Self-evaluation and peer-feedback of medical students' communication skills using a web-based video annotation system. Exploring content and specificity

Peer assessment in medical communication skills training in programmatic assessment: A qualitative study examining faculty and student perceptions

INTRODUCTION

Current literature recommends assessment of communication skills in medical education combining different settings and multiple observers. There is still a gap in understanding about whether and how peers assessment facilitates learning in communication skills training.

METHODS

We designed a qualitative study using focus group interviews and thematic analysis, in a medical course in the Netherlands. We aimed to explore medical students' and teachers' experiences, perceptions, and perspectives about challenges and facilitating factors in PACST (Peer assessment in medical communication skills training).

RESULTS

Most of the participants reported that peer feedback was a valuable experience when learning communication skills. The major challenges for the quality and credibility of PACST reported by the participants are the question whether peer feedback is critical enough for learning and the difficulty of actually engaging students in the assessment process.

CONCLUSION

Teachers reviewing students' peer assessments may improve the quality and their credibility and the reviewed assessments can best be used for learning purposes. We suggest to pay sufficient attention to teachers' roles in PACST, ensuring a safe and trustworthy environment and additionally helping students to internalize the value of being vulnerable during the evaluation process.

Training in medical communication competence through video-based e-learning: How effective are video modeling and video reflection?

OBJECTIVE

The present study investigated the efficacy of the didactic approaches of video modeling (VM, best-practice examples), video reflection (VR, problem-based approach), and the combination of both (VMR) in fostering medical communication competence in a video-based digital learning environment.

METHODS

N = 126 third-year medical students who participated in the pre-post study were assigned to either the intervention groups (VM, VR, and VMR) or the wait-list control group. The efficacy of the three approaches was assessed by means of a situational judgment test (SJT) of medical communication competence. To investigate the differences between the wait-list control and the intervention groups (H1), between the single-mode and combined conditions (H2), and between VM and VR (H3), we applied planned contrast analyses.

RESULTS

The planned contrasts showed that the VR condition significantly improved learning outcomes in comparison to the VM condition (H3). The decreased mean scores of the VM condition offset the increased mean scores of VR, and thus no significant differences could be found in H1 and H2.

CONCLUSIONS

Our study provides promising evidence that VR fosters medical communication competence more effectively than VM.

PRACTICAL IMPLICATIONS

Medical students' learning in video-based digital environments can be facilitated by the use of interactive VR.

Application of bilingual simulated patients in the medical history collection for international medical students in China

BACKGROUND

In all international medical student (IMS) programs in China, language barriers between IMSs and Chinese patients greatly reduced the learning in clinical practice and brought great challenges to IMSs in their transition from preclinical to clinical practice. This study aimed to investigate the role of bilingual simulated patients (B-SPs) in IMSs learning of medical history collection in China.

METHODS

48 IMSs of grade 4 between October 2020 to Jan 2021 were enrolled in this study. During the training of medical history collection, students were randomly arranged into two groups trained with either B-SPs (B-SP group) or English-speaking SP (E-SP group). All SPs in Objective Structured Clinical Exam station (OSCE) were trained in the Affiliated Hospital of Wuhan University. Clinical skills in medical history collection were assessed by instructors during pre-clinical, post-clinical OSCE and clinical rotations.

RESULTS

The scores of IMSs in each group were analyzed in terms of medical history collection including the ability to effectively consult for information and key communication skills related to patient care. Our results indicated that IMS in B-SP group obtained similar scores in preclinical training for history collection (67.3 ± 8.46 vs 67.69 ± 8.86, P < 0.05) compared to E-SP group, while obtaining significantly higher score improvements between pre- and post-OSCE (17.22 (95% CI 12.74 to 21.70) vs 10.84 (95% CI 3.53 to 18.15), P = 0.0007).

CONCLUSION

B-SPs are more conducive to doctor-patient communication and actually improve IMSs learning in medical history collection in China.

