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Elnasseh A, Mehta VS, Manolova G, Pedersen GA, Golden S, Eloul L, Gebrekristos F, Collins PY, Mutavi T, Mbwayo AW, Mathai M, Concepcion T, El Masri R, Steen F, Galea JT, Contreras C, Akellot J, Kasujja R, Wasereka S, Mutamba BB, Tol WA, Raji M, Moufarrej S, Schafer A, Kohrt BA. Perspectives on competency-based feedback for training non-specialists to deliver psychological interventions: multi-site qualitative study of the EQUIP competency-based approach. BJPsych Open 2024; 10:e125. [PMID: 38826043 DOI: 10.1192/bjo.2024.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND The use of feedback to address gaps and reinforce skills is a key component of successful competency-based mental health and psychosocial support intervention training approaches. Competency-based feedback during training and supervision for personnel delivering psychological interventions is vital for safe and effective care. AIMS For non-specialists trained in low-resource settings, there is a lack of standardised feedback systems. This study explores perspectives on competency-based feedback, using structured role-plays that are featured on the Ensuring Quality in Psychosocial and Mental Health Care (EQUIP) platform developed by the World Health Organization and United Nations Children's Fund. METHOD Qualitative data were collected from supervisors, trainers and trainees from multiple EQUIP training sites (Ethiopia, Kenya, Lebanon, Peru and Uganda), from 18 key informant interviews and five focus group discussions (N = 41 participants). Qualitative analysis was conducted in Dedoose, using a codebook with deductively and inductively developed themes. RESULTS Four main themes demonstrated how a competency-based structure enhanced the feedback process: (a) competency-based feedback was personalised and goal-specific, (b) competency-based feedback supported a feedback loop, (c) competency-based feedback supported a comfortable and objective feedback environment, and (d) competency-based feedback created greater opportunities for flexibility in training and supervision. CONCLUSIONS A better understanding of the role of feedback supports the implementation of competency-based training that is systematic and effective for trainers and supervisors, which ultimately benefits the learning process for trainees.
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Affiliation(s)
- Abdelrhman Elnasseh
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Health, The George Washington School of Medicine and Health Sciences, USA
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, USA
| | - Varun S Mehta
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Health, The George Washington School of Medicine and Health Sciences, USA
| | | | - Gloria A Pedersen
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Health, The George Washington School of Medicine and Health Sciences, USA
| | - Shannon Golden
- The Center for Victims of Torture, Addis Ababa, Ethiopia
| | - Liyam Eloul
- The Center for Victims of Torture, Addis Ababa, Ethiopia
| | | | - Pamela Y Collins
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, USA
| | - Teresia Mutavi
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, Kenya
| | - Anne W Mbwayo
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, Kenya
| | - Muthoni Mathai
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, Kenya
| | | | - Rozane El Masri
- Research and Development Department, War Child, Beirut, Lebanon
| | - Frederik Steen
- Research and Development Department, War Child, Amsterdam, The Netherlands
| | | | | | | | - Rosco Kasujja
- Department of Mental Health, Makerere University, Uganda
| | | | | | - Wietse A Tol
- Section of Global Health, Department of Public Health, University of Copenhagen, Denmark
| | - Mansurat Raji
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Health, The George Washington School of Medicine and Health Sciences, USA
| | - Sacha Moufarrej
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Health, The George Washington School of Medicine and Health Sciences, USA
| | - Alison Schafer
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Brandon A Kohrt
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Health, The George Washington School of Medicine and Health Sciences, USA
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, USA
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Murry LT, Boyer JG, Catledge K, Gettig JP, Travlos DV, Zarembski D, Kiersma ME. The Intersection of Growth Mindset and Accreditation in Pharmacy Education. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100711. [PMID: 38723896 DOI: 10.1016/j.ajpe.2024.100711] [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: 09/19/2023] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES To describe existing growth mindset literature within pharmacy and health care education, describe how a growth mindset can be beneficial in the accreditation process, and propose potential ways to promote a growth mindset in faculty, preceptors, students, and staff within pharmacy education. FINDINGS To help pharmacy learners develop a growth mindset, existing literature emphasizes the need for a shift toward and aligning assessment with a growth mindset, helping to create self-directed adaptive learners, leading to health care providers who can adjust their practice to tackle expected and unexpected challenges throughout their careers. Strategies to create a culture of growth mindset identified include training faculty and learners on growth mindset and developing new assessments that track a learner's growth. Recommendations for pharmacy educators include encouraging educators to assess their own growth mindset and use a variety of teaching methods and provide feedback on learner effort that encourages the process of learning rather than focusing on individual attributes, traits, and results. SUMMARY Growth mindset intersects with accreditation standards for both professional degree programs and providers of continuing pharmacy education. Continuing professional development process is one way to encourage faculty, staff, and students to develop a growth mindset. While a growth mindset can have many positive impacts on pharmacy accreditation, it is essential to recognize that achieving and maintaining accreditation is a multifaceted process involving numerous factors. A growth mindset can positively influence pharmacy education accreditation by fostering a culture of continuous improvement, innovation, resilience, student-centeredness, data-driven decision-making, collaboration, and effective leadership.
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Affiliation(s)
- Logan T Murry
- Accreditation Council for Pharmacy Education, Chicago, IL, USA
| | - J Gregory Boyer
- Accreditation Council for Pharmacy Education, Chicago, IL, USA
| | | | - Jacob P Gettig
- Accreditation Council for Pharmacy Education, Chicago, IL, USA
| | | | - Dawn Zarembski
- Accreditation Council for Pharmacy Education, Chicago, IL, USA
| | - Mary E Kiersma
- Accreditation Council for Pharmacy Education, Chicago, IL, USA.
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Sims DA, Lucio-Ramirez CA, Cilliers FJ. Factors influencing clinician-educators' assessment practice in varied Southern contexts: a health behaviour theory perspective. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024:10.1007/s10459-024-10341-3. [PMID: 38811446 DOI: 10.1007/s10459-024-10341-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 05/12/2024] [Indexed: 05/31/2024]
Abstract
In many contexts, responsibility for exit-level assessment design and implementation in undergraduate medical programmes lies with individuals who convene clinical clerkships. Their assessment practice has significant consequences for students' learning and the patients and communities that graduates will serve. Interventions to enhance assessment must involve these assessors, yet little is known about factors influencing their assessment practice. The purpose of this study was to explore factors that influence assessment practice of clerkship convenors in three varied low-and-middle income contexts in the global South. Taking assessment practice as a behaviour, Health Behaviour Theory (HBT) was deployed as a theoretical framework to explore, describe and explain assessor behaviour. Thirty-one clinician-educators responsible for designing and implementing high-stakes clerkship assessment were interviewed in South Africa and Mexico. Interacting personal and contextual factors influencing clinician-educator assessment intention and action were identified. These included attitude, influenced by impact and response appraisal, and perceived self-efficacy; along with interpersonal, physical and organisational, and distal contextual factors. Personal competencies and conducive environments supported intention to action transition. While previous research has typically explored factors in isolation, the HBT framing enabled a systematic and coherent account of assessor behaviour. These findings add a particular contextual perspective to understanding assessment practice, yet also resonate with and extend existing work that predominantly emanates from high-income contexts in the global North. These findings provide a foundation for the planning of assessment change initiatives, such as targeted, multi-factorial faculty development.
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Affiliation(s)
- Danica Anne Sims
- University of Oxford, Oxford, UK.
- University of Johannesburg, Johannesburg, South Africa.
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Sanchayan S, Olupeliyawa A, Chandratilake M. Feedback practices in undergraduate clinical teaching in Sri Lanka - a qualitative study. BMC MEDICAL EDUCATION 2024; 24:559. [PMID: 38778350 PMCID: PMC11112894 DOI: 10.1186/s12909-024-05556-2] [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: 12/12/2023] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Feedback is integral to medical education, enabling students to improve their knowledge, skills, and attitudes. Feedback practices may vary according to prevalent cultural and contextual factors. This study aimed to explore how feedback is conceptualized and practised in the clinical education of medical students in Sri Lanka. METHODS The study was conducted in three medical schools and affiliated hospitals that represent the cultural diversity of Sri Lanka. Purposive sampling was utilized to recruit clinical teachers and students who would provide rich information for the study. The study had three components: an observation study, interviews with clinical teachers and focus group discussions with clinical students. During the observation study, video recording was used as a data collection tool to observe feedback in real-life clinical teaching/learning settings. A constructivist grounded theory approach was adapted for analysis to explore current practices and perceptions inductively. RESULTS Feedback was conceptualised as spontaneous unidirectional provision of information for the improvement of students. It was often provided in public settings and in student groups. Error correction was the primary focus of feedback, but both teachers and students desired a balanced approach with reinforcement and reflection. Although the direct approach to corrective feedback was found beneficial for student learning, participants agreed that harsh feedback was to be avoided. The hierarchical culture and lack of programmed feedback in the curricula influenced feedback practices, suggesting the need for modification. CONCLUSIONS This study highlighted feedback practices in the local context, emphasizing the need to address the hierarchical gap in clinical settings, balance reinforcement and correction, and promote dialogue and reflection in the feedback processes. The findings will help clinical teachers from both the global south as well as the global north to recognize cultural and contextual differences in providing feedback.
