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Mohd Noor MN, Fatima S, Grace Cockburn J, Romli MH, Pallath V, Hong WH, Vadivelu J, Foong CC. Systematic review of feedback literacy instruments for health professions students. Heliyon 2024; 10:e31070. [PMID: 38813152 PMCID: PMC11133658 DOI: 10.1016/j.heliyon.2024.e31070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 05/06/2024] [Accepted: 05/09/2024] [Indexed: 05/31/2024] Open
Abstract
Successfully managing and utilizing feedback is a critical skill for self-improvement. Properly identifying feedback literacy level is crucial to facilitate teachers and learners especially in clinical learning to plan for better learning experience. The present review aimed to gather and examine the existing definitions and metrics used to assess feedback literacy (or parts of its concepts) for health professions education. A systematic search was conducted on six databases, together with a manual search in January 2023. Quality of the included studies were appraised using the COSMIN Checklist. Information on the psychometric properties and clinical utility of the accepted instruments were extracted. A total 2226 records of studies were identified, and 11 articles included in the final analysis extracting 13 instruments. These instruments can be administered easily, and most are readily accessible. However, 'appreciating feedback' was overrepresented compared to the other three features of feedback literacy and none of the instruments had sufficient quality across all COSMIN validity rating sections. Further research studies should focus on developing and refining feedback literacy instruments that can be adapted to many contexts within health professions education. Future research should apply a rigorous methodology to produce a valid and reliable student feedback literacy instrument.
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Affiliation(s)
| | - Sahar Fatima
- Medical Education and Research Development Unit, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | | | - Vinod Pallath
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Wei-Han Hong
- Medical Education and Research Development Unit, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Jamuna Vadivelu
- Medical Education and Research Development Unit, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chan Chong Foong
- Medical Education and Research Development Unit, Universiti Malaya, Kuala Lumpur, Malaysia
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Fuentes-Cimma J, Sluijsmans D, Riquelme A, Villagran I, Isbej L, Olivares-Labbe MT, Heeneman S. Designing feedback processes in the workplace-based learning of undergraduate health professions education: a scoping review. BMC MEDICAL EDUCATION 2024; 24:440. [PMID: 38654360 PMCID: PMC11036781 DOI: 10.1186/s12909-024-05439-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/17/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Feedback processes are crucial for learning, guiding improvement, and enhancing performance. In workplace-based learning settings, diverse teaching and assessment activities are advocated to be designed and implemented, generating feedback that students use, with proper guidance, to close the gap between current and desired performance levels. Since productive feedback processes rely on observed information regarding a student's performance, it is imperative to establish structured feedback activities within undergraduate workplace-based learning settings. However, these settings are characterized by their unpredictable nature, which can either promote learning or present challenges in offering structured learning opportunities for students. This scoping review maps literature on how feedback processes are organised in undergraduate clinical workplace-based learning settings, providing insight into the design and use of feedback. METHODS A scoping review was conducted. Studies were identified from seven databases and ten relevant journals in medical education. The screening process was performed independently in duplicate with the support of the StArt program. Data were organized in a data chart and analyzed using thematic analysis. The feedback loop with a sociocultural perspective was used as a theoretical framework. RESULTS The search yielded 4,877 papers, and 61 were included in the review. Two themes were identified in the qualitative analysis: (1) The organization of the feedback processes in workplace-based learning settings, and (2) Sociocultural factors influencing the organization of feedback processes. The literature describes multiple teaching and assessment activities that generate feedback information. Most papers described experiences and perceptions of diverse teaching and assessment feedback activities. Few studies described how feedback processes improve performance. Sociocultural factors such as establishing a feedback culture, enabling stable and trustworthy relationships, and enhancing student feedback agency are crucial for productive feedback processes. CONCLUSIONS This review identified concrete ideas regarding how feedback could be organized within the clinical workplace to promote feedback processes. The feedback encounter should be organized to allow follow-up of the feedback, i.e., working on required learning and performance goals at the next occasion. The educational programs should design feedback processes by appropriately planning subsequent tasks and activities. More insight is needed in designing a full-loop feedback process, in which specific attention is needed in effective feedforward practices.
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Affiliation(s)
- Javiera Fuentes-Cimma
- Department of Health Sciences, Faculty of Medicine, Pontificia Universidad Católica de Chile, Avenida Vicuña Mackenna 4860, Macul, Santiago, Chile.
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands.
| | | | - Arnoldo Riquelme
- Centre for Medical and Health Profession Education, Department of Gastroenterology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ignacio Villagran
- Department of Health Sciences, Faculty of Medicine, Pontificia Universidad Católica de Chile, Avenida Vicuña Mackenna 4860, Macul, Santiago, Chile
| | - Lorena Isbej
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
- School of Dentistry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Sylvia Heeneman
- Department of Pathology, Faculty of Health, Medicine and Health Sciences, Maastricht University, Maastricht, Netherlands
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Liao M, Zhu K, Wang G. Can human-machine feedback in a smart learning environment enhance learners' learning performance? A meta-analysis. Front Psychol 2024; 14:1288503. [PMID: 38268803 PMCID: PMC10805823 DOI: 10.3389/fpsyg.2023.1288503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/11/2023] [Indexed: 01/26/2024] Open
Abstract
Objective The human-machine feedback in a smart learning environment can influences learners' learning styles, ability enhancement, and affective interactions. However, whether it has stability in improving learning performance and learning processes, the findings of many empirical studies are controversial. This study aimed to analyze the effect of human-machine feedback on learning performance and the potential boundary conditions that produce the effect in a smart learning environment. Methods Web of Science, EBSCO, PsycINFO, and Science Direct were searched for publications from 2010 to 2022. We included randomized controlled trials with learning performance as outcome. The random effects model was used in the meta-analysis. The main effect tests and the heterogeneity tests were used to evaluate the effect of human-machine feedback mechanism on learning performance, and the boundary conditions of the effect were tested by moderating effects. Moreover, the validity of the meta-analysis was proved by publication bias test. Results Out of 35 articles identified, 2,222 participants were included in this study. Human-machine interaction feedback had significant effects on learners' learning process (d = 0.594, k = 26) and learning outcomes (d = 0.407, k = 42). Also, the positive effects of human-machine interaction feedback were regulated by the direction of feedback, the form of feedback, and the type of feedback technique. Conclusion To enhance learning performance through human-machine interactive feedback, we should focus on using two-way and multi-subject feedback. The technology that can provide emotional feedback and feedback loops should be used as a priority. Also, pay attention to the feedback process and mechanism, avoid increasing students' dependence on machines, and strengthen learners' subjectivity from feedback mechanism.