Effectiveness of a Mobile Technology-Supported Self-Reflective Course in Communication Behaviors for Outpatient Nurses

Background Communication is a core competency for outpatient nurses. This study investigated the effectiveness of a mobile technology-supported self-reflective (MTS) course in communication behaviors among outpatient nurses. Method This quasi-experimental study used a convenience sample of 78 outpatient nurses (experimental group = 39; control group = 39). The experimental group completed the MTS communication course. Communication behaviors were evaluated before, 1 week after, and 1 month after the course. Results There was no significant difference in communication behaviors between the groups before the intervention. One week after the intervention, communication behavior scores significantly increased in both groups without significant between-group differences (p > .05). One month after the intervention, the experimental group showed significantly higher communication behavior scores (p < .05). Both groups demonstrated high learning satisfaction. Conclusion The MTS communication course was successful in promoting effective outpatient nurse-patient communication. Health care facilities may want to incorporate the MTS course into their orientation program. [J Contin Educ Nurs. 2022;53(6):279-288.].

There's an app for that: Teaching residents to communicate diagnostic uncertainty through a mobile gaming application

BACKGROUND

Clear communication is integral to good clinical care; however, communication training is cost and time intensive. Mobile applications (apps) may provide a useful adjunct to traditional simulation skills training.

OBJECTIVE

To evaluate (1) use of an app for teaching communication skills about diagnostic uncertainty, (2) feedback on app use, and (3) the association between use and skill mastery.

PATIENT INVOLVEMENT

The app under study is designed to improve doctor-patient communication.

METHODS

The study was a planned sub-analysis of a randomized controlled waitlist trial with emergency medicine resident physicians randomized to receive immediate or delayed access to an educational curriculum focused on diagnostic uncertainty. The curriculum included a web-based interactive module and the app. Metrics describing participants' use of the app, feedback on use, and association of use and achieving mastery in communicating diagnostic uncertainty are reported. Differences between groups utilizing the app were analyzed using Chi-squared test; logistic regression assessed the association between app use and achieving mastery of the communication skill.

RESULTS

Among 109 participants completing the trial, only 34 (31.2%) used the app. Most participants engaged with the app on one occasion for a median of 50 min (IQR 31, 87). Senior residents were more likely to use the app than junior residents (41.3% vs 23.8%, p=0.05). Overall reviews were positive; 76% reported the app helped them learn. There was no significant association between app use and achieving mastery of the communication skill in the trial [OR 2.1, 95% CI (0.91-4.84)].

DISCUSSION

Despite positive reviews of app use, overall use was low and there was no association with achieving mastery.

PRACTICAL VALUE

Offering an app as an auxiliary training opportunity may be beneficial to some residents, but shouldn't be planned for use as a primary didactic modality unless there is evidence for effectiveness and use is mandated.

AVAILABILITY OF DATA AND MATERIALS

The datasets generated and/or analyzed during the current study are not publicly available since some data may be identifiable but are available from the corresponding author on reasonable request.

Can Distance Communication Skills Training Increase the Empathy Levels in Medical Students? An Application During the Pandemic Period

Background and Purpose: The aim is to determine the effect of the communication skills training (CST) using interactive synchronous and asynchronous methods, which was applied for the first time on medical students’ empathy levels. Methods: This study is a cross-sectional-analytical, self-controlled intervention. The distance CST program was applied to first-year medical students. The change in students’ empathy levels was measured with the student version of the Jefferson Empathy Scale. Results: 241 students’ forms were included. Empathy mean score increased significantly, this increase was higher in women. Conclusion: The distance CST produced a positive effect on empathy levels. While interactive PowerPoint® presentations, videos, movie clips, cartoons, real-life examples, written/audio question- answer activities, surveys, feedback and, small group work were used in live lessons; in the asynchronous process, student-based techniques (self-assessment, homework, WhatsApp® sharing) were used to support the online learning climate. We believe that all of them support the cognitive and social existence of students throughout the training. We propose our program as a model that can be used during situations where face-to-face education is not possible and to support face-to-face education in medical education.

A video- and feedback-based approach to teaching communication skills in undergraduate clinical dental education: The student perspective

OBJECTIVE

Student evaluation of a communication-education programme that combined patient consultation videos with peer- or expert-based feedback.

METHODS

A self-perception questionnaire was given to undergraduate dental students who had undertaken a curricular communication training and feedback programme, in which each participant was videoed three times during a patient interview or consultation, subsequently receiving either peer (PG) or expert feedback (EG). The questionnaire used feedback programme content to evaluate student perspectives, ascertaining whether the students experienced a gain in knowledge and professional conversational skills, whether videos or feedback helped them improve more and general questions about the structure and content of the curriculum. Differences between feedback groups were analysed (Mann-Whitney U test).