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Affiliation(s)
- Sivapalan Sanchayan
- Medical Education Unit, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka.
| | - Asela Olupeliyawa
- Department of Medical Education, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Madawa Chandratilake
- Department of Medical Education, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Hrdy M, Tarver EM, Lei C, Moss HC, Wong AH, Moadel T, Beattie LK, Lamberta M, Cohen SB, Cassara M, Hughes MD, De Castro A, Sahi N, Chen TH. Applying simulation learning theory to identify instructional strategies for Generation Z emergency medicine residency education. AEM EDUCATION AND TRAINING 2024; 8:S56-S69. [PMID: 38774828 PMCID: PMC11102949 DOI: 10.1002/aet2.10981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 03/13/2024] [Accepted: 03/25/2024] [Indexed: 05/24/2024]
Abstract
Introduction Generation Z learners are entering emergency medicine (EM) residency training, bringing unique learning preferences that influence their engagement with residency education. To optimally teach and motivate this incoming generation of learners, EM educators must understand and adapt to the changing instructional landscape. Methodology The Simulation Leaders Advancing the Next Generation in Emergency Medicine (SLANG-EM) Workgroup was created to identify effective educational strategies for Generation Z learners entering EM. Members were faculty in the Society for Academic Emergency Medicine (SAEM) Simulation Academy, well versed in learning theory supporting simulation-based education (SBE) and actively involved in EM residency education. Unique treatment/analysis Through primary and secondary literature searches, the SLANG-EM Workgroup identified four distinctive learning preferences of Generation Z learners: (1) individualized and self-paced learning, (2) engaging and visual learning environments, (3) immediate and actionable feedback, and (4) combined personal and academic support. Workgroup members evaluated these learning preferences using a novel conceptual framework informed by the theoretical principles underpinning SBE, recommending instructional strategies for Generation Z EM residency learners across multiple educational environments. Implications for educators Instructional strategies were described for the didactic, simulation, and clinical learning environments. In the didactic environment, identified instructional strategies included meaningful asynchronous education, interactive small-group learning, and improved multimedia design. In the simulation environment, educational innovations particularly suitable for Generation Z learners included learner-centered debriefing, rapid-cycle deliberate practice, and virtual simulation. In the clinical environment, described instructional strategies involved setting learner-centered goals and delivering facilitative feedback in the context of an educational alliance. Overall, these instructional strategies were clustered around themes of student-centered education and the educator as facilitator, which align well with Generation Z learning preferences. These findings were synthesized and presented as an advanced workshop, "Delivering Effective Education to the Next Generation," at the 2023 SAEM Annual Meeting.
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Affiliation(s)
- Michael Hrdy
- University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- The Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Emily M. Tarver
- University of Mississippi Medical CenterJacksonMississippiUSA
| | - Charles Lei
- Hennepin County Medical CenterMinneapolisMinnesotaUSA
| | | | | | - Tiffany Moadel
- Donald and Barbara Zucker School of Medicine at Hofstra NorthwellHempsteadNew YorkUSA
| | - Lars K. Beattie
- University of Florida College of MedicineGainesvilleFloridaUSA
| | | | | | - Michael Cassara
- Donald and Barbara Zucker School of Medicine at Hofstra NorthwellHempsteadNew YorkUSA
- Northwell Health Center for Learning and InnovationLake SuccessNew YorkUSA
| | | | - Aga De Castro
- University of Connecticut School of MedicineFarmingtonConnecticutUSA
- Hartford HospitalHartfordConnecticutUSA
| | - Nidhi Sahi
- University of TorontoTorontoOntarioCanada
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Thompson CM, Kerr AM. Identity influences on medical students' orientation to feedback during third year clinical rotations. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:477-486. [PMID: 37436526 DOI: 10.1007/s10459-023-10264-5] [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: 09/21/2022] [Accepted: 06/18/2023] [Indexed: 07/13/2023]
Abstract
Medical students' feedback orientation (their attitudes about and preferences for feedback from preceptors) may change over the course of the third year of medical school and is likely influenced by identity-related factors. This study proposed that both how students view themselves personally (i.e., impostor syndrome) and how they view themselves in relation to the group (i.e., identification with the profession) are identity factors related to related to feedback orientation during clinical rotations. 177 third-year medical students enrolled in a four-phase longitudinal survey study beginning at the start of clinical rotations and continuing every twelve weeks of the academic year thereafter. Feedback orientation was conceptualized and measured as comprising aspects of utility (i.e., feedback is valuable and useful), sensitivity (i.e., feeling intimidated or threatened by corrective feedback), confidentiality (i.e., public/private context of feedback), and retention (i.e., feedback remembered). Results indicated that these aspects of feedback orientation did not significantly change during the third year. Instead, impostor syndrome was at least marginally, significantly associated with all aspects of feedback orientation across phases. Group identity was associated with feedback utility and retention, and female-identifying students reported significantly greater feedback confidentiality and feedback retention. Interventions may be needed to improve medical students' attitudes about feedback, particularly for those who experience impostor syndrome. Fostering group cohesion among medical students may influence how well students remember feedback and find it useful.
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Affiliation(s)
- Charee M Thompson
- Department of Communication, College of Liberal Arts & Sciences, University of Illinois at Urbana-Champaign, 702 S. Wright Street, Urbana, IL, 61801, USA.
| | - Anna M Kerr
- Department of Primary Care Heritage College of Osteopathic Medicine, Ohio University, 252 Medical Education Building 2, Dublin, OH, 43016, USA.
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Memari M, Gavinski K, Norman MK. Beware False Growth Mindset: Building Growth Mindset in Medical Education Is Essential but Complicated. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:261-265. [PMID: 37643577 DOI: 10.1097/acm.0000000000005448] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
ABSTRACT Mindset theory aims to explain how learners' beliefs about intelligence and learning affect how they perceive effort, react to failure, and respond to feedback in challenging learning contexts. Mindset theory distinguishes between growth mindset (the belief that human capacities can be developed over time) and fixed mindset (the belief that human capacities are inherent and unchangeable). Efforts to develop growth mindset in learners have shown a wide range of benefits, including positive effects on students' resilience, commitment to lifelong learning, and persistence in a field of study, with notable impacts on learners who are struggling, learners from minoritized groups, and women in scientific fields. In recent years, mindset theory interventions have caught the interest of medical educators hoping to engage learners as partners in their own learning and progression to competence. Educators hoping to apply this theory to educational programs and learner-teacher interactions in ways that promote growth mindsets would benefit from awareness of the concept of false growth mindset , a term coined by Carol Dweck to refer to common pitfalls in the theory's application. In this article, the authors highlight important findings from mindset interventions in medical education, identify common pitfalls of false growth mindset in the context of medical learners, and offer suggestions for how educators and institutions can better instigate changes to promote growth mindsets within medical education.
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Phatak UP, Encandela J, Green M, Slade M, Osborn R, Weiss P. Feedback Culture Perceived by Trainees in an Academic Institution: A Mixed Methods Study. Hosp Pediatr 2023; 13:984-991. [PMID: 37791431 DOI: 10.1542/hpeds.2022-007004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVES Lack of a well-functioning institutional feedback culture can undermine acquisition of skills essential for high quality patient care. The objective of this study was to assess feedback culture perceived by resident and fellow trainees, utilizing a mixed methods design. METHODS Pediatric fellows and residents completed an anonymous feedback environment survey consisting of 7 constructs: source credibility, feedback quality, feedback delivery, reinforcing feedback, constructive feedback, source availability, and promotion of feedback seeking, using a 7-point Likert scale. Trainee ratings were compared using two-sided Fisher's exact tests. Multivariable analyses used a linear regression model. For the qualitative study, semistructured interviews of residents were conducted. The constant comparative method was used to incrementally code, categorize data, and derive themes. RESULTS Fifty-two residents and 21 fellows completed the survey (response rates 65% and 47%, respectively). Scores were more favorable for fellows compared with residents in 6 of 7 feedback constructs (P < .05), including on multivariate analysis. Hispanic ethnicity and female gender were associated with lower scores on source credibility (P = .04) and constructive feedback (P = .03), respectively. Two qualitative themes were identified: expectation of efficiency in patient care compromises the quality and quantity of feedback, and a culture that prioritizes courtesy over candor negatively impacts feedback quality. These themes were more pronounced when residents worked with pediatric subspecialists compared with hospitalists. CONCLUSIONS We described the feedback culture, which was less favorable in the residency program. The need for efficient patient care and a culture of courtesy adversely impacted the quality of feedback, especially among subspecialists.