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Affiliation(s)
- Mengyi Liao
- School of Education, Pingdingshan University, Pingdingshan, Henan, China
| | - Kaige Zhu
- School of Education, Pingdingshan University, Pingdingshan, Henan, China
| | - Guangshuai Wang
- National Engineering Research Center of Educational Big Data, Faculty of Artificial Intelligence in Education, Central China Normal University, Wuhan, Hubei, China
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Yoong SQ, Wang W, Seah ACW, Zhang H. The quality of verbal feedback given by nursing near-peer tutors: A qualitative study. NURSE EDUCATION TODAY 2023; 130:105944. [PMID: 37611513 DOI: 10.1016/j.nedt.2023.105944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/27/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Students' acceptance of peer feedback (PF) in health professions education has been mixed because of doubts about its quality and accuracy. Providing peer tutor (PT) training in giving effective feedback may increase the quality of PF. OBJECTIVES To analyse the (1) quality and (2) accuracy of near-PF provided to first-year nursing students after simulated practice and (3) evaluate the discrepancies between what faculty, PTs and clinical staff teach about certain nursing skills by analysing PT-student feedback discussions. DESIGN Qualitative study using content analysis. SETTINGS This study was conducted in a simulation centre in a Singapore university during first-year undergraduate nursing students' laboratory lessons. PARTICIPANTS Near-PT (second- to fourth-year undergraduate nursing students). METHODS Near-PTs received virtual training on providing structured feedback. They provided in-person PF to first-year nursing students after simulated practice of a technical nursing skill. PF was audio recorded. Quality was determined by PTs' adherence to the proposed PF structure and the Debriefing Assessment for Simulation in Healthcare-Rater Version Short Form (DASH-RV-Short) scores. Directed content analyses were also conducted to qualitatively evaluate PF quality based on DASH-RV-Short, PF accuracy and discrepancies in content taught for each nursing skill. RESULTS Most PTs evaluated the skill chronologically or focused on the mistakes made instead of following the PF structure. DASH-RV-Short scores were 'good' for most elements because PTs gave specific suggestions and justified them, ensured students' psychological safety, and used effective verbal communication. PF was mostly accurate, but expectations relating to each nursing skill differed among the PTs, faculty and clinical staff. CONCLUSIONS With training, senior nursing students can provide specific and detailed feedback to their juniors, which may fill the gap for timely and specific feedback in health professions education. Future PT training programmes should clarify common variations and mistakes in skills performance to ensure PTs and faculty tutors agree on what students should learn.
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Affiliation(s)
- Si Qi Yoong
- Alice Lee Centre of Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Wenru Wang
- Alice Lee Centre of Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Alvin Chuen Wei Seah
- Alice Lee Centre of Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Hui Zhang
- Alice Lee Centre of Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; St Andrew's Community Hospital, Singapore.
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Cordovani L, Tran C, Wong A, Jack SM, Monteiro S. Undergraduate Learners' Receptiveness to Feedback in Medical Schools: A Scoping Review. MEDICAL SCIENCE EDUCATOR 2023; 33:1253-1269. [PMID: 37886291 PMCID: PMC10597920 DOI: 10.1007/s40670-023-01858-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 10/28/2023]
Abstract
Feedback from educators to learners is considered an important element of effective learning in medical school. While early studies were focused on the processes of providing feedback, recent work has showed that factors related to how learners receive feedback seems to be equally important. Considering that the literature on this topic is new in medical education, and studies are diverse and methodologically variable, we sought to conduct a scoping review to map the articles on receptiveness to feedback, to provide an overview of its related factors, to identify the types of research conducted in this area, and to document knowledge gaps in the existing literature. Using the Joanna Briggs Institute scoping review methodology, we searched four databases (CINAHL, Ovid, PubMed, and Web of Science) and screened 9120 abstracts, resulting in 98 articles for our final analysis. In this sample, 80% of studies on the feedback receiver were published in the last 10 years, and there is a vast variation in the studies' methodologies. The main factors that affect medical students' receptiveness to feedback are students' characteristics, feedback content, educators' credibility, and the learning environment. Feedback literacy is a very recent and rarely used term in medical education; therefore, an important area for further investigation. Lastly, we identified some gaps in the literature that might guide future research, such as studying receptiveness to feedback based on academic seniority and feedback literacy's long-term impacts on learning. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-023-01858-0.