RESULTS

45 participants (peer group: n = 23, expert group: n = 22) took part in the study. The peer group experienced watching their video (38%) and receiving feedback (33%) as their major beneficial aspect to improve communication skills (watching fellow student´s video: 17%, providing feedback: 12%). The expert group experienced the major effect in receiving expert feedback (73%, video watching: 27%). The students said that communication skills should be a core competency in dental education learning outcomes (PG: 4.48 ± 0.67, EG: 4.41 ± 0.67; P > 0.05) and that communication curricula should include video-based feedback (PG: 3.91 ± 0.73, EG: 4.00 ± 0.93; P > 0.05).

CONCLUSION

Watching videos and both receiving and providing peer group feedback were experienced as helpful in improving students' communication skills. These findings suggest that a longitudinal communication curriculum, which includes both video-based peer feedback and correlated self-reflection, is a promising learning approach for dental education.

[Impact of training on Motivational Interviewing (MI) for Family Physicians: Design and assessment of a Training Program (MOTIVA)]

Objetivo

Desarrollar un programa de formación en Entrevista Motivacional (EM) para Médicos de Familia y evaluar el impacto.

Diseño

Ensayo clínico multicéntrico a doble ciego y aleatorizado, con 2 ramas (experimental (GE) y control (GC)) de Médicos de Familia, con un seguimiento de 12 meses.

Emplazamiento

32 Centros de Atención Primaria.

Descripción de la muestra

54 médicos (GC = 28, GE = 26).

Intervenciones

Programa de formación MOTIVA en EM con un curso presencial inicial (16 h), seguido de actividades en línea durante 12 meses y reuniones presenciales (entrevistas basadas en problemas con feedback de expertos).

Medidas principales

las habilidades comunicativas en EM se evaluaron en base a videograbaciones (VG) con la escala EVEM 2.0, por parejas de revisores. Se analizaron 236 VG con pacientes estandarizados y 96 VG con pacientes reales.

Resultados

Los resultados promedio en la escala EVEM (hasta 56 puntos) al inicio del estudio fueron GE = 21,27 (IC 95% 15,8-26,7) y GC = 20,23 (IC95% 16,4-23,9) sin diferencias entre ambos grupos (p = 0,79). Después del curso, la puntuación GE aumentó en 13,89 puntos (P <0,001), promedio 35,16 (IC 95% 29,8-40,6). Las VG de pacientes reales en GE durante el periodo de 12 meses mantiene sus habilidades en EM con un promedio de 36,9 puntos (IC 95% 30,3-43,6) versus GC 15,9 puntos (IC 95% 9,8-22,0). Una vez finalizado el Programa de Formación MOTIVA, el GE mantiene las habilidades adquiridas: GE promedio final = 37.6 (IC 95% 33.2-41.1) versus GC = 24,3 (IC95% 19,0-29,2) (p <0,001).

Conclusiones

El Programa de Formación MOTIVA mejora significativamente las habilidades de entrevista motivacional, mejorando después de un curso presencial y actividades secuenciales de mantenimiento. La eficacia del programa ha sido probada en el tercer y cuarto escalón de la Pirámide de Miller.

Using self and peer video annotations of simulated patient encounters in communication training to facilitate the reflection of communication skills: an implementation study

Background: The mandatory communication skills course for fourth-year medical students at the University of Bern Medical School aims to prepare students for challenging communication situations. Students role-play four different scenarios with simulated patients (SPs) and receive feedback from the patient's perspective. The scenarios are video-recorded and uploaded onto the University's virtual learning environment. Students can watch and annotate their own videos and give others access to view them. Project description: Although the course is well liked by students, we identified three areas for improvement: lack of faculty feedback; little active use of the video-recordings;lack of opportunity for students to discuss their experiences with each other. We aimed to address these shortcomings by introducing an additional learning task: students are asked to annotate a section of the video in which they had performed well, and one in which they thought they could have done better, in both their own and a colleague's videos. These video clips and annotations served as the basis of a subsequent two-hour small-group seminar with a physician tutor. The course was evaluated by a mandatory online questionnaire. Results: All 247 students completed the questionnaire. The annotation tool and task were deemed to be comprehensible. Students believed they had learnt more from annotating a peers' video than from their own and most thought being assessed by peers was acceptable. The physician tutors' comments were largely deemed as helpful. The mean mark for the course given by students was 4.6 (median 5) (1=very poor, 6=very good). Conclusion: A communication skills course expanded by video-annotations and group discussions with a physician tutor was shown to be feasible and was well received by students and faculty.

