Third year medical students impersonalize and hedge when providing negative upward feedback to clinical faculty

When students' words hurt: 12 tips for helping faculty receive and respond constructively to student evaluations of teaching

Student evaluations of curricular experiences and instructors are employed by institutions to obtain feedback and guide improvement. However, to be effective, evaluations must prompt faculty action. Unfortunately, evaluative comments that engender strong reactions may undermine the process by hindering innovation and improvement steps. The literature suggests that faculty interpret evaluation feedback as a judgment not just on their teaching ability but on their personal and professional identity. In this context, critical evaluations, even when constructively worded, can result in disappointment, hurt, and shame. The COVID pandemic has challenged institutions and faculty to repeatedly adapt curricula and educational practices, heightening concerns for faculty burnout. In this context, the risk of 'words that hurt' is higher than ever. This article offers guidance for faculty and institutions to support effective responses to critical feedback and ameliorate counterproductive effects of learner evaluations.

Upward Feedback: Exploring Learner Perspectives on Giving Feedback to their Teachers

Introduction

Feedback from learners is known to be an important motivator for medical teachers, but it can be de-motivating if delivered poorly, leaving teachers frustrated and uncertain. Research has identified challenges learners face in providing upward feedback, but has not explored how challenges influence learners' goals and approaches to giving feedback. This study explored learner perspectives on providing feedback to teachers to advance understanding of how to optimize upward feedback quality.

Methods

We conducted semi-structured interviews with 16 learners from the MD program at the University of British Columbia. Applying an interpretive description methodology, interviews continued until data sufficiency was achieved. Iterative analysis accounted for general trends across seniority, site of training, age and gender as well as individual variations.

Findings

Learners articulated well-intentioned goals in relation to upward feedback (e.g., to encourage effective teaching practices). However, conflicting priorities such as protecting one's image created tensions leading to feedback that was discordant with teaching quality. Several factors, including the number of feedback requests learners face and whether learners think their feedback is meaningful mediated the extent to which upward feedback goals or competing goals were enacted.

Discussion

Our findings offer a nuanced understanding of the complexities that influence learners' approaches to upward feedback when challenges arise. In particular, goal conflicts make it difficult for learners to contribute to teacher support through upward feedback. Efforts to encourage the quality of upward feedback should begin with reducing competition between goals by addressing factors that mediate goal prioritization.

Thinking about social power and hierarchy in medical education

CONTEXT

Social power has been diversely conceptualised in many academic areas. Operating on both the micro (interactional) and macro (structural) levels, we understand power to shape behaviour and knowledge through both repression and production. Hierarchies are one organising form of power, stratifying individuals or groups based on the possession of valued social resources.

DISCUSSION

Medicine is a highly organised social context where work and learning are contingent on interaction and thereby influenced greatly by social power and hierarchy. Despite the relevance of power to education research, there are many unrealized opportunities to use this construct to expand our understanding of how physicians work and learn. Hierarchy, when considered in our field, is typically gestured to as an omnipresent feature of the clinical environment that harms low-status individuals by repressing their ability to communicate openly and exercise their agency. This may be true in many circumstances, but this conceptualization of hierarchy neglects consideration of other aspects of hierarchy that may be generative for understanding the experiences of medical learners. For example, medical learners may experience the superimposition of multiple hierarchies, some of which are fluid and some of which are calcified, some of which are productive and helpful and some of which are oppressive and harmful. Power may work 'up' and 'across' hierarchical ranks, rather than just from higher status to lower status individuals.

CONCLUSION

The conceptualizations of how social power shapes human behaviour are diverse. Often paired with hierarchy, or social arrangement, these social scientific ideas have much to offer our collective study of the ways that health professionals learn and practice. Accordingly, we posit that a consideration of the ways social power works through hierarchies to nurture or harm the growth of learners should be granted explicit consideration in the framing and conduct of medical education research.

User Experience of Training Pediatric Students on Interactive Simulator During COVID-19 Pandemic

BACKGROUND

COVID-19 pandemic is a reason to revise traditional approaches to medical education. The disadvantage of online education is inability to train practical skills.

PURPOSE

To evaluate the effectiveness of training students on an interactive pediatric simulator during distance learning.

PATIENTS AND METHODS

An online survey was conducted during quarantine COVID-19 to clear out the attitude to distance learning of third-year students of the Sechenov First Moscow State Medical University (n = 150). During training the level of students' motivation to learn decreased, and what is most important their practical skills deteriorated. Eighty-four out of 150 students had the effectiveness of their training on the multimedia simulator "Filatov. Pediatrics" analyzed.

RESULTS

The simulator reproduces clinical tasks using three-dimensional models of children of different ages and genders and has access to personal computers of students. The cases include imitation of a dialogue with a virtual patient, methods of physical examination, the appointment of laboratory and instrumental methods of research, treatment. The use of a pediatric simulator showed greater efficiency in mastering practical skills compared to a group of students who did not use the simulator in class. Summing up the results of the intermediate objective structured clinical exam (OSCE) on physical examination on dummies of the Simulation and Accreditation Center showed better results in the main group (n = 48) compared to the control (n = 36). The students who additionally studied on the simulator completed the tasks on the checklist on a cardiology dummy by 98.3 ± 1.5%. In the control group, the percentage of completed tasks was 94.3 ± 1.3 (p = 0.05). The OSCE for examining the respiratory system on an auscultative dummy revealed 97.3 ± 1.5 and 93.1 ± 1.4%, respectively (p = 0.05).

CONCLUSION

The interactive pediatric simulator is a tool for mastering practical skills of medical students during the COVID-19 pandemic, with the use of which the OSCE results are significantly higher.

An online discussion between students and teachers: a way forward for meaningful teacher feedback?

BACKGROUND

Student evaluation is an essential component in feedback processes in faculty and learner development. Ease of use and low cost have made paper evaluation forms a popular method within teaching programmes, but they are often seen as a formality, offering variable value towards the improvement of teaching. Students report poor motivation to engage with existing feedback tools whilst teachers describe receiving vague, contradicting, or irrelevant information. We believe that feedback for teachers needs to be a two-way process, similar to feedback for students, for it to be effective. An online feedback tool has been implemented for third-year medical students from Imperial College London to promote open discussion between teachers and students. The feedback tool is accessible throughout students' clinical attachment with the option of maintaining anonymity. We aim to explore the benefits and challenges of this online feedback tool and assess its value as a method for teacher feedback.

METHODS

Qualitative data was obtained from both volunteer third-year medical students of Imperial College London and Clinical Teaching Fellows using three focus groups and a questionnaire. Data was analysed through iterative coding and thematic analysis to provide over-arching analytical themes.

RESULTS

Twenty-nine students trialled this feedback tool with 17 responding to the evaluative questionnaire. Four over-arching themes were identified: reasons for poor participation with traditional feedback tools; student motivators to engage with 'open feedback'; evaluative benefits from open feedback; concerns and barriers with open feedback.

CONCLUSION

This feedback tool provides a platform for two-way feedback by encouraging open, transparent discussion between teachers and learners. It gives a unique insight into both teachers and peers' perspectives. Students engage better when their responses are acknowledged by the teachers. We elaborate on the benefits and challenges of public open feedback and approaches to consider in addressing the self-censorship of critical comments.