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Affiliation(s)
- Uma Padhye Phatak
- Yale School of Medicine
- Department of Pediatrics
- Pediatric Gastroenterology, Hepatology and Nutrition
| | - John Encandela
- Yale School of Medicine
- Yale Teaching and Learning Center, School of Medicine, Yale University, New Haven, Connecticut
| | - Michael Green
- Yale School of Medicine
- Yale Teaching and Learning Center, School of Medicine, Yale University, New Haven, Connecticut
- Divisions of General Medicine, Department of Internal Medicine
| | - Martin Slade
- Yale School of Medicine
- Yale Teaching and Learning Center, School of Medicine, Yale University, New Haven, Connecticut
| | - Rachel Osborn
- Yale School of Medicine
- Department of Pediatrics
- Hospital Medicine
| | - Pnina Weiss
- Yale School of Medicine
- Department of Pediatrics
- Pulmonology, Allergy, Immunology, and Sleep Medicine
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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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Berger S, Stalmeijer RE, Marty AP, Berendonk C. Exploring the Impact of Entrustable Professional Activities on Feedback Culture: A Qualitative Study of Anesthesiology Residents and Attendings. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:836-843. [PMID: 36812061 DOI: 10.1097/acm.0000000000005188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE Entrustable professional activities (EPAs) were introduced as a potential way to optimize workplace-based assessments. Yet, recent studies suggest that EPAs have not yet overcome all of the challenges to implementing meaningful feedback. The aim of this study was to explore the extent to which the introduction of EPAs via mobile app impacts feedback culture as experienced by anesthesiology residents and attending physicians. METHOD Using a constructivist grounded theory approach, the authors interviewed a purposive and theoretical sample of residents (n = 11) and attendings (n = 11) at the Institute of Anaesthesiology, University Hospital of Zurich, where EPAs had recently been implemented. Interviews took place between February and December 2021. Data collection and analysis were conducted iteratively. The authors used open, axial, and selective coding to gain knowledge and understanding on the interplay of EPAs and feedback culture. RESULTS Participants reflected on a number of changes in their day-to-day experience of feedback culture with the implementation of EPAs. Three main mechanisms were instrumental in this process: lowering the feedback threshold, change in feedback focus, and gamification. Participants felt a lower threshold to feedback seeking and giving and that the frequency of feedback conversations increased and tended to be more focused on a specific topic and shorter, while feedback content tended to focus more on technical skills and more attention was given to average performances. Residents indicated that the app-based approach fostered a game-like motivation to "climb levels," while attendings did not perceive a game-like experience. CONCLUSIONS EPAs may offer a solution to problems of infrequent occurrence of feedback and invite attention to average performances and technical competencies, but may come at the expense of feedback on nontechnical skills. This study suggests that feedback culture and feedback instruments have a mutually interacting influence on each other.
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Affiliation(s)
- Sabine Berger
- S. Berger is a third-year medical resident, Internal Medicine Training Program, St. Claraspital, Basel, Switzerland
| | - Renee E Stalmeijer
- R.E. Stalmeijer is associate professor, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Adrian P Marty
- A.P. Marty is currently senior attending physician and team lead for education, Institute of Anaesthesiology, Intensive Care and Pain Medicine, Orthopedic University Hospital Balgrist, Zurich, Switzerland. At the time of writing, he was attending physician, Institute of Anaesthesiology, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Christoph Berendonk
- C. Berendonk is senior lecturer in medical education, Institute for Medical Education, University of Bern, Bern, Switzerland
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Mills LM, O'Sullivan PS, Ten Cate O, Boscardin C. Investigating feedback orientation in medical learners. MEDICAL TEACHER 2023; 45:492-498. [PMID: 36306388 DOI: 10.1080/0142159x.2022.2138741] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND/PURPOSE Feedback processes in health professions education (HPE) are not always successful. While recommendations to improve feedback provision dominate the literature, studying specific learner attributes that impact feedback uptake may also improve feedback processes. Feedback orientation is a concept from management science involving four dimensions of learner attributes and attitudes that impact their feedback uptake: utility, accountability, social awareness, and feedback self-efficacy. Feedback orientation may represent a valuable concept in HPE. We aimed to understand medical learners' feedback orientation at different stages in their development. METHODS We used the Feedback Orientation Scale, a 20-item survey instrument, for a cross-sectional analysis of feedback orientation in medical students and Internal Medicine residents at one large academic center. We performed descriptive statistics and analysis of variance for data analysis. RESULTS We found the same factors (dimensions) to feedback orientation in our population as in management science. Overall feedback orientation scores were high and were largely consistent across trainee levels. Utility was the domain that was highest across learners, whereas feedback self-efficacy was lowest. CONCLUSIONS Feedback orientation represents a useful concept to explore medical learners' attitudes toward feedback's role in their development. The four domains can help guide further nuanced feedback research and application.[Box: see text].
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Affiliation(s)
- Lynnea M Mills
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Olle Ten Cate
- University Medical Center Utrecht, Utrecht, the Netherlands
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Sari SM, Suhoyo Y, Mulyana D, Claramita M. The interactional communication of feedback in clinical education: A focused ethnographic study in a hierarchical and collectivist culture. Heliyon 2023; 9:e14263. [PMID: 36938453 PMCID: PMC10019999 DOI: 10.1016/j.heliyon.2023.e14263] [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: 06/06/2022] [Revised: 02/12/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
Background The definition of feedback in clinical education has shifted from information delivery to student-teacher dialogue. However, based on Hofstede's theory, countries with large power distance or a robust social hierarchy and collectivistic cultural dimensions can reduce the feedback dialogue to a minimum. Indonesia is classified in this group, with some Asian, African, Mediterranean, and Latin American countries. This study explores the interactional communication of feedback during clinical education in a hierarchical and collectivistic context. Methods The focused ethnographic approach was applied to the clinical rotation program in an Indonesian teaching hospital. Data sources included observations of feedback episodes during workplace-based assessments followed by interviews with clinical supervisors and students. The data were compiled within 16 weeks of observation in 7 groups of clinical departments, consisting of 28 field notes, audiotaped interviews including nine focus group discussions of students (N = 42), and seven in-depth interviews with clinical supervisors. Data were analyzed through transcription, coding, categorization, and thematic analysis using the symbolic interactionist perspective. Results We identified four themes representing actual interactional communication and its 'meaning' or interpretation. The interactional communication in feedback is described in the first and second themes, such as 1) Students play the subordinate roles in a feedback dialogue; 2) The feedback content is focused on explanation and students' limitations. The third and fourth themes represent the clinical supervisors' and students' interpretation of their feedback experience, such as 3) Clinical supervisors' perspectives are mostly on dissatisfaction and teaching authority; 4) Students' acceptance of reality and negative affection. Conclusions This study shows that the social gap between students and clinical supervisors in Indonesia, and other countries in the same cultural classification, potentially causes communication barriers in the feedback dialogue. The adaptation of 'feedback as a dialogue' requires further effort and research to develop communication strategies in feedback that consider the national culture and context.
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Affiliation(s)
- Sylvia Mustika Sari
- Department of Medical Education and Bioethics, Faculty of Medicine, Jenderal Achmad Yani University Indonesia
- Department of Medical Education and Bioethics, Faculty of Medicine, Public health, and Nursing, Universitas Gadjah Mada, Indonesia
| | - Yoyo Suhoyo
- Department of Medical Education and Bioethics, Faculty of Medicine, Public health, and Nursing, Universitas Gadjah Mada, Indonesia
| | - Deddy Mulyana
- Department of Journalism, Faculty of Communication Sciences, Universitas Padjadjaran, Indonesia
| | - Mora Claramita
- Department of Medical Education and Bioethics, Faculty of Medicine, Public health, and Nursing, Universitas Gadjah Mada, Indonesia
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Puri A, Memari M, Sottile EM, Snydman LK, Lee WW, Bonnema RA, Jones D, Nandiwada DR. Changing the Assessment Paradigm: Promoting a Growth Mindset Across the Medical Education Continuum. Am J Med 2023; 136:207-212. [PMID: 36441037 DOI: 10.1016/j.amjmed.2022.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/18/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Aditi Puri
- Department of Internal Medicine, MacNeal Hospital, Loyola University Health System, North Riverside, Ill.
| | - Milad Memari
- Division of General Internal Medicine University of Pittsburgh Medical Center, Pa
| | - Elisa M Sottile
- Division of General Internal Medicine, University of Florida College of Medicine - Jacksonville
| | - Laura K Snydman
- Division of General Internal Medicine, Tufts Medical Center, Boston, Mass
| | - Wei Wei Lee
- Section of General Internal Medicine, University of Chicago Pritzker School of Medicine, Ill
| | - Rachel A Bonnema
- Division of General Internal Medicine, University of Texas Southwestern School of Medicine, Dallas
| | - Danielle Jones
- Division of General Internal Medicine, Emory University of Medicine, Atlanta, Ga
| | - D Rani Nandiwada
- Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
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14
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Eijkelboom MCL, de Kleijn RAM, van Diemen WJM, Maljaars CDN, van der Schaaf MF, Frenkel J. Patients as Feedback Providers: Exploring Medical Students' Credibility Judgments. PERSPECTIVES ON MEDICAL EDUCATION 2023; 12:129-140. [PMID: 37064270 PMCID: PMC10103723 DOI: 10.5334/pme.842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/07/2023] [Indexed: 05/05/2023]
Abstract
Introduction Patient feedback is becoming ever more important in medical education. Whether students engage with feedback is partly determined by how credible they think the feedback provider is. Despite its importance for feedback engagement, little is known about how medical students judge the credibility of patients. The purpose of this study was therefore to explore how medical students make credibility judgments regarding patients as feedback providers. Methods This qualitative study builds upon McCroskey's conceptualization of credibility as a three-dimensional construct comprising: competence, trustworthiness, and goodwill. Since credibility judgments are shaped by the context, we studied students' credibility judgments in both a clinical and non-clinical context. Medical students were interviewed after receiving feedback from patients. Interviews were analyzed through template and causal network analysis. Results Students based their credibility judgments of patients on multiple interacting arguments comprising all three dimensions of credibility. In estimating a patient's credibility, students reasoned about aspects of the patient's competence, trustworthiness, and goodwill. In both contexts students perceived elements of an educational alliance between themselves and patients, which could increase credibility. Yet, in the clinical context students reasoned that therapeutic goals of the relationship with patients might impede educational goals of the feedback interaction, which lowered credibility. Discussion Students' credibility judgments of patients were a weighing of multiple sometimes conflicting factors, within the context of relationships and their associated goals. Future research should explore how goals and roles can be discussed between students and patients to set the stage for open feedback conversations.