Communication skills of medical students: survey of self- and external perception in a longitudinally based trend study

BACKGROUND

As good communication skills are crucial for doctor-patient interactions, it is recommended to incorporate them in medical school programs from the very beginning. On this basis medical schools in Germany introduced the OSCE (objective structured clinical examination) to examine and by this foster learning of communication skills as assessment drives learning. The aim of the study was to examine the development of the communication skills of medical students during an OSCE to investigate how communication competence has developed between different student cohorts.

METHODS

This study is a longitudinal trend study based on seven semester-cohorts, examining the communication skills of medical students in the OSCE both from the perspective of students and from the viewpoint of standardized patients (SP). Altogether, 1027 students from seven semester cohorts were asked to rate their own communication skills (self-perception) before the OSCE exam started. Here, sub-analyses were performed to outline a potential influence of previous history-taking group participation. The SP evaluated the students' communication skills in external perception during the OSCE exam at each station with history-taking or physical examinations. The communication skills in both groups were ascertained in the dimensions of empathy, content structure, verbal expression, and non-verbal expression.

RESULTS

Only in the dimension of non-verbal expression could a statistically significant change be found in students' self-perception over the years. Notably, the rating of communication skills as self-rated by the students has risen constantly, whereas they deteriorated from the perspective of standardized patients (SP). It has also been found that previous history-taking courses have a positive influence on the structural dimension of communication skills in particular.

CONCLUSIONS

The results of this study support conclusions of other studies which also suggest differences between self- and external perception of medical students' communication skills. Nevertheless, students showed good overall communication skills in the four dimensions of empathy, content structure, verbal expression, and non-verbal expression, as demonstrated in a longitudinal trend study over seven semesters. However, we noted that externally rated empathy levels declined over the semester cohorts, suggesting the need for new priorities to be set in student teaching.

Developing a digital training tool to support oncologists in the skill of information-provision: a user centred approach

BACKGROUND

For patients with cancer, being well informed by their oncologist about treatment options and the implications thereof is highly relevant. Communication skills training (CST) programs have shown to be effective in improving clinicians' communication skills, yet CSTs are time-consuming, inconvenient to schedule, and costly. Online education enables new ways of accessible learning in a safe and personalised environment.

AIM AND METHODS

We describe the design of a digital CST-tool for information provision skills that meets oncologists' learning needs. We used the CeHRes Roadmap for user-centred design as a guiding framework. Phase 1 (Contextual Inquiry) involved consultation of the literature and a focus group interview study to uncover the learning needs and training preferences of clinicians' regarding a digital training for the skill of information-provision. In phase 2 (Value Specification), two multidisciplinary expert panels specified the learning content and format of a digital training. Phase 3 (Design) encompassed an iterative development process, including two user group assessment sessions and 5 individual user sessions in which prototypes were tested. All sessions were recorded and independently analyzed by two researchers.

RESULTS

Based on literature and consultation of the users in the inquiry phase of the development process, and on expert opinion in the value specification phase, relevant (sub) skills and user requirements were defined to consider for the digital training format. It was decided to develop a conventional e-learning and a chatbot. Personalization and interactivity were integrated in the prototypes by including features that allow for e.g., choosing text, video or animation; to upload video-recorded consultations to receive peer-feedback; and to consult a communication expert. Results revealed that, overall, participants expressed a willingness to use a digital training tool to acquire information-provision skills. Individual user testing (including junior clinicians), indicated a preference for the chatbot over the e-learning.

CONCLUSION

We offer a description of extensive development work which was conducted in collaboration with multiple health care professionals to iteratively develop two innovative prototypes of digital tools that would appropriately engage oncologists in learning effective information giving skills. The resulting prototypes were well appreciated and thus provide a solid basis for further development and testing.