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Affiliation(s)
- Ligia Cordovani
- Department of Health Research Methods, Evidence, Impact, McMaster University, Hamilton, ON Canada
| | - Cody Tran
- School of Medicine, McMaster University, Hamilton, ON Canada
| | - Anne Wong
- Department of Anesthesia, McMaster University, Hamilton, ON Canada
| | - Susan M. Jack
- School of Nursing, McMaster University, Hamilton, ON Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada
| | - Sandra Monteiro
- Department of Medicine, McMaster University, Hamilton, ON Canada
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Javadi A, Keshmiri F. Surgical Nursing Students' Perception of Feedback in Clinical Education: A Mixed-method Study. EDUCATION FOR HEALTH (ABINGDON, ENGLAND) 2023; 36:131-134. [PMID: 38133129 DOI: 10.4103/efh.efh_55_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/18/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Feedback is a critical component of education but may not always be delivered in a useful manner. This study assessed surgical nursing students' perception of the feedback they received on a clinical rotation. METHODS This is a sequential mixed-method study. The first stage surveyed surgical nursing students in surgical units about the feedback they received. In the second stage, participants' experiences receiving feedback were explored in interviews, and analyzed by a conventional content analysis approach. RESULTS The majority of nurses found that feedback was not helpful, citing a lack of constructive feedback. Negative feedback was often delivered in a public setting. Comments were frequently based on secondary information rather than direct observation. DISCUSSION Feedback to nurses on the surgical unit is not perceived by students as constructive. Clinical teachers did not appear to be aware of the educational effect of the feedback on the learning process of students. In addition, the setting for feedback often undermined its effectiveness. Staff development on effective feedback for teachers on the surgical unit is recommended.
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Affiliation(s)
- Alireza Javadi
- Department of Surgical Technology, Paramedical School, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fatemeh Keshmiri
- Department of Medical Education, Education Development Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Noble C, Young J, Brazil V, Krogh K, Molloy E. Developing residents' feedback literacy in emergency medicine: Lessons from design-based research. AEM EDUCATION AND TRAINING 2023; 7:e10897. [PMID: 37529173 PMCID: PMC10387830 DOI: 10.1002/aet2.10897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 08/03/2023]
Abstract
Objectives Residents in emergency medicine have reported dissatisfaction with feedback. One strategy to improve feedback is to enhance learners' feedback literacy-i.e., capabilities as seekers, processors, and users of performance information. To do this, however, the context in which feedback occurs needs to be understood. We investigated how residents typically engage with feedback in an emergency department, along with the potential opportunities to improve feedback engagement in this context. We used this information to develop a program to improve learners' feedback literacy in context and traced the reported translation to practice. Methods We conducted a year-long design-based research study informed by agentic feedback principles. Over five cycles in 2019, we interviewed residents and iteratively developed a feedback literacy program. Sixty-six residents participated and data collected included qualitative evaluation surveys (n = 55), educator-written reflections (n = 5), and semistructured interviews with residents (n = 21). Qualitative data were analyzed using framework analysis. Results When adopting an agentic stance, residents reported changes to the frequency and tenor of their feedback conversations, rendering the interactions more helpful. Despite reporting overall shifts in their conceptions of feedback, they needed to adjust their feedback engagement depending on changing contextual factors such as workload. These microsocial adjustments suggest their feedback literacy develops through an interdependent process of individual intention for feedback engagement-informed by an agentic stance-and dynamic adjustment in response to the environment. Conclusions Resident feedback literacy is profoundly contextualized, so developing feedback literacy in emergency contexts is more nuanced than previously reported. While feedback literacy can be supported through targeted education, our findings raise questions for understanding how emergency medicine environments afford and constrain learner feedback engagement. Our findings also challenge the extent to which this contextual feedback know-how can be "developed" purposefully outside of the everyday work.
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Affiliation(s)
- Christy Noble
- Academy for Medical Education, Medical SchoolThe University of QueenslandHerstonQueenslandAustralia
| | - Jessica Young
- Emergency DepartmentGold Coast Hospital and Health ServiceGold CoastQueenslandAustralia
| | - Victoria Brazil
- Emergency DepartmentGold Coast Hospital and Health ServiceGold CoastQueenslandAustralia
- Bond Translational Simulation Collaborative Translational Simulation Collaborative, Faculty of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia
| | - Kristian Krogh
- Department of Anaesthesiology and Intensive CareAarhus University HospitalAarhusDenmark
- Research Center for Emergency MedicineAarhus University HospitalAarhusDenmark
| | - Elizabeth Molloy
- Faculty of Medicine, Dentistry and Health SciencesThe University of MelbourneMelbourneAustralia
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McGinness HT, Caldwell PHY, Gunasekera H, Scott KM. 'Every Human Interaction Requires a Bit of Give and Take': Medical Students' Approaches to Pursuing Feedback in the Clinical Setting. TEACHING AND LEARNING IN MEDICINE 2023; 35:411-421. [PMID: 35733380 DOI: 10.1080/10401334.2022.2084401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 05/12/2022] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Hannah T McGinness
- Specialty of Child and Adolescent Health, The University of Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, New South Wales, Australia
| | - Patrina H Y Caldwell
- Specialty of Child and Adolescent Health, The University of Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, New South Wales, Australia
- Specialty of Child and Adolescent Health, The University of Sydney, New South Wales, Australia
| | - Hasantha Gunasekera
- Specialty of Child and Adolescent Health, The University of Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, New South Wales, Australia
| | - Karen M Scott
- Specialty of Child and Adolescent Health, The University of Sydney, New South Wales, Australia
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Ajjawi R, Bearman M, Molloy E, Noble C. The role of feedback in supporting trainees who underperform in clinical environments. Front Med (Lausanne) 2023; 10:1121602. [PMID: 37181376 PMCID: PMC10167016 DOI: 10.3389/fmed.2023.1121602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Underperformance in clinical environments can be costly and emotional for all stakeholders. Feedback is an important pedagogical strategy for working with underperformance - both formal and informal strategies can make a difference. Feedback is a typical feature of remediation programs, and yet there is little consensus on how feedback should unfold in the context of underperformance. Methods This narrative review synthesises literature at the intersections of feedback and underperformance in clinical environments where service, learning and safety need to be considered. We do so with a critical eye towards generating insights for working with underperformance in the clinical environment. Synthesis and discussion There are compounding and multi-level factors that contribute to underperformance and subsequent failure. This complexity overwrites simplistic notions of 'earned' failure through individual traits and deficit. Working with such complexity requires feedback that goes beyond educator input or 'telling'. When we shift beyond feedback as input to process, we recognise that these processes are fundamentally relational, where trust and safety are necessary for trainees to share their weaknesses and doubts. Emotions are always present and they signal action. Feedback literacy might help us consider how to engage trainees with feedback so that they take an active (autonomous) role in developing their evaluative judgements. Finally, feedback cultures can be influential and take effort to shift if at all. A key mechanism running through all these considerations of feedback is enabling internal motivation, and creating conditions for trainees to feel relatedness, competence and autonomy. Broadening our perceptions of feedback, beyond telling, might help create environments for learning to flourish.