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Affiliation(s)
- M. C. L. Eijkelboom
- Faculty of Medicine, Utrecht University, the Netherlands
- Department of Pediatrics, University Medical Center Utrecht, the Netherlands
| | - R. A. M. de Kleijn
- Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, the Netherlands
| | - W. J. M. van Diemen
- Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, the Netherlands
| | | | - M. F. van der Schaaf
- Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, the Netherlands
| | - J. Frenkel
- Department of Pediatrics, University Medical Center Utrecht, the Netherlands
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Joyce J, Cantillon P, Geoghegan R. Peer feedback in graduate training: A phenomenological investigation of possibilities. MEDICAL TEACHER 2022; 44:1362-1367. [PMID: 35793243 DOI: 10.1080/0142159x.2022.2094229] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Whilst feedback is an essential component of clinical education, it is often lacking in clinical workplaces due to competing priorities. Peer feedback has been proposed as a potential solution but remains underexplored in terms of practicality and effects. We aimed to examine the experiences of peer feedback among paediatric trainees, and the associated feedback culture. METHODS Following an Interpretative Phenomenological Analysis approach, the personal experiences of 12 paediatric trainees were explored using semi-structured interviews. Interpretive themes were developed between the transcripts using processes of abstraction, subsumption, contextualisation, and cross-case analysis. Themes were subsequently subjected to member checking and peer debriefing processes. RESULTS We found that peer feedback was influenced by three contextual factors, namely, prevalent feedback culture, interpersonal consent, and the quality of relationships. Peer feedback culture was lacking in clinical workplaces. Feedback between peers was constrained by avoiding criticism and maintaining work relationships. Social and cultural norms inhibited constructive peer feedback without explicit consent. CONCLUSIONS Enabling peer feedback in clinical settings requires attention to cultural, relational, and consent barriers. Potential approaches should include helping clinicians to develop greater cultural reflexivity, resident training in how to be peer educators, and enhancing institutional supports for peer feedback.
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Affiliation(s)
- John Joyce
- Department of Paediatrics, School of Medicine, National University of Ireland, Galway, Ireland
| | - Peter Cantillon
- Discipline of General Practice, National University of Ireland, Galway, Ireland
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Safavi AH, Papadakos J, Papadakos T, Quartey NK, Lawrie K, Klein E, Storer S, Croke J, Millar BA, Jang R, Bezjak A, Giuliani ME. Feedback Delivery in an Academic Cancer Centre: Reflections From an R2C2-based Microlearning Course. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1790-1797. [PMID: 34169464 DOI: 10.1007/s13187-021-02028-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 06/13/2023]
Abstract
Feedback delivery and training have not been characterized in the context of academic cancer centres. The purpose of this study was to assess the feasibility and utility of a microlearning course based on the R2C2 (Relationship, Reaction, Content, Coaching) feedback model and characterize multidisciplinary healthcare provider (HCP) perspectives on existing feedback practices in an academic cancer centre. Five HCP (two radiation oncologists, one medical oncologist, and two allied health professionals) with supervisory roles were selected by purposive sampling to participate in a prospective longitudinal qualitative study. Each participant completed a web-based multimedia course. Semi-structured one-on-one interviews were conducted with each participant at four time points: pre- and immediately post-course, and at one- and three-months post course. All participants found the course to be time feasible and completed it in 10-20 min. Participants expressed that the course fulfilled their need for feedback training and that its adoption may normalize a feedback culture in the cancer centre. Three themes were identified regarding perceptions of existing feedback practices: (1) hierarchical and interdisciplinary relationships modulate feedback delivery, (2) interest in feedback delivery varies by duration of the supervisory relationship, and (3) the transactionality of supervisor-trainee relationships influences feedback delivery. This study demonstrates the perceived feasibility and utility of a digital microlearning approach for development of feedback competencies in an academic cancer centre, perceptions of cultural barriers to feedback delivery, and the need for organizational commitment to developing a feedback culture.
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Affiliation(s)
- Amir H Safavi
- Department of Radiation Oncology, University of Toronto, Toronto, ON, M5T 1P5, Canada
| | - Janet Papadakos
- Cancer Education, Princess Margaret Cancer Centre, 585 University Ave, Munk Building B-PMB 130, Toronto, ON, M5G 2M9, Canada
- Patient Education, Ontario Health, Toronto, ON, M5S 1A1, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Tina Papadakos
- Cancer Education, Princess Margaret Cancer Centre, 585 University Ave, Munk Building B-PMB 130, Toronto, ON, M5G 2M9, Canada
- Patient Education, Ontario Health, Toronto, ON, M5S 1A1, Canada
| | - Naa Kwarley Quartey
- Cancer Education, Princess Margaret Cancer Centre, 585 University Ave, Munk Building B-PMB 130, Toronto, ON, M5G 2M9, Canada
| | - Karen Lawrie
- Cancer Education, Princess Margaret Cancer Centre, 585 University Ave, Munk Building B-PMB 130, Toronto, ON, M5G 2M9, Canada
| | - Eden Klein
- Cancer Education, Princess Margaret Cancer Centre, 585 University Ave, Munk Building B-PMB 130, Toronto, ON, M5G 2M9, Canada
| | - Sarah Storer
- Cancer Education, Princess Margaret Cancer Centre, 585 University Ave, Munk Building B-PMB 130, Toronto, ON, M5G 2M9, Canada
| | - Jennifer Croke
- Department of Radiation Oncology, University of Toronto, Toronto, ON, M5T 1P5, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, 700 University Ave 7th Floor, Toronto, ON, M5G 2M9, Canada
| | - Barbara-Ann Millar
- Department of Radiation Oncology, University of Toronto, Toronto, ON, M5T 1P5, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, 700 University Ave 7th Floor, Toronto, ON, M5G 2M9, Canada
| | - Raymond Jang
- Division of Medical Oncology and Hematology, University of Toronto, 700 University Ave 7th Floor, Toronto, ON, M5G 2M9, Canada
| | - Andrea Bezjak
- Department of Radiation Oncology, University of Toronto, Toronto, ON, M5T 1P5, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, 700 University Ave 7th Floor, Toronto, ON, M5G 2M9, Canada
| | - Meredith E Giuliani
- Department of Radiation Oncology, University of Toronto, Toronto, ON, M5T 1P5, Canada.
- Cancer Education, Princess Margaret Cancer Centre, 585 University Ave, Munk Building B-PMB 130, Toronto, ON, M5G 2M9, Canada.
- Radiation Medicine Program, Princess Margaret Cancer Centre, 700 University Ave 7th Floor, Toronto, ON, M5G 2M9, Canada.
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Branfield Day L, Rassos J, Billick M, Ginsburg S. 'Next steps are…': An exploration of coaching and feedback language in EPA assessment comments. MEDICAL TEACHER 2022; 44:1368-1375. [PMID: 35944554 DOI: 10.1080/0142159x.2022.2098098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Entrustable Professional Activities (EPA) assessments are intended to facilitate meaningful, low-stakes coaching and feedback, partly through the provision of written comments. We sought to explore EPA assessment comments provided to internal medicine (IM) residents for evidence of feedback and coaching language as well as politeness. METHODS We collected all written comments from EPA assessments of communication from a first-year IM resident cohort at the University of Toronto. Sensitized by politeness theory, we analyzed data using principles of constructivist grounded theory. RESULTS Nearly all EPA assessments (94%) contained written feedback based on focused clinical encounters. The majority of comments demonstrated coaching language, including phrases like 'don't forget to,' and 'next steps are,' followed by specific suggestions for improvement. A variety of words, including 'autonomy' and 'independence' denoted entrustment decisions. Linguistic politeness strategies such as hedging were pervasive, seemingly to minimize harm to the supervisor-trainee relationship. CONCLUSION Evidence of written coaching feedback suggests that EPA assessment comments are being used as intended as a means of formative feedback to promote learning. Yet, the frequent use of polite language suggests that EPAs may be higher-stakes than expected, highlighting a need for changes to the assessment culture and improved feedback literacy.
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Affiliation(s)
- Leora Branfield Day
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - James Rassos
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maxime Billick
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Shiphra Ginsburg
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Wilson Centre for Research in Education, Toronto, Canada
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18
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Soemantri D, Nurokhmanti H, Qomariyah N, Claramita M. The Practice of Feedback in Health Professions Education in the Hierarchical and Collectivistic Culture: a Scoping Review. MEDICAL SCIENCE EDUCATOR 2022; 32:1219-1229. [PMID: 36276778 PMCID: PMC9583993 DOI: 10.1007/s40670-022-01597-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 06/16/2023]
Abstract
The global trend in student assessment is moving towards outcome-based assessment that requires multiple systematic data points and continuous feedback. However, in hierarchical and collectivistic cultures, one-way communication is practised more often, leading to less dialogical feedback. This scoping review explored feedback practice in Asian educational setting. Based on the 17 articles selected, the findings were categorised into four themes, i.e. inhibiting or facilitating factors of feedback, influences of cultural factors on feedback, discrepancies between students' and teachers' perceptions of feedback and impact of feedback. Hierarchical and collectivist cultural aspects, such as preference for group feedback, are pertinent to feedback practice, which likely influence the readiness for programmatic assessment.