Video-based feedback using real consultations for a formative assessment in communication skills

BACKGROUND

Pre-recorded videotapes have become the standard approach when teaching clinical communication skills (CCS). Furthermore, video-based feedback (VF) has proven to be beneficial in formative assessments. However, VF in CCS with the use of pre-recorded videos from real-life settings is less commonly studied than the use of simulated patients. To explore: 1) perceptions about the potential benefits and challenges in this kind of VF; 2) differences in the CCC scores in first-year medical residents in primary care, before and after a communication program using VF in a curricular formative assessment.

METHOD

We conducted a pre/post study with a control group. The intervention consisted of VF sessions regarding CCS, performed in a small group with peers and a facilitator. They reviewed clinical consultations pre-recorded in a primary care setting with real patients. Before and after the intervention, 54 medical residents performed two clinical examinations with simulated patients (SP), answered quantitative scales (Perception of Patient-Centeredness and Jefferson Empathy Scale), and semi-structured qualitative questionnaires. The performances were scored by SP (Perception of Patient-Centeredness and CARE scale) and by two blind raters (SPIKES protocol-based and CCOG-based scale). The quantitative data analysis employed repeated-measures ANOVA. The qualitative analysis used the Braun and Clarke framework for thematic analysis.

RESULTS

The quantitative analyses did not reveal any significant differences in the sum scores of the questionnaires, except for the Jefferson Empathy Scale. In the qualitative questionnaires, the main potential benefits that emerged from the thematic analysis of the VF method were self-perception, peer-feedback, patient-centered approach, and incorporation of reflective practices. A challenging aspect that emerged from facilitators was the struggle to relate the VF with theoretical references and the resident's initial stress to record and watch oneself on video.

CONCLUSION

VF taken from real-life settings seems to be associated with a significant increase in self-perceived empathy. The study of other quantitative outcomes related to this VF intervention needs larger sample sizes. VF with clinical patients from real healthcare settings appears to be an opportunity for a deeper level of self-assessment, peer-feedback, and reflective practices.

Pharmacy students' perceptions toward peer assessment and its use in teaching patient presentation skills

BACKGROUND AND PURPOSE

Conducting peer assessment has been associated with positive learning outcomes in higher education. The primary objective was to evaluate pharmacy students' perceptions of using peer assessment as a pedagogical strategy in learning patient presentation skills. Secondary objectives were to determine helpful factors for providing and/or receiving peer assessment and to compare students' perceptions of peer assessment relative to receiving feedback from teaching assistants (TAs).

EDUCATIONAL ACTIVITY AND SETTING

Patient presentation skills were taught to third-year pharmacy students in three sessions (session 1: didactic lecture, session 2: faculty-led patient presentation workshops followed by peer assessment, session 3: one-on-one patient presentations to TAs). An anonymous survey instrument consisting of five-point Likert scale, yes/no, and open-ended questions was administered.

FINDINGS

A total of 187 students (98%) completed the survey. Peer assessment was perceived as a useful way to obtain feedback on patient presentations (87%). It facilitated higher level thinking and a self-reflection of students' own patient presentations. Most students felt that they received constructive feedback from peers (82%) that helped them improve their patient presentation skills (72%). However, students were more trusting of TAs' skills in assessing patient presentations (76% versus 93%, p < 0.001). Some students were concerned about the specificity and criticalness of feedback they received from peers.

SUMMARY

Peer assessment is a useful pedagogical strategy for providing formative feedback to students in learning patient presentations skills in the classroom setting. Students may benefit from additional training to improve the quality of feedback in peer assessment.

A Bibliometric Analysis of the Health Field Regarding Social Networks and Young People

Social networks have historically been used to share information and support regarding health-related topics, and this usage has increased with the rise of online social media. Young people are high users of social media, both as passive listeners and as active contributors. This study aimed to map the trends in publications focused on social networks, health, and young people over the last 40 years. Scopus and the program VOSviewer were used to map the frequency of the publications, keywords, and clusters of researchers active in the field internationally. A structured keyword search using the Scopus database yielded 11,966 publications. The results reveal a long history of research on social networks, health, and young people. Research articles were the most common type of publication (68%), most of which described quantitative studies (82%). The main discipline represented in this literature was medicine, with 6062 documents. North American researchers dominate the field, both as authors and partners in international research collaborations. The present article adds to the literature by elucidating the growing importance of social networks in health research as a topic of study. This may help to inform future investments in public health research and surveillance using these novel data sources.