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Affiliation(s)
- Rola Ajjawi
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, VIC, Australia
| | - Margaret Bearman
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, VIC, Australia
| | - Elizabeth Molloy
- Department of Medical Education, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Christy Noble
- Academy for Medical Education, Medical School, The University of Queensland, Herston, QLD, Australia
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Ma T, Li Y, Yuan H, Li F, Yang S, Zhan Y, Yao J, Mu D. Reflection on the teaching of student-centred formative assessment in medical curricula: an investigation from the perspective of medical students. BMC MEDICAL EDUCATION 2023; 23:141. [PMID: 36864421 PMCID: PMC9980864 DOI: 10.1186/s12909-023-04110-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Formative assessment (FA) is becoming increasingly common in higher education, although the teaching practice of student-centred FA in medical curricula is still very limited. In addition, there is a lack of theoretical and pedagogical practice studies observing FA from medical students' perspectives. The aim of this study is to explore and understand ways to improve student-centred FA, and to provide a practical framework for the future construction of an FA index system in medical curricula. METHODS This study used questionnaire data from undergraduate students in clinical medicine, preventive medicine, radiology, and nursing at a comprehensive university in China. The feelings of medical students upon receiving student-centred FA, assessment of faculty feedback, and satisfaction were analysed descriptively. RESULTS Of the 924 medical students surveyed, 37.1% had a general understanding of FA, 94.2% believed that the subject of teaching assessment was the teacher, 59% believed that teacher feedback on learning tasks was effective, and 36.3% received teacher feedback on learning tasks within one week. In addition, student satisfaction results show that students' satisfaction with teacher feedback was 1.71 ± 0.747 points, and their satisfaction with learning tasks was 1.83 ± 0.826 points. CONCLUSION Students as participants and collaborators in FA provide valid feedback for improving student-centred FA in terms of student cognition, empowered participation, and humanism. In addition, we suggest that medical educators avoid taking student satisfaction as a single indicator for measuring student-centred FA and to try to build an assessment index system of FA, to highlight the advantages of FA in medical curricula.
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Affiliation(s)
- Tianjiao Ma
- School of Nursing, Jilin University, Changchun, Jilin Province, China
- Institute of Communication and Social Governance, Jilin University, China, Changchun, Jilin Province
| | - Yin Li
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Hua Yuan
- School of Nursing, Jilin University, Changchun, Jilin Province, China
| | - Feng Li
- School of Nursing, Jilin University, Changchun, Jilin Province, China
| | - Shujuan Yang
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Yongzhi Zhan
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Jiannan Yao
- School of Nursing, Jilin University, Changchun, Jilin Province, China
| | - Dongmei Mu
- Division of Clinical Research, The First Hospital of Jilin University, Changchun, Jilin Province, China.
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Davies KM, Coombes ID, Keogh S, Hay K, Whitfield KM. Medication administration evaluation and feedback tool: Longitudinal cohort observational intervention. Collegian 2023. [DOI: 10.1016/j.colegn.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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Rietmeijer CBT, van Esch SCM, Blankenstein AH, van der Horst HE, Veen M, Scheele F, Teunissen PW. A phenomenology of direct observation in residency: Is Miller's 'does' level observable? MEDICAL EDUCATION 2023; 57:272-279. [PMID: 36515981 PMCID: PMC10107098 DOI: 10.1111/medu.15004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Guidelines on direct observation (DO) present DO as an assessment of Miller's 'does' level, that is, the learner's ability to function independently in clinical situations. The literature, however, indicates that residents may behave 'inauthentically' when observed. To minimise this 'observer effect', learners are encouraged to 'do what they would normally do' so that they can receive feedback on their actual work behaviour. Recent phenomenological research on patients' experiences with DO challenges this approach; patients needed-and caused-some participation of the observing supervisor. Although guidelines advise supervisors to minimise their presence, we are poorly informed on how some deliberate supervisor participation affects residents' experience in DO situations. Therefore, we investigated what residents essentially experienced in DO situations. METHODS We performed an interpretive phenomenological interview study, including six general practice (GP) residents. We collected and analysed our data, using the four phenomenological lenses of lived body, lived space, lived time and lived relationship. We grouped our open codes by interpreting what they revealed about common structures of residents' pre-reflective experiences. RESULTS Residents experienced the observing supervisor not just as an observer or assessor. They also experienced them as both a senior colleague and as the patient's familiar GP, which led to many additional interactions. When residents tried to act as if the supervisor was not there, they could feel insecure and handicapped because the supervisor was there, changing the situation. DISCUSSION Our results indicate that the 'observer effect' is much more material than was previously understood. Consequently, observing residents' 'authentic' behaviour at Miller's 'does' level, as if the supervisor was not there, seems impossible and a misleading concept: misleading, because it may frustrate residents and cause supervisors to neglect patients' and residents' needs in DO situations. We suggest that one-way DO is better replaced by bi-directional DO in working-and-learning-together sessions.