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Affiliation(s)
- Diantha Soemantri
- Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Hikmawati Nurokhmanti
- Department of Medical, Health Professions Education, and Bioethics, Faculty of Medicine-Public Health-and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Nurul Qomariyah
- Department of Community Medicine, Faculty of Medicine, Universitas Ahmad Dahlan, Yogyakarta, Indonesia
| | - Mora Claramita
- Department of Medical, Health Professions Education, and Bioethics, Faculty of Medicine-Public Health-and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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19
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Rutledge M, Link K, Zapata I, Carter S. Medical student confidence when training for a female genitourinary exam using models and standardized patients. J Obstet Gynaecol Res 2022; 48:1466-1474. [PMID: 35272394 DOI: 10.1111/jog.15222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022]
Abstract
AIM The purpose of this study is to investigate what factors make students feel confident and competent when performing a female genitourinary exam (FGUE) with normal, nonpathologic findings. We anticipated that students would increase their confidence and perceived competence from the first year to the second year of medical school, would prefer the use of specialized standardized patients (SSPs) over models, and that the results would vary by student demographics. METHODS Student confidence and perceived competence were measured using voluntary survey methods pre- and postinterventions. Interventions were defined as learning the FGUE on models alone for first-year medical students and learning the FGUE on SSPs with prior experience using models for second-year students. Survey responses were evaluated via generalized linear mixed models for numeric responses. RESULTS The results demonstrated that first- and second-year medical students of racial and ethnic minorities rated themselves as more confident and competent than Caucasian counterparts, which was in many cases more extensive than the effect of an additional year of medical education. Students felt that using SSPs alone was the best mode of learning the exam than either models alone or the combination of models and SSPs. Students' current specialty of choice did not correlate with increased confidence or perceived competence. CONCLUSION This study highlights how cultural differences have an impact on confidence and perceived competence in medical students as they prepare for performing a procedure as intimate to the patient as the FGUE.
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Affiliation(s)
- Mallory Rutledge
- Office of Simulation in Medicine and Surgery, Rocky Vista University, Parker, CO, USA
| | - Kelsey Link
- Office of Simulation in Medicine and Surgery, Rocky Vista University, Parker, CO, USA
| | - Isain Zapata
- Department of Biomedical Sciences, Rocky Vista University, Parker, CO, USA
| | - Susan Carter
- Office of Simulation in Medicine and Surgery, Rocky Vista University, Parker, CO, USA
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20
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Dart J, Ash S, McCall L, Rees C. ‘We’re our own worst enemies’: A qualitative exploration of sociocultural factors in dietetic education influencing student-dietitian transitions. J Acad Nutr Diet 2022; 122:2036-2049.e4. [DOI: 10.1016/j.jand.2022.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 11/25/2022]
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Murthy V, Sethuraman KR, Choudhury S, Shakila R. Application of Practice Oriented-Peer Review for Prosthodontics (PRO-PReP)-A Qualitative Study. Int J Psychiatry Med 2022; 57:117-133. [PMID: 33472469 DOI: 10.1177/0091217421990142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Communication skills diminish with time and must be applied and updated frequently. Due to various professional constraints, the dentists may not be able to attend training programs to sharpen their skills. During patient interactions, dentists may face difficult situations which they may be unable to handle and, consequently, make them overreact. Therefore, there is a need to provide a platform to freely discuss their feelings, ideas, and take opinion from peers. METHODS Training in communication skills customized for dealing with complete denture patients was conducted for the prosthodontic postgraduates. Based on feedback obtained, it was decided to have periodic meetings and the concept of Practice-Oriented-Peer Review for Prosthodontics (PrO-PReP) was introduced. This novel concept is a combination of the Relationship building, exploring Reactions, exploring Content, and Coaching (R2C2) model of residency education and the Balint method. The meetings were scheduled every one or two months based on the available caseload of the patients treated by the postgraduates. RESULTS The thematic analysis of the postgraduates' self-reflection during the sessions and the video recorded observations (assessed using the Kalamazoo scale) revealed that these sessions were effective in positively engaging the postgraduates to discuss their experiences, reflect on their performances, practice their newly gained skills, and learn from peer sharing. CONCLUSION The postgraduates felt that they have changed in their working style and were more confident to manage patients. They found such sessions very useful for being updated with the already-learned skills.
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Affiliation(s)
- Varsha Murthy
- Department of Prosthodontics and Implantology, Sri Venkateshwaraa Dental College, Ariyur, Pondicherry, India
| | - K R Sethuraman
- Faculty of Medicine, 60605AIMST University, Bedong, Malaysia
| | - Sunayana Choudhury
- Department of Psychiatry, Mahatma Gandhi Medical College and Research Institute, Pilliyarkuppam, Pondicherry, India
| | - R Shakila
- Department of Prosthodontics and Crown & Bridge, 179249Mahatma Gandhi Postgraduate Institute of Dental Sciences, Gorimedu, Pondicherry, India
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Sedney CL, Dekeseredy P, Elmo R, Sofka S. Exploring Resident Physician Wellness at an Allopathic Medical School in West Virginia: A Qualitative Study. THE WEST VIRGINIA MEDICAL JOURNAL 2022; 118:18-24. [PMID: 35600669 PMCID: PMC9119293 DOI: 10.21885/wvmj.2022.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Social support is key to wellness, especially during times of stress and uncertainty. The working climate, including the multidisciplinary medical community provides opportunities for both positive and negative wellness experiences. The purpose of this study is to explore residents' concepts of wellness and the influence of programs, faculty, peers, and nursing and ancillary staff. METHODS An email with a link to the REDCap survey was sent to each resident (n=450) in the school of medicine at West Virginia University asking them to give examples of ways their wellness has been supported (or not) by faculty members, their program, co-residents, and nursing and ancillary staff. The residents returned 51 completed surveys (11% response rate). Seven residents participated in a face to face interview. A content analysis using Hale's adaptation of resident wellness (based upon Maslow's Hierarchy of Needs) as the theoretical framework was conducted on the data. RESULTS Positive wellness elements frequently focused on time, supportive actions, and social connection. Negative examples impacting wellness included feeling disrespected, not being included in decision making, conflicts, and feeling unappreciated. Suggestions from the residents often described low cost interventions such as being" included" and feeling part of the team. CONCLUSION The participants described how all members of the healthcare team can support resident wellness in a variety of domains. Peers, support staff in the hospital environment, faculty supervisors, and the program overall can contribute to the basic physiologic needs, safety, belonging, esteem, and self-actualization of resident learners through social support.
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Affiliation(s)
- Cara L. Sedney
- Cara Sedney MD MA. Associate Professor Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Patricia Dekeseredy
- Patricia Dekeseredy MScN RN. Clinical Research Specialist in the Department of Neurosurgery, WVU Medicine, Morgantown, WV, USA
| | - Rebecca Elmo
- Rebecca Elmo Accreditation Specialist Department of Medical Education, West Virginia University School of Medicine
| | - Sarah Sofka
- Sarah Sofka MD. Associate Professor General Internal Medicine, West Virginia University School of Medicine
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Fullerton PD, Sarkar M, Haque S, McKenzie W. Culture and understanding the role of feedback for health professions students: realist synthesis protocol. BMJ Open 2022; 12:e049462. [PMID: 35190412 PMCID: PMC8860032 DOI: 10.1136/bmjopen-2021-049462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Clinical education has moved to a 'competency-based' model with an emphasis on workplace-based learning and assessment which, in turn, depends on feedback to be effective. Further, the understanding of feedback has changed from information about a performance directed to the learner performing the task, to a dialogue, which enables the learner to act and develop.In health professional education, feedback is a complex interaction between trainee, supervisor and the healthcare system. Most published research on feedback in health professional education originates in Europe and North America. Our interest is on the impact of Culture on this process, particularly in the context of Asian cultures.The (scientific) realist approach of Pawson and Tilley provides a means to examine complex interventions in social situations, and thus is an appropriate lens to use for this study. This is a protocol for a realist synthesis which asks how, why and in what circumstances do Asian Cultures influence health professional trainees to seek, respond to and use feedback given in the clinical environment, if at all. METHODS AND ANALYSIS An initial search was performed to help define the scope of the review question and develop our initial programme theory. The formal electronic search was carried out in February 2020 and included: CINAHL, ERIC, Medline and PsycInfo, and repeated in October 2020. Retrieved articles were imported into Covidence for screening and data extraction, after which components of the Context-Mechanisms-Outcomes configurations will be sought to refine the initial programme theory. ETHICS AND DISSEMINATION As this study is a literature review, ethics approval is not required.The findings will be documented in line with the RAMESES (Realist And MEta-narrative Evidence Syntheses: Evolving Standards) publications standards for Realist syntheses, and we plan to disseminate the findings by means of a peer-reviewed journal article and conference presentation(s).
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Affiliation(s)
- Paul Douglas Fullerton
- Clinical School Johor Bahru, Monash University Malaysia, Johor Bahru, Johor, Malaysia
- Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Mahbub Sarkar
- Monash Centre for Scholarship in Health Education, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Shamsul Haque
- Department of Psychology, Jeffrey Cheah School of Medicine and Health Science, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Wendy McKenzie
- Office of Deputy Dean, Education, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
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Liang Y, Noble LM. Chinese doctors' views on workplace-based assessment: trainee and supervisor perspectives of the mini-CEX. MEDICAL EDUCATION ONLINE 2021; 26:1869393. [PMID: 33380291 PMCID: PMC7782920 DOI: 10.1080/10872981.2020.1869393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/15/2020] [Accepted: 12/22/2020] [Indexed: 05/28/2023]
Abstract
Purpose: This study investigated whether the mini-clinical evaluation exercise (mini-CEX) has been successfully integrated into the Chinese context, following its introduction as part of the national general training programme. Materials and methods: Online questionnaires (N = 91) and interviews (N = 22) were conducted with Year 1 trainee doctors and clinical supervisors at a cancer hospital in China to explore users' experiences, attitudes and opinions of the mini-CEX. Results" Trainees were more likely than supervisors to report understanding the purpose of the mini-CEX and agree that it encouraged reflection and helped improve overall performance. Both trainees and supervisors felt that it provided a framework for learning, that it was useful in identifying underperformance, and that it informed learning progression. Groups were equally positive about the commitment of their counterpart in the process and valued the focus on detailed feedback. It was perceived as cultivating the learner-teacher relationship. Overall, both groups felt they 'bought in' to using the mini-CEX. However, concerns were raised about subjectivity of ratings and lack of benchmarking with expected standards of care. Conclusions: Chinese trainees and supervisors generally perceived the mini-CEX as an acceptable and valuable medical training tool, although both groups suggested enhancements to improve its efficacy.