Video feedback and e-Learning enhances laboratory skills and engagement in medical laboratory science students

BACKGROUND

Traditionally, the training of medical laboratory science students has taken place in the laboratory and has been led by academic and pathology experts in a face-to-face context. In recent years, budgetary pressures, increasing student enrolments and limited access to laboratory equipment have resulted in reduced staff-student contact hours in medical laboratory science education. While this restructure in resources has been challenging, it has encouraged innovation in online blended learning.

METHODS

Blended learning histology lessons were implemented in a face-to-face and e-Learning format in a medical laboratory science program to teach tissue morphology and technical procedures outside of the traditional laboratory classroom. Participating students were randomly allocated to either the 'video' group (n = 14) or the 'control' group (n = 14). After all students attempted the e-Learning lessons and viewed expert-led video recordings online, students demonstrated their hands-on practical skills in the laboratory. Technical skills, demonstration of safety awareness, and use of histology equipment was captured by video through first person 'point of view' recordings for the 'video' group only. The 'control' group performed the same activities but were not recorded. Prior to summative assessment, the 'video' group students had a digital resource portfolio that enabled them to review their skills, receive captured feedback and retain a visual copy of their recorded procedure.

RESULTS

Results showed that students who participated in the online video format had statistically better practical examination scores and final grades compared to the control group.

CONCLUSION

Findings from this study suggest that students are engaged and motivated when being taught in a blended learning format and respond positively to the use of video recordings with expert feedback for the initial learning of hands-on techniques. For the academic, developing a blended learning medical laboratory science program, which includes annotated virtual microscopy, video demonstrations, and online interactive e-Learning activities, provides an effective and economic approach to learning and teaching.

Reliability of peer assessment of patient education simulations

BACKGROUND

At Belmont University College of Pharmacy, the final introductory pharmacy practice experience (IPPE) course in the IPPE series, IPPE V, is designed to assess readiness for advanced pharmacy practice experiences and includes three patient counseling simulations. These simulations have required greater resources. The objective of our study was to determine if student performance on patient counseling simulations can be accurately assessed by peers.

EDUCATIONAL ACTIVITY

Students were required to participate in patient counseling simulations throughout the semester. For each simulation, students were assigned one role: pharmacist, patient, or peer-evaluator. Each pharmacist counseled the patient on a specific product while the peer-evaluator assessed the accuracy and completeness of the counseling using a detailed checklist. The patient used a checklist to assess the pharmacist's communication skills. Faculty assessed the student evaluators and the patients by counting the number of discrepancies between the student evaluator's and the live faculty checklists. Students were surveyed at the end of the semester regarding their beliefs and perceptions of peer assessment for the communication simulations.

CRITICAL ANALYSIS OF THE EDUCATIONAL ACTIVITY

Of 65 students enrolled in the spring 2018 course, complete recordings and checklists were available for 54 simulations (83.1%). Interrater reliability was high with all correlation coefficients exceeding 0.86. Students agreed that they were comfortable assessing patient education content (82.14%) and communication skills (82.14%). Our results indicate that peer evaluation during patient education simulation is reliable and acceptable to students.

Face yourself! - learning progress and shame in different approaches of video feedback: a comparative study

BACKGROUND

Feedback is a crucial part of medical education and with on-going digitalisation, video feedback has been increasingly in use. Potentially shameful physician-patient-interactions might particularly benefit from it, allowing a meta-perspective view of ones own performance from a distance. We thus wanted to explore different approaches on how to deliver specifically video feedback by investigating the following hypotheses: 1. Is the physical presence of a person delivering the feedback more desired, and associated with improved learning outcomes compared to using a checklist? 2. Are different approaches of video feedback associated with different levels of shame in students with a simple checklist likely to be perceived as least and receiving feedback in front of a group of fellow students being perceived as most embarrassing?

