextual influences that feedback can be understood more fully. With such understanding we should be better placed to develop interventions capable of improving the long elusive experience of successful feedback.