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Affiliation(s)
- Yuying Liang
- Department of Medical Education, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
- UCL Medical School, University College London, London, UK
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Roshan A, Wagner N, Acai A, Emmerton-Coughlin H, Sonnadara RR, Scott TM, Karimuddin AA. Comparing the Quality of Narrative Comments by Rotation Setting. JOURNAL OF SURGICAL EDUCATION 2021; 78:2070-2077. [PMID: 34301523 DOI: 10.1016/j.jsurg.2021.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the effect of rotation setting on trainee-directed narrative comments within a Canadian General Surgery Residency Program. The primary outcome was to use the McMaster Narrative Comment Rating Scale (MNCRS) to evaluate the quality of narrative comments across five domains: valence of language, degree of correction versus reinforcement, specificity, actionability and overall usefulness. As distributed medical education in the postgraduate training context becomes more prevalent, delineating differences in feedback between various sites will be imperative, as it may affect how narrative comments are interpreted by clinical competency committee (CCC) members. DESIGN, SETTING, AND PARTICIPANTS A retrospective analysis of 2,469 assessments obtained between July 1, 2014 and May 5, 2019 from the General Surgery Residency Program at the University of British Columbia (UBC) was conducted. Narrative comments were rated using the McMaster Narrative Comment Rating Scale (MNCRS), a validated instrument for evaluating the quality of narrative comments. A repeated measures Analysis of Variance (ANOVA) was conducted to explore the impact of rotation setting, academic, urban tertiary, distributed urban, and distributed rural on the quality of narrative feedback. RESULTS Overall, the quality of the narrative comments varied substantially between and within rotation settings. Academic sites tended to provide more actionable comments (p = 0.01) and more corrective versus reinforcing comments, compared with other sites (p's < 0.01). Comments produced by the urban tertiary rotation setting were consistently lower in quality across all scale categories compared with other settings (p's < 0.01). CONCLUSION The type of rotation setting has a significant effect on the quality of faculty feedback for trainees. Faculty development on the provision of feedback is necessary, regardless of rotation setting, and should appropriately combine rotation-specific needs and overarching program goals to ensure trainees and clinical competence committees receive high quality narrative.
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Affiliation(s)
- Aishwarya Roshan
- University of British Columbia, Vancouver, British Columbia, Canada.
| | - Natalie Wagner
- Office of Professional Development & Educational Scholarship, Queen's University, Kingston, Ontario Canada
| | - Anita Acai
- Department of Psychology, Neuroscience & Behavior, McMaster University, Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Office of Education Science, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Heather Emmerton-Coughlin
- Department of Surgery, University of British Columbia, Vancouver, British Columbia Canada; Department of Surgery, Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Ranil R Sonnadara
- Office of Education Science, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Tracy M Scott
- Department of Surgery, University of British Columbia, Vancouver, British Columbia Canada; Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Ahmer A Karimuddin
- Department of Surgery, University of British Columbia, Vancouver, British Columbia Canada; Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada
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Bindels E, van den Goor M, Scherpbier A, Lombarts K, Heeneman S. Sharing Reflections on Multisource Feedback in a Peer Group Setting: Stimulating Physicians' Professional Performance and Development. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1449-1456. [PMID: 33951680 DOI: 10.1097/acm.0000000000004142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Reflecting on and using feedback are important for physicians' continuous professional development (CPD). A common format is the discussion of multisource feedback (MSF) in a one-on-one session with a trusted peer or coach. A new approach is to discuss MSF during a peer group session moderated by a professional facilitator. This qualitative study explored how physicians experience participation in these peer group sessions in the context of their CPD. METHOD Between March and July 2018, 26 physicians were interviewed about their experiences in a peer group session. These physicians represented 13 monospecialty physician groups from 5 general hospitals in the Netherlands. Interviews were transcribed verbatim and analyzed iteratively, following the interpretative phenomenological approach. RESULTS Participation was experienced as a process of disclosing and sharing personal reflections with peers while striking a balance between interpersonal proximity to and distance from peers. Sharing reflections with peers rendered the feedback more meaningful, deepened collegial relationships, and created a sense of urgency for improvement. Improvement goals were mostly related to relational fine-tuning in collaboration; goals related to individual career management remained in the background. Influential factors for the perceived effectiveness of the group sessions were related to the facilitator's expertise, group size, continuity and quality of collegial relationships, personal vulnerabilities, and the context of CPD policy. CONCLUSIONS Peer group sessions offered interactivity and established a clear link between individual physicians and their work environments. Sharing reflections on MSF in a peer group setting provided physicians with nuanced insight into their professional performance and fostered a community spirit that supported the implementation of intended changes. Future research should focus on the role of group dynamics and communication strategies and the application of coaching principles, such as drawing up a detailed plan of action and monitoring the follow-up process.
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Affiliation(s)
- Elisa Bindels
- E. Bindels was a PhD candidate, Amsterdam Center for Professional Performance and Compassionate Care, Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam, the Netherlands, and Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands, at the time of the study. The author is now a lecturer, Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands; ORCID: https://orcid.org/0000-0001-6096-4950
| | - Myra van den Goor
- M. van den Goor is CEO, Q3 Company for Physician Development, Den Bosch, the Netherlands; ORCID: https://orcid.org/0000-0002-6361-0178
| | - Albert Scherpbier
- A. Scherpbier is professor, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0001-9652-0163
| | - Kiki Lombarts
- K. Lombarts is professor, Amsterdam Center for Professional Performance and Compassionate Care, Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam, the Netherlands; ORCID: https://orcid.org/0000-0001-6167-0620
| | - Sylvia Heeneman
- S. Heeneman is professor, Department of Pathology, Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0002-6103-8075
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Fredette J, Michalec B, Billet A, Auerbach H, Dixon J, Poole C, Bounds R. A qualitative assessment of emergency medicine residents' receptivity to feedback. AEM EDUCATION AND TRAINING 2021; 5:e10658. [PMID: 34527849 PMCID: PMC8426887 DOI: 10.1002/aet2.10658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 05/09/2023]
Abstract
BACKGROUND Effective feedback is the cornerstone of competency-based education. The emergency department (ED) is a unique learning and feedback environment. Developing our understanding of emergency medicine (EM) residents' experiences around feedback will improve resident training and inform EM faculty development programs. OBJECTIVE This qualitative study explores the feedback culture and practices in EM and resident's experiences and attitudes toward feedback in this specific training environment. METHODS At a large categorical EM program, 15 residents voluntarily participated in semistructured interviews regarding feedback. These individual interviews were performed by a nonphysician investigator and transcripts underwent an inductive multistep coding process. Transcripts were analyzed to identify common factors influencing feedback and then comparisons were made between residents to explore the interconnectedness of identified factors and further categorize consistent themes. RESULTS Factors inherent to the ED environment make the delivery of effective feedback challenging. Residents also revealed that feedback-seeking/-avoidant behavior and receptivity to feedback are multifactorial. Residents actively seek feedback when they feel that they performed well but tend to avoid feedback interactions when they expect constructive feedback. Finally, residents filter feedback based on attending personality and perceived practice style as well as their own desired practice style. CONCLUSIONS It is important for program leaders to understand their residents' experiences with feedback and engage both faculty and residents in conversations around feedback delivery and receptivity. An improved understanding of these experiences might also reveal barriers to performance assessment and guide efforts to improve the accuracy and reliability of resident evaluations.
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Affiliation(s)
| | | | - Amber Billet
- Wellspan York Hospital SystemYorkPennsylvaniaUSA
| | | | - Jessica Dixon
- Thomas Jefferson Medical SchoolPhiladelphiaPennsylvaniaUSA
| | | | - Richard Bounds
- University of Vermont Medical CenterBurlingtonVermontUSA
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Könings KD, Mordang S, Smeenk F, Stassen L, Ramani S. Learner involvement in the co-creation of teaching and learning: AMEE Guide No. 138. MEDICAL TEACHER 2021; 43:924-936. [PMID: 33153367 DOI: 10.1080/0142159x.2020.1838464] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
This AMEE guide aims to emphasize the value of active learner involvement in the design and development of education, referred to as co-creation, and provides practical tips for medical educators interested in implementing co-created educational initiatives at their own institutions. Starting with definitions of co-creation and related terms, we then describe its benefits and summarize the literature in medical and higher education to provide an appropriate context and a shared mental model for health professions educators across the world. Potential challenges and barriers to implementation of co-creation in practice are described in detail from the perspective of learners, teachers, and institutions. Challenges are linked to relevant principles of Self-Determination Theory, Positioning Theory and theory on Psychological Safety, to provide direction and fundamental reasons for implementation of co-creation. Finally, solutions to listed challenges and practical approaches to education design and implementation using co-creation are described in detail. These tips include strategies for supporting learners and teachers in the process, enhancing the collaboration between them, and ensuring appropriate support at the organizational level.