METHODS

Second-year medical students had to manage a consultation with a simulated patient. Students received structured video feedback according to one randomly assigned approach: checklist (CL), group (G), student tutor (ST), or teacher (T). Shame (ESS, TOSCA, subjective rating) and effectiveness (subjective ratings, remembered feedback points) were measured. T-tests for dependent samples and ANOVAs were used for statistical analysis.

RESULTS

n = 64 students could be included. Video feedback was in hindsight rated significantly less shameful than before. Subjectively, there was no significant difference between the four approaches regarding effectiveness or the potential to arise shame. Objective learning success showed CL to be significantly less effective than the other approaches; additionally, T showed a trend towards being more effective than G or ST.

CONCLUSIONS

There was no superior approach as such. But CL could be shown to be less effective than G, ST and T. Feelings of shame were higher before watching one's video feedback than in hindsight. There was no significant difference regarding the different approaches. It does not seem to make any differences as to who is delivering the video feedback as long as it is a real person. This opens possibilities to adapt curricula to local standards, preferences, and resource limitations. Further studies should investigate, whether the present results can be reproduced when also assessing external evaluation and long-term effects.

Developing a digital communication training tool on information-provision in oncology: uncovering learning needs and training preferences

BACKGROUND

Adequate information-provision forms a crucial component of optimal cancer care. However, information-provision is particularly challenging in an oncology setting. It is therefore imperative to help oncological health care practitioners (HCP) optimise their information-giving skills. New forms of online education, i.e. e-learning, enable safe and time and location independent ways of learning, enhancing access to continuous learning for HCP. As part of a user-centred approach to developing an e-learning to improve information-giving skills, this study aims to: 1) uncover the learning needs of oncological healthcare providers related to information- provision, and 2) explore their training preferences in the context of clinical practice.

METHODS

Focus groups and interviews were organised with oncological HCP (medical specialists and clinical nurse specialists) addressing participants' learning needs concerning information- provision and their training preferences with respect to a new digital training tool on this issue. All sessions were audiorecorded and transcribed verbatim. Using an inductive approach, transcripts were independently coded by three researchers and discussed to reach consensus. Main themes were summarised and discussed.

RESULTS

Four focus group sessions (total n = 13) and three interviews were conducted. The first theme concerned the patient outcomes HCP try to achieve with their information. We found HCP to mainly strive to promote patients' understanding of information. The second theme concerned HCP reported strategies and challenges when trying to inform their patients. These entailed tailoring of information to patient characteristics, structuring of information, and dealing with patients' emotions. Regarding HCP training preferences, an e-learning should be neatly connected to clinical practice. Moreover, participants desired a digital training to allow for feedback on their own (videotaped) information-giving skills from peers, communication experts, and/or patients; to monitor their progress and to tailored the training to individual learning needs.

CONCLUSIONS

An e-learning for improvement of information-giving skills of oncological HCP should be aimed at the transfer of skills to clinical practice, rather than at enhancing knowledge. Moreover, an e-learning is probably most effective when the facilitates individual learning needs, supports feedback on competence level and improvement, and allows input from significant others (experts, peers, or patients).

The Feedback Tango: An Integrative Review and Analysis of the Content of the Teacher-Learner Feedback Exchange

PURPOSE

To conduct an integrative review and analysis of the literature on the content of feedback to learners in medical education.

METHOD

Following completion of a scoping review in 2016, the authors analyzed a subset of articles published through 2015 describing the analysis of feedback exchange content in various contexts: audiotapes, clinical examination, feedback cards, multisource feedback, videotapes, and written feedback. Two reviewers extracted data from these articles and identified common themes.

RESULTS

Of the 51 included articles, about half (49%) were published since 2011. Most involved medical students (43%) or residents (43%). A leniency bias was noted in many (37%), as there was frequently reluctance to provide constructive feedback. More than one-quarter (29%) indicated the feedback was low in quality (e.g., too general, limited amount, no action plans). Some (16%) indicated faculty dominated conversations, did not use feedback forms appropriately, or provided inadequate feedback, even after training. Multiple feedback tools were used, with some articles (14%) describing varying degrees of use, completion, or legibility. Some articles (14%) noted the impact of the gender of the feedback provider or learner.