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Affiliation(s)
- Chris B. T. Rietmeijer
- Department of General PracticeAmsterdam UMC, location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Suzanne C. M. van Esch
- Department of General PracticeAmsterdam UMC, location University of AmsterdamAmsterdamThe Netherlands
| | - Annette H. Blankenstein
- Department of General PracticeAmsterdam UMC, location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Henriëtte E. van der Horst
- Department of General PracticeAmsterdam UMC, location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Mario Veen
- Department of General PracticeErasmus Medical CenterRotterdamThe Netherlands
| | - Fedde Scheele
- School of Medical Sciences, Athena Institute for Transdisciplinary ResearchAmsterdam UMC, location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Pim W. Teunissen
- School of Health Professions EducationMaastricht UniversityMaastrichtThe Netherlands
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Factors that enhance midwifery students' learning and development of self-efficacy in clinical placement: A systematic qualitative review. Nurse Educ Pract 2023; 66:103510. [PMID: 36462273 DOI: 10.1016/j.nepr.2022.103510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022]
Abstract
AIM To conduct a systematic review and synthesis of qualitative studies to explore the significant factors that enhance midwifery students' learning experiences and development of self-efficacy in clinical placement. BACKGROUND Midwifery education programs leading to registration as a midwife require students to achieve academic, clinical, and professional competence. Clinical placement comprises a significant part of the program as students work and are assessed under the direct supervision of the Registered Midwife or preceptor. This learning and teaching partnership aims to enable the transfer of knowledge, skills, and behavior, i.e., competence, while providing the opportunity for students to become socialized into the midwifery practice culture. Against this background, characterized by the shortage of midwives, declining fertility rates, and a stressful environment, students learn to become a midwife and develop self-efficacy. Self-efficacy is the belief in one's ability to master challenges, which is described as a component in learning theories. There seems to be a need to identify factors that contribute to this development. DESIGN A qualitative systematic literature review. METHOD A systematic database search was conducted to identify primary peer reviewed qualitative literature published between 2000 and 2021 that has explored what enhances midwifery students' learning during their clinical placement. The databases searched included CINAHL (EBSCO), Medline (Ovid), Embase (Ovid), PsycINFO (Ovid), JBI Joanna Briggs Institute (Ovid), SveMed+ , and Web of Science. The search yielded a total of 354 results, of which 22 met the inclusion criteria. The relevant findings from the 22 studies were thematically analyzed and presented in the results. RESULTS The analysis revealed two descriptive themes - 'A nurturing relationship' and 'Predictability in the learning process, contextual factors. In addition, one analytic theme emerged - 'Gaining access to and belonging in an enabling educational and working culture'. CONCLUSION The relationship with the preceptor is a prerequisite for midwife students learning process and achievement of self-efficacy. A learning culture appears to be the fertile ground in which midwife students thrive and where they develop the self-efficacy needed to meet the demands of clinical placement.
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Coelho V, Scott A, Bilgic E, Keuhl A, Sibbald M. Understanding Feedback for Learners in Interprofessional Settings: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10732. [PMID: 36078451 PMCID: PMC9517787 DOI: 10.3390/ijerph191710732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Varun Coelho
- Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Andrew Scott
- Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Elif Bilgic
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Amy Keuhl
- Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Matthew Sibbald
- Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
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Ajjawi R, Olson RE, McNaughton N. Emotion as reflexive practice: A new discourse for feedback practice and research. MEDICAL EDUCATION 2022; 56:480-488. [PMID: 34806217 PMCID: PMC9299671 DOI: 10.1111/medu.14700] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Like medicine and health care, feedback is a practice imbued with emotions: saturated with feelings relevant to one's identity and status within a given context. Often this emotional dimension of feedback is cast as an impediment to be ignored or managed. Such a perspective can be detrimental to feedback practices as emotions are fundamentally entwined with learning. In this critical review, we ask: What are the discourses of emotion in the feedback literature and what 'work' do they do? METHODS We conducted a critical literature review of emotion and feedback in the three top journals of the field: Academic Medicine, Medical Education and Advances in Health Sciences Education. Analysis was informed by a Foucauldian critical discourse approach and involved identifying discourses of emotion and interpreting how they shape feedback practices. FINDINGS Of 32 papers, four overlapping discourses of emotion were identified. Emotion as physiological casts emotion as internal, biological, ever-present, immutable and often problematic. Emotion as skill positions emotion as internal, mainly cognitive and amenable to regulation. A discourse of emotion as reflexive practice infers a social and interpersonal understanding of emotions, whereas emotion as socio-cultural discourse extends the reflexive practice discourse seeing emotion as circulating within learning environments as a political force. DISCUSSION Drawing on scholarship within the sociology of emotions, we suggest the merits of studying emotion as inevitable (not pathological), as potentially paralysing and motivating and as situated within (and often reinforcing) a hierarchical social health care landscape. For future feedback research, we suggest shifting towards recognising the discourse-theory-practice connection with emotion in health professional education drawing from reflexive and socio-cultural discourses of emotion.
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Affiliation(s)
- Rola Ajjawi
- Centre for Research in Assessment and Digital LearningDeakin UniversityMelbourneVictoriaAustralia
| | - Rebecca E. Olson
- School of Social ScienceThe University of QueenslandSt LuciaQueenslandAustralia
| | - Nancy McNaughton
- Centre for Learning Innovation and Simulation at the Michener InstituteUniversity Health NetworkTorontoOntarioCanada
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Roberts A, Jellicoe M, Fox K. How does a move towards a coaching approach impact the delivery of written feedback in undergraduate clinical education? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:7-21. [PMID: 34518963 PMCID: PMC8938375 DOI: 10.1007/s10459-021-10066-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 08/22/2021] [Indexed: 06/13/2023]
Abstract
Feedback uptake relies on interactions between learners and educators Winstone (Educ Psychol 52: 17-37, 2017). Feedback that coaches using a feedforward approach, is considered to be more personal and emotionally literate Bussey (Bull R Coll Surg Engl 99: 180-182, 2017), Hattie (Rev Educ Res 77: 81-112, 2007). Many modes of feedback are employed in clinical teaching environments, however, written feedback is particularly important, as a component of feedback discourse, as significant time may elapse before a similar clinical situation is encountered. In practice, time constraints often result in brief or descriptive written feedback rather than longer coaching feedback. This study aimed to explore whether a change in ethos and staff development would encourage clinical dental tutors to utilise a coaching approach in their written feedback. Across two time-points, written feedback was categorised into either descriptive, evaluative or coaching approaches. Cross-sections of data from 2017 to 2019 were examined to determine whether changes in practice were noted and whether there were any alterations in the affective nature of the language used. Feedback moved significantly towards coaching and away from a descriptive approach. A shift towards the use of more positive language was seen overall, although this was solely driven by a change in the evaluative feedback category. Descriptive feedback generally used neutral language with coaching feedback using marginally more positive language. Both categories employed significantly lower levels of affective language than evaluative feedback. These data indicate a move towards feedback approaches and language that may support increased uptake and utilisation of feedback.
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Affiliation(s)
- Amanda Roberts
- Education Research and Scholarship Group, The School of Dentistry, The University of Liverpool, Pembroke Place, Liverpool, L3 5PS, United Kingdom.
| | - Mark Jellicoe
- Education Research and Scholarship Group, The School of Dentistry, The University of Liverpool, Pembroke Place, Liverpool, L3 5PS, United Kingdom
| | - Kathryn Fox
- Education Research and Scholarship Group, The School of Dentistry, The University of Liverpool, Pembroke Place, Liverpool, L3 5PS, United Kingdom
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17
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Martiáñez-Ramírez NL, Pineda-Galán C, Rodríguez-Bailón M, Romero-Galisteo RP. Competence assessment rubric in the Physiotherapy Practicum. PLoS One 2022; 17:e0264120. [PMID: 35213586 PMCID: PMC8880643 DOI: 10.1371/journal.pone.0264120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 02/03/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Competence-based learning must be integrated into the practical development of Physiotherapy. Teamwork, interpersonal relations, analytical skills or critical/clinical thinking are some examples of internationally recommended competences in this kind of university studies. Therefore, there is a need to evaluate this learning in Physiotherapy through valid tools that facilitate this task.
Objective
To analyze the psychometric properties according to competences in Clinical Practices (RECOPC-FIS II) in order to assess 14 transversal or universal competences of under-graduate students in the Physiotherapy degree.
Methods
A validation study was conducted with 197 students in the 3rd and 4th year of the Physiotherapy degree and 202 clinical tutors who assessed these students using the RECOPC-FIS II. Different psychometric properties were analyzed: factor structure, internal consistency and sensitivity to change.
Results
The RECOPC-FIS II has a high internal consistency. Its 14 items saturate in a single factor. Regarding the sensitivity to change, the rubric showed higher scores in the Practicum of the 4th year with respect to that of the 3rd year, reaching significant differences in all of them.
Conclusion
The RECOPC-FIS II is a valid and reliable instrument to assess the transversal competencies of undergraduate students of Physiotherapy during their clinical practice. Therefore, it is intended to facilitate the acquisition of essential skills for the development of their professional career. The flexibility of this tool would allow its adaptation to other health science courses.
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Affiliation(s)
- Noa Lola Martiáñez-Ramírez
- Department of Physiotherapy, La Salle Higher Education Center, Autonomous University of Madrid, Madrid, Spain
| | | | - María Rodríguez-Bailón
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, Málaga, Spain
- * E-mail:
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Barry K, Shields M, McGavin S, Blefari C. How to navigate the evolving world of clinical placement: an Australian university collaboration to support clinical supervision. J Med Imaging Radiat Sci 2021; 52:S39-S44. [PMID: 34561210 DOI: 10.1016/j.jmir.2021.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/13/2021] [Accepted: 08/28/2021] [Indexed: 10/20/2022]
Abstract
Clinical placement is an integral part of medical radiation science student learning and development. Clinical placement provides opportunity for students to apply their theoretical knowledge and enable students to prepare for their future professional practice. Clinical supervisors have a significant role in this process to facilitate student learning on clinical placement. However, clinical supervisors often have little formal training to supervising students on placement and will default to their own previous learning experience. There is a need to provide an educational perspective from tertiary education partners to assist medical radiation practitioners in their role of supervising students. This paper is a collaboration between Australian Nuclear Medicine University partners with the aim to support and educate nuclear medicine technologists, and indeed all medical radiation practitioners to competently fulfil their role regarding student supervision and assessment.
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Affiliation(s)
- Kym Barry
- Charles Sturt University, Australia.
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Tripodi N, Feehan J, Wospil R, Vaughan B. Twelve tips for developing feedback literacy in health professions learners. MEDICAL TEACHER 2021; 43:960-965. [PMID: 33131374 DOI: 10.1080/0142159x.2020.1839035] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Despite feedback being widely-used by health professions educators as a tool to develop clinical competencies, strategies to guide its successful implementation remain limited. In addition, health professions learners are often dissatisfied with the quality and/or volume of feedback they receive. Efforts to better engage learners in feedback processes have resulted in the development of a number of theoretical frameworks to guide educators, one being feedback literacy. Feedback literacy can be conceptualised as a learner's ability to recognise, comprehend, generate, and take action on feedback they encounter during their learning to aid health professions learners' clinical competency development. Here, we draw on both a conceptual framework of feedback literacy and other contemporary feedback literature to provide 12 practical tips by which feedback literacy can be developed in health professions learners.
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Affiliation(s)
- Nicholas Tripodi
- First Year College, Victoria University, Melbourne, Australia
- Institute of Health and Sport, Victoria University, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne, Victoria University and Western Health, Melbourne, Australia
| | - Jack Feehan
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne, Victoria University and Western Health, Melbourne, Australia
- Department of Medicine, Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Rebecca Wospil
- First Year College, Victoria University, Melbourne, Australia
| | - Brett Vaughan
- Department of Medical Education, University of Melbourne, Melbourne, Australia
- School of Health and Human Sciences, Southern Cross University, Lismore, Australia
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20
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Johnson CE, Keating JL, Leech M, Congdon P, Kent F, Farlie MK, Molloy EK. Development of the Feedback Quality Instrument: a guide for health professional educators in fostering learner-centred discussions. BMC MEDICAL EDUCATION 2021; 21:382. [PMID: 34253221 PMCID: PMC8276464 DOI: 10.1186/s12909-021-02722-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/06/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Face-to-face feedback plays an important role in health professionals' workplace learning. The literature describes guiding principles regarding effective feedback but it is not clear how to enact these. We aimed to create a Feedback Quality Instrument (FQI), underpinned by a social constructivist perspective, to assist educators in collaborating with learners to support learner-centred feedback interactions. In earlier research, we developed a set of observable educator behaviours designed to promote beneficial learner outcomes, supported by published research and expert consensus. This research focused on analysing and refining this provisional instrument, to create the FQI ready-to-use. METHODS We collected videos of authentic face-to-face feedback discussions, involving educators (senior clinicians) and learners (clinicians or students), during routine clinical practice across a major metropolitan hospital network. Quantitative and qualitative analyses of the video data were used to refine the provisional instrument. Raters administered the provisional instrument to systematically analyse educators' feedback practice seen in the videos. This enabled usability testing and resulted in ratings data for psychometric analysis involving multifaceted Rasch model analysis and exploratory factor analysis. Parallel qualitative research of the video transcripts focused on two under-researched areas, psychological safety and evaluative judgement, to provide practical insights for item refinement. The provisional instrument was revised, using an iterative process, incorporating findings from usability testing, psychometric testing and parallel qualitative research and foundational research. RESULTS Thirty-six videos involved diverse health professionals across medicine, nursing and physiotherapy. Administering the provisional instrument generated 174 data sets. Following refinements, the FQI contained 25 items, clustered into five domains characterising core concepts underpinning quality feedback: set the scene, analyse performance, plan improvements, foster learner agency, and foster psychological safety. CONCLUSIONS The FQI describes practical, empirically-informed ways for educators to foster quality, learner-centred feedback discussions. The explicit descriptions offer guidance for educators and provide a foundation for the systematic analysis of the influence of specific educator behaviours on learner outcomes.
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Affiliation(s)
- Christina E Johnson
- Department of Medical Education, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
| | - Jennifer L Keating
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michelle Leech
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Monash Health, Melbourne, Victoria, Australia
| | - Peter Congdon
- Royal Australian and New Zealand College of Psychiatrists, Melbourne, Victoria, Australia
| | - Fiona Kent
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Melanie K Farlie
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Monash Health, Melbourne, Victoria, Australia
| | - Elizabeth K Molloy
- Department of Medical Education, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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21
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Noble C, Young J, Hourn E, Sheehan D. Becoming clinical supervisors: identity learnings from a registrar faculty development program. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:125-129. [PMID: 33369714 PMCID: PMC7952496 DOI: 10.1007/s40037-020-00642-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/10/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
This article shares our experiences and surprises as we developed, implemented and evaluated a 12-week faculty development program for registrars as clinical supervisors over three cohorts. The program has consistently been rated highly by participants. Yet, following a comprehensive curriculum review, we were surprised that our goal of encouraging identity development in clinical supervisors seemed to be unmet. Whilst our evaluation suggests that the program made important contributions to the registrars' knowledge, application and readiness as clinical supervisors, challenges linked to developing a supervisor identity and managing the dual identity of supervisor and clinician remain. In this article we describe our program and argue for the importance of designing faculty development programs to support professional identity formation. We present the findings from our program evaluation and discuss the surprising outcomes and ongoing challenges of developing a cohesive clinical educator identity. Informed by recent evidence and workplace learning theory we critically appraise our program, explain the mechanisms for the unintended outcomes and offer suggestions for improving curricular and pedagogic practices of embedded faculty development programs. A key recommendation is to not only consider identity formation of clinical supervisors from an individualist perspective but also from a social perspective.
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Affiliation(s)
- Christy Noble
- Faculty of Medicine and School of Pharmacy, The University of Queensland, Herston, Australia.
| | | | - Ellen Hourn
- Gold Coast Health, Southport, Australia
- School of Medicine, Griffith University, Southport, Australia
| | - Dale Sheehan
- The University of Canterbury, Canterbury, New Zealand
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Matthews A, Hall M, Parra JM, Hayes MM, Beltran CP, Ranchoff BL, Sullivan AM, William JH. Receiving Real-Time Clinical Feedback: A Workshop and OSTE Assessment for Medical Students. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:861-867. [PMID: 33209072 PMCID: PMC7669508 DOI: 10.2147/amep.s271623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Many programs designed to improve feedback to students focus on faculty's ability to provide a safe learning environment, and specific, actionable suggestions for improvement. Little attention has been paid to improving students' attitudes and skills in accepting and responding to feedback effectively. Effective "real-time" feedback in the clinical setting is dependent on both the skill of the teacher and the learner's ability to receive the feedback. Medical students entering their clinical clerkships are not formally trained in receiving feedback, despite the significant amount of feedback received during this time. METHODS We developed and implemented a one-hour workshop to teach medical students strategies for effectively receiving and responding to "real-time" (formative) feedback in the clinical environment. Subjective confidence and skill in receiving real-time feedback were assessed in pre- and post-workshop surveys. Objective performance of receiving feedback was evaluated before and after the workshop using a simulated feedback encounter designed to re-create common clinical and cognitive pitfalls for medical students, called an objective structured teaching exercise (OSTE). RESULTS After a single workshop, students self-reported increased confidence (mean 6.0 to 7.4 out of 10, P<0.01) and skill (mean 6.0 to 7.0 out of 10, P=0.10). Compared to pre-workshop OSTE scores, post-workshop OSTE scores objectively measuring skill in receiving feedback were also significantly higher (mean 28.8 to 34.5 out of 40, P=0.0131). CONCLUSION A one-hour workshop dedicated to strategies in receiving real-time feedback may improve effective feedback reception as well as self-perceived skill and confidence in receiving feedback. Providing strategies to trainees to improve their ability to effectively receive feedback may be a high-yield approach to both strengthen the power of feedback in the clinical environment and enrich the clinical experience of the medical student.
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Affiliation(s)
- Andrew Matthews
- Perelman School of Medicine, University of Pennsylvania Health Systems, Department of Medicine, Philadelphia, PA, USA
| | - Matthew Hall
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jose M Parra
- Carl J. Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Margaret M Hayes
- Harvard Medical School; Carl J. Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Christine P Beltran
- Carl J. Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Brittany L Ranchoff
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA, USA
| | - Amy M Sullivan
- Harvard Medical School; Carl J. Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jeffrey H William
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
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McGinness HT, Caldwell PHY, Gunasekera H, Scott KM. An educational intervention to increase student engagement in feedback. MEDICAL TEACHER 2020; 42:1289-1297. [PMID: 32805145 DOI: 10.1080/0142159x.2020.1804055] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The learner has a central role in feedback. We developed a feedback workshop for medical students grounded in two concepts: (1) Student agency in feedback and its interplay in the context of brief clinical attachments; (2) The educational alliance. AIMS To determine whether a brief feedback training workshop prior to a series of two-week clinical attachments improves agentic student feedback behaviour (e.g. seeking, recognising, evaluating and utilising feedback) and student satisfaction with feedback. METHODS We conducted surveys among three consecutive student cohorts undertaking three fortnightly paediatric clinical attachments. We pilot tested a workshop with Cohort 1 and implemented it for the entire Cohorts 2 (n = 58) and 3 (n = 68). Participants completed the same survey at the start and end of term, with different free-text items. Quantitative and qualitative responses were compared between groups. RESULTS Student-reported agentic feedback behaviour increased across all outcomes except for feedback utilisation. Overall student satisfaction with feedback increased during the term in Cohorts 2 (23-65%, p = 0.002) and 3 (40-70%, p = 0.003) but not in Cohort 1 non-participating students (27-42%, p = 0.42). CONCLUSIONS A brief one-off student-directed feedback workshop may improve agentic student feedback behaviours (e.g. feedback-seeking) and student satisfaction with feedback.
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Affiliation(s)
- Hannah T McGinness
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
- The Children's Hospital at Westmead, Sydney, Australia
| | - Patrina H Y Caldwell
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
- The Children's Hospital at Westmead, Sydney, Australia
| | - Hasantha Gunasekera
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
- The Children's Hospital at Westmead, Sydney, Australia
| | - Karen M Scott
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
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Johnson CE, Keating JL, Molloy EK. Psychological safety in feedback: What does it look like and how can educators work with learners to foster it? MEDICAL EDUCATION 2020; 54:559-570. [PMID: 32170881 DOI: 10.1111/medu.14154] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/17/2020] [Accepted: 03/10/2020] [Indexed: 06/10/2023]
Abstract
CONTEXT Feedback conversations play a central role in health professions workplace learning. However, learners face a dilemma: if they engage in productive learning behaviours (such as asking questions, raising difficulties, offering opinions or contesting ideas), they risk exposing their limitations or offending the educator. This highlights the importance of psychological safety in encouraging learners to candidly engage in interactive dialogue and the co-construction of knowledge. Previous research has recommended that building safety, trust or an educational alliance is key to productive feedback encounters. Yet it is unclear how to translate this into practice. Hence our research question was: What does psychological safety look like in workplace feedback and how can educators work with learners to foster it? METHODS We analysed 36 videos of routine formal feedback episodes in clinical practice involving diverse health professionals. A psychologically safe learning environment was inferred when learners progressively disclosed information and engaged in productive learning behaviours during the conversation. We used thematic analysis to identify associated educator strategies, which seemed to promote psychological safety. RESULTS Four themes were identified: (a) setting the scene for dialogue and candour; (b) educator as ally; (c) a continuing improvement orientation, and (d) encouraging interactive dialogue. Educators approaches captured within these themes, seemed to foster a psychologically safe environment by conveying a focus on learning, and demonstrating respect and support to learners. CONCLUSIONS This study builds on claims regarding the importance of psychological safety in feedback by clarifying what psychological safety in workplace feedback conversations might look like and identifying associated educator approaches. The results may offer educators practical ways they could work with learners to encourage candid dialogue focused on improving performance.
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Affiliation(s)
- Christina E Johnson
- Monash Doctors Education, Monash Health, Clayton, Victoria, Australia
- Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer L Keating
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Elizabeth K Molloy
- Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
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