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Affiliation(s)
- Karen D Könings
- Educational Development and Research and School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Serge Mordang
- Educational Development and Research and School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Frank Smeenk
- Educational Development and Research and School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Pulmonary Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Laurents Stassen
- Educational Development and Research and School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Subha Ramani
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Research and Scholarship, Harvard Macy Institute, Boston, MA, USA
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Baumgardner DJ. The Weight of a Word. J Patient Cent Res Rev 2021; 8:229-231. [PMID: 34322574 PMCID: PMC8297492 DOI: 10.17294/2330-0698.1879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Dennis J Baumgardner
- Department of Family Medicine, Aurora UW Medical Group, Advocate Aurora Health, Milwaukee, WI
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30
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Lam DL, Sarkany DS, Whitman GJ, Straus CM. It's a Two-Way Street: Giving and Receiving Feedback to the Unaware. Curr Probl Diagn Radiol 2021; 51:17-20. [PMID: 34304948 DOI: 10.1067/j.cpradiol.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022]
Abstract
Giving and receiving constructive feedback is a valuable skill and an evolving process due to improved understanding and changes in culture. This article provides a practical review of key elements of effective feedback skills and strategies for providing constructive feedback, with a focus on how to address recipients who may have impaired insight into the issue at hand. Commonly known tips and tricks include direct, immediate, and specific feedback delivered in a safe setting and in a conversational manner. This article specifically considers how the feedback will be heard or accepted by the intended recipient, in order for the educator to best overcome hurdles in relaying constructive criticism.
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Affiliation(s)
- Diana L Lam
- Department of Radiology, University of Washington School of Medicine, Seattle, WA.
| | - David S Sarkany
- Department of Radiology, Staten Island University Hospital, Northwell Health, Staten Island, NY
| | - Gary J Whitman
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Richardson D, Kinnear B, Hauer KE, Turner TL, Warm EJ, Hall AK, Ross S, Thoma B, Van Melle E. Growth mindset in competency-based medical education. MEDICAL TEACHER 2021; 43:751-757. [PMID: 34410891 DOI: 10.1080/0142159x.2021.1928036] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The ongoing adoption of competency-based medical education (CBME) across health professions training draws focus to learner-centred educational design and the importance of fostering a growth mindset in learners, teachers, and educational programs. An emerging body of literature addresses the instructional practices and features of learning environments that foster the skills and strategies necessary for trainees to be partners in their own learning and progression to competence and to develop skills for lifelong learning. Aligned with this emerging area is an interest in Dweck's self theory and the concept of the growth mindset. The growth mindset is an implicit belief held by an individual that intelligence and abilities are changeable, rather than fixed and immutable. In this paper, we present an overview of the growth mindset and how it aligns with the goals of CBME. We describe the challenges associated with shifting away from the fixed mindset of most traditional medical education assumptions and practices and discuss potential solutions and strategies at the individual, relational, and systems levels. Finally, we present future directions for research to better understand the growth mindset in the context of CBME.
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Affiliation(s)
- Denyse Richardson
- Department of Medicine, Division of Physiatry, University of Toronto, Ontario, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
| | - Benjamin Kinnear
- Internal Medicine and Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Karen E Hauer
- University of California, San Francisco, San Francisco, CA, USA
| | - Teri L Turner
- Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Eric J Warm
- Internal Medicine and Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew K Hall
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
- Department of Emergency Medicine, Queen's University, Kingston, Canada
| | - Shelley Ross
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - Brent Thoma
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Elaine Van Melle
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
- Department of Family Medicine, Queen's University, Kingston, Canada
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Olvet DM, Willey JM, Bird JB, Rabin JM, Pearlman RE, Brenner J. Third year medical students impersonalize and hedge when providing negative upward feedback to clinical faculty. MEDICAL TEACHER 2021; 43:700-708. [PMID: 33657329 DOI: 10.1080/0142159x.2021.1892619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Medical students provide clinical teaching faculty with feedback on their skills as educators through anonymous surveys at the end of their clerkship rotation. Because faculty are in a position of power, students are hesitant to provide candid feedback. Our objective was to determine if medical students were willing to provide negative upward feedback to clinical faculty and describe how they conveyed their feedback. A qualitative analysis of third year medical students' open-ended comments from evaluations of six clerkships was performed using politeness theory as a conceptual framework. Students were asked to describe how the clerkship enhanced their learning and how it could be improved. Midway through the academic year, instructions to provide full names of faculty/residents was added. Overall, there were significantly more comments on what worked well than suggestions for improvement regarding faculty/residents. Instructing students to name-names increased the rate of naming from 35% to 75% for what worked well and from 13% to 39% for suggestions for improvement. Hedging language was included in 61% of suggestions for improvement, but only 2% of what worked well. Students described the variability of their experience, used passive language and qualified negative experiences with positive ones. Medical students may use linguistic strategies, such as impersonalizing and hedging, to mitigate the impact of negative upward feedback. Working towards a culture that supports upward feedback would allow students to feel more comfortable providing candid comments about their experience.
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Affiliation(s)
- Doreen M Olvet
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Joanne M Willey
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Jeffrey B Bird
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Jill M Rabin
- Department of Obstetrics & Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - R Ellen Pearlman
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Judith Brenner
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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Young JQ, Frank JR, Holmboe ES. Advancing Workplace-Based Assessment in Psychiatric Education: Key Design and Implementation Issues. Psychiatr Clin North Am 2021; 44:317-332. [PMID: 34049652 DOI: 10.1016/j.psc.2021.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
With the adoption of competency-based medical education, assessment has shifted from traditional classroom domains of knows and knows how to the workplace domain of doing. This workplace-based assessment has 2 purposes; assessment of learning (summative feedback) and the assessment for learning (formative feedback). What the trainee does becomes the basis for identifying growth edges and determining readiness for advancement and ultimately independent practice. High-quality workplace-based assessment programs require thoughtful choices about the framework of assessment, the tools themselves, the platforms used, and the contexts in which the assessments take place, with an emphasis on direct observation.
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Affiliation(s)
- John Q Young
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and, Zucker Hillside Hospital at Northwell Health, 75-59 263rd Street, Kaufman Building, Glen Oaks, NY 11004, USA.
| | - Jason R Frank
- Department of Emergency Medicine, University of Ottawa, Royal College of Physicians and Surgeons of Canada, 774 Echo Drive, Ottawa, Ontario K15 5NB, Canada
| | - Eric S Holmboe
- Accreditation Council for Graduate Medical Education, ACGME, 401 North Michigan Avenue, Chicago, IL 60611, USA
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34
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Colbert CY, Brateanu A, Nowacki AS, Prelosky-Leeson A, French JC. An Examination of Resident Perspectives on Survey Participation and Methodology: Implications for Educational Practice and Research. J Grad Med Educ 2021; 13:390-403. [PMID: 34178265 PMCID: PMC8207917 DOI: 10.4300/jgme-d-20-01431.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/05/2021] [Accepted: 03/25/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND In medical education, self-administered questionnaires are used to gather information for needs assessments, innovation projects, program evaluations, and research studies. Despite the importance of survey methodology, response rates have declined for years, especially for physicians. OBJECTIVE This study explored residents' experiences with survey participation and perceptions of survey design and implementation. METHODS In 2019, residents at a large Midwestern academic medical center were recruited via email to participate in mixed specialty focus groups (FGs). Narrative comments were recorded, transcribed, and then analyzed via conventional content analysis, utilizing cognitive sociology as a conceptual framework. Themes and subthemes were generated iteratively. RESULTS Postgraduate year 1-4 residents (n = 33) from internal medicine, surgery, and neurology participated in 7 FGs (3-7 participants/group) from April-May 2019. Eight themes were generated during content analysis: Negative emotions, professionalism, accuracy, impact, survey design/implementation, biases, survey fatigue, and anonymity. Residents questioned the accuracy of survey data, given the tendency for self-selection to drive survey participation. Residents wanted survey participation to be meaningful and reported non-participation for a variety of reasons, including doubts over impact. Satisficing and breakoffs were commonly reported. CONCLUSIONS Though residency program cultures differ across institutions, the findings from this study, including potential barriers to survey participation, should be relevant to anyone in graduate medical education using survey methodology for programmatic data collection, accreditation, and research purposes.