CONCLUSIONS

The findings reveal that the exchange of feedback is troubled by low-quality feedback, leniency bias, faculty deficient in feedback competencies, challenges with multiple feedback tools, and gender impacts. Using the tango dance form as a metaphor for this dynamic partnership, the authors recommend ways to improve feedback for teachers and learners willing to partner with each other and engage in the complexities of the feedback exchange.

Inter-rater reliability of a reflective rubric to assess pharmacy students' reflective thinking

INTRODUCTION

Many health education programs aspire to foster reflective practices to enhance the reflective thinking of students during their study years and throughout their professional careers. Given the increasing attention paid to incorporating reflective practice activities into health education and evidence attributed to rater variability, it is important for educators to carefully consider the assessment criteria and reliability of assessment tools. A reflective rubric was developed to assess pharmacy students' levels of reflection from a reflective writing task. This study investigates the inter-rater reliability (IRR) of a rubric as a tool to assess the levels of reflective thinking apparent in students' written statements.

METHODS

The research involved four raters from different disciplines utilizing a rubric to assess a random sample of the same forty-three reflective statements from a cohort of two hundred and sixty-four students. The IRR was measured using the intra-class correlation coefficient (ICC), using a two-way random effects model (ANOVA) with absolute agreement, to determine reliability of the assessment tool among the raters.

RESULTS

Results showed measures between the raters for (i) overall reflective statement scores, and (ii) average scores for stages of reflection with an "almost perfect" agreement, ICC = 0.81 (95% CI 0.61-0.90), (F(42, 126) = 7.83, p < 0.01); and ICC = 0.89 (95% CI 0.83-0.93), (F(42, 840) = 12.49, p < 0.01) respectively.

DISCUSSION AND CONCLUSIONS

The proposed rubric utilized by four raters showed high agreement with each other's scores, and is a tool for academic assessment of pharmacy students' reflective thinking processes.

Monitoring communication with patients: analyzing judgments of satisfaction (JOS)

Medical students struggle to put into practice communication skills learned in medical school. In order to improve our instructional designs, better insight into the cause of this lack of transfer is foundational. We therefore explored students' cognitions by soliciting self-evaluations of their history-taking skills, coined 'judgments of satisfaction (JOSs)'. Our cognitive-psychological approach was guided by Koriat's cue-utilization framework (J Exp Psychol Gen 126:349-370. doi: 10.1037/0096-3445.126.4.349 , 1997) which rests on the assumption that internal and external cues inform learners' metacognitive judgments, which, in turn, steer their actions. Judgments based on unsuitable cues will cause ineffective behavior. Consequently, students are unable to adequately master these skills or properly apply them in similar situations. For the analysis, we had 524 medical undergraduates select scenes they were satisfied or dissatisfied with from their video-recorded simulated-patient encounters and explain why. Twenty transcripts were sampled for directed content analysis. We found that approximately one-third of students' judgments focused on content (JOS-type-a); about half on the quality of the communication skills (JOS-type-b); and about ten percent targeted the appropriateness of the skills harnessed (JOS-type-c). This lack of reflection on appropriateness may explain why students experience problems adapting to new situations. It was primarily high-performance students who formed type-c judgments; poor performers tended to give type-a and type-b judgments. Future research would benefit from the use of our modified version of Koriat's framework in order to further explore how high and poor performing medical students differ in the way they form JOSs during communications skills training.

The effect of video review of resident laparoscopic surgical skills measured by self- and external assessment

BACKGROUND

Video review of surgical skills is an educational modality that allows trainees to reflect on self-performance. The purpose of this study was to determine whether resident and attending assessments of a resident's laparoscopic performance differ and whether video review changes assessments.

METHODS

Third-year surgery residents were invited to participate. Elective laparoscopic procedures were video recorded. The Global Operative Assessment of Laparoscopic Skills evaluation was completed immediately after the procedure and again 7 to 10 days later by both resident and attending. Scores were compared using t tests.

RESULTS

Nine residents participated and 76 video reviews were completed. Residents scored themselves significantly lower than the faculty scores both before and after video review. Resident scores did not change significantly after video review.

CONCLUSIONS

Attending and resident self-assessment of laparoscopic skills differs and subsequent video review does not significantly affect Global Operative Assessment of Laparoscopic Skills scores. Further studies should evaluate the impact of video review combined with verbal feedback on skill acquisition and assessment.