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Affiliation(s)
- Colleen Y. Colbert
- Colleen Y. Colbert, PhD, is Director, Office of Educator and Scholar Development, Education Institute, Cleveland Clinic, and Associate Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (CWRU)
| | - Andrei Brateanu
- Andrei Brateanu, MD, is Associate Program Director, Internal Medicine Residency Program, Cleveland Clinic, and Associate Professor of Medicine, Cleveland Clinic Lerner College of Medicine of CWRU
| | - Amy S. Nowacki
- Amy S. Nowacki, PhD, is Associate Staff Biostatistician, Department of Quantitative Health Sciences in the Lerner Research Institute at Cleveland Clinic, and Associate Professor of Medicine, Cleveland Clinic Lerner College of Medicine of CWRU
| | - Allison Prelosky-Leeson
- Allison Prelosky-Leeson, MEd, is Program Manager, Office of Educator and Scholar Development, Education Institute, Cleveland Clinic
| | - Judith C. French
- Judith C. French, PhD, is Vice Chair and Surgical Educator, General Surgery Residency Program, Cleveland Clinic, and Assistant Professor of Medicine, Cleveland Clinic Lerner College of Medicine of CWRU
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Areemit RS, Cooper CM, Wirasorn K, Paopongsawan P, Panthongviriyakul C, Ramani S. Hierarchy, "Kreng Jai" and Feedback: A Grounded Theory Study Exploring Perspectives of Clinical Faculty and Medical Students in Thailand. TEACHING AND LEARNING IN MEDICINE 2021; 33:235-244. [PMID: 33023318 DOI: 10.1080/10401334.2020.1813584] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Phenomenon: Institutional learning culture influences how feedback is provided, accepted, and acted upon. The Thai societal culture, characterized by strict hierarchy and collectivism, may have a significant impact on the learning culture and, therefore, feedback conversations between teachers and learners. This study explored: common approaches used by faculty to provide feedback to students; and faculty and student perspectives regarding sociocultural factors that impact feedback seeking, provision, and acceptance. Approach: Using a constructivist paradigm, we explored perspectives of clinical faculty and medical students at an academic medical center in Thailand using focus groups (students) and a focus group and individual interviews (faculty). Sessions were audiotaped, transcribed, and de-identified prior to analysis. Constant comparative analysis was performed on transcripts, focusing on perceived cultural factors that impacted feedback conversations. Findings: Thirty faculty participated in the study, four participated in a focus group, and 27 participated in individual interviews. Twenty-two medical students participated in four focus groups. We identified the following key themes, which could be grouped under three categories: (1) Faculty approaches to providing feedback (1.1) Feedback should be initiated by faculty. (1.2) Feedback is initiated primarily for deficit identification and correction. (2) Factors impacting students' feedback seeking and acceptance. (2.1) Students are willing to accept harsh feedback when it provides suggestions for improvement. (2.2) Feedback is most credible when faculty have direct knowledge of the student's effort. (2.3) Feedback seeking is considered a burden on teachers. (3) Cultural factors that influence feedback (3.1) Societal hierarchy perpetuates unidirectional top-down feedback. (3.2) Kreng jai (the balance between consideration for others and self-interests) affects feedback seeking and provision. Insights: Though the value of feedback on learning was emphasized by all participants, the hierarchical culture of Thai society was perceived to have a significant influence on feedback seeking, provision, and acceptance. Identifying and addressing societal as well as institutional cultural factors would be key in designing growth-enhancing feedback initiatives relevant to the local context. One size feedback training does not fit all.
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Affiliation(s)
- Rosawan S Areemit
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Cynthia M Cooper
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kosin Wirasorn
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Subha Ramani
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Valentine N, Durning S, Shanahan EM, Schuwirth L. Fairness in human judgement in assessment: a hermeneutic literature review and conceptual framework. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:713-738. [PMID: 33123837 DOI: 10.1007/s10459-020-10002-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/19/2020] [Indexed: 06/11/2023]
Abstract
Human judgement is widely used in workplace-based assessment despite criticism that it does not meet standards of objectivity. There is an ongoing push within the literature to better embrace subjective human judgement in assessment not as a 'problem' to be corrected psychometrically but as legitimate perceptions of performance. Taking a step back and changing perspectives to focus on the fundamental underlying value of fairness in assessment may help re-set the traditional objective approach and provide a more relevant way to determine the appropriateness of subjective human judgements. Changing focus to look at what is 'fair' human judgement in assessment, rather than what is 'objective' human judgement in assessment allows for the embracing of many different perspectives, and the legitimising of human judgement in assessment. However, this requires addressing the question: what makes human judgements fair in health professions assessment? This is not a straightforward question with a single unambiguously 'correct' answer. In this hermeneutic literature review we aimed to produce a scholarly knowledge synthesis and understanding of the factors, definitions and key questions associated with fairness in human judgement in assessment and a resulting conceptual framework, with a view to informing ongoing further research. The complex construct of fair human judgement could be conceptualised through values (credibility, fitness for purpose, transparency and defensibility) which are upheld at an individual level by characteristics of fair human judgement (narrative, boundaries, expertise, agility and evidence) and at a systems level by procedures (procedural fairness, documentation, multiple opportunities, multiple assessors, validity evidence) which help translate fairness in human judgement from concepts into practical components.
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Affiliation(s)
- Nyoli Valentine
- Prideaux Health Professions Education, Flinders University, Bedford Park 5042, SA, Australia.
| | - Steven Durning
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Ernst Michael Shanahan
- Prideaux Health Professions Education, Flinders University, Bedford Park 5042, SA, Australia
| | - Lambert Schuwirth
- Prideaux Health Professions Education, Flinders University, Bedford Park 5042, SA, Australia
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Dai CM, Bertram K, Chahine S. Feedback Credibility in Healthcare Education: a Systematic Review and Synthesis. MEDICAL SCIENCE EDUCATOR 2021; 31:923-933. [PMID: 34457934 PMCID: PMC8368112 DOI: 10.1007/s40670-020-01167-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 05/21/2023]
Abstract
PURPOSE The purpose of this study was to systematically review and synthesize factors that influence learners' perceptions of credibility when feedback is provided by an authority figure in a healthcare environment. METHODS This study reviewed literature from medicine, psychology, and education using systematic review and qualitative synthesis methods. In a multi-step process, major electronic bibliographic databases were searched for relevant studies until October 2020. RESULTS The search identified 9216 articles. A total of 134 abstracts underwent full-text review. Of these, 22 articles met inclusion criteria. The studies were heterogenous and the majority utilized a qualitative design with interviews and focus groups. A few studies employed mixed methodology (n = 2) and two studies used a quantitative design. Four main themes were identified: feedback characteristics, context of feedback, source credibility, and recipient characteristics. CONCLUSION As programs implement major educational change initiatives to create more formative assessment practices, feedback will become even more crucial. The four main themes identified are important factors that contribute to the perception of feedback credibility. While the factors are described independently, they may be viewed as interrelated and the association between these factors and feedback may be driven more by learning culture than each characteristic. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-020-01167-w.
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Affiliation(s)
- Cecilia M. Dai
- Schulich School of Medicine & Dentistry, Western University, London, Ontario Canada
- Health Sciences Addition, Western University, Room H110B, London, Ontario N6A 5C1 Canada
| | - Kaitlyn Bertram
- Royal Victoria Regional Health Centre (RVH), University of Toronto Department of Family and Community Medicine, Toronto, Ontario Canada
| | - Saad Chahine
- Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ontario Canada
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Pagram H, Bilszta JLC, Szabo RA. Defining competency for Royal Australian and New Zealand College of Obstetricians and Gynaecologists training: An exploratory study of Victorian Integrated Training Program coordinators' understanding of competency. Aust N Z J Obstet Gynaecol 2021; 61:454-462. [PMID: 33772747 DOI: 10.1111/ajo.13324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Competency-based medical education (CBME) is increasingly employed by postgraduate training programs worldwide, including obstetrics and gynaecology. Focusing on assessment of outcomes rather than time-in-training, and utilising a well-defined curricular framework, CBME aims to train doctors capable of meeting the needs of modern society. When this study was undertaken, in 2019, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) had a time-based curriculum and was due to undergo a curriculum review starting in 2020. AIMS To explore Victorian RANZCOG Integrated Training Program (ITP) coordinators' understanding of the concept of competency and how it is taught and assessed within RANZCOG training. MATERIALS AND METHODS A qualitative, grounded theory design using semi-structured interviews was employed. Victorian RANZCOG ITP coordinators from inner and outer metropolitan, and regional sites, were approached to participate. Transcripts were coded and analysed using thematic analysis. RESULTS Themes identified were: Competence, Vision and Innovation, Structures, ITP Coordinator Role and Teaching and Learning. Competence was defined as a combination of independent practice and understanding of ones' own limits, in addition to required clinical skills and knowledge. Enablers and barriers to achieving competency were identified and associated with structures, human and logistical factors. Victorian ITP coordinators believed the current training program has positive elements but could be further improved. CONCLUSIONS Several areas for future research were identified regarding understanding of competency, relevant if RANZCOG is to introduce a CBME framework. Replicating this research across all RANZCOG jurisdictions in Australia and New Zealand would be prudent to determine if the themes are universal.
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Affiliation(s)
| | - Justin L C Bilszta
- Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca A Szabo
- Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.,Gandel Simulation Service, The Royal Women's Hospital, Melbourne, Victoria, Australia
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Brand PLP, Jaarsma ADC, van der Vleuten CPM. Driving lesson or driving test? : A metaphor to help faculty separate feedback from assessment. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:50-56. [PMID: 32902828 PMCID: PMC7809072 DOI: 10.1007/s40037-020-00617-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Although there is consensus in the medical education world that feedback is an important and effective tool to support experiential workplace-based learning, learners tend to avoid the feedback associated with direct observation because they perceive it as a high-stakes evaluation with significant consequences for their future. The perceived dominance of the summative assessment paradigm throughout medical education reduces learners' willingness to seek feedback, and encourages supervisors to mix up feedback with provision of 'objective' grades or pass/fail marks. This eye-opener article argues that the provision and reception of effective feedback by clinical supervisors and their learners is dependent on both parties' awareness of the important distinction between feedback used in coaching towards growth and development (assessment for learning) and reaching a high-stakes judgement on the learner's competence and fitness for practice (assessment of learning). Using driving lessons and the driving test as a metaphor for feedback and assessment helps supervisors and learners to understand this crucial difference and to act upon it. It is the supervisor's responsibility to ensure that supervisor and learner achieve a clear mutual understanding of the purpose of each interaction (i.e. feedback or assessment). To allow supervisors to use the driving lesson-driving test metaphor for this purpose in their interactions with learners, it should be included in faculty development initiatives, along with a discussion of the key importance of separating feedback from assessment, to promote a feedback culture of growth and support programmatic assessment of competence.
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Affiliation(s)
- Paul L P Brand
- Department of Medical Education and Faculty Development, Isala Hospital, Isala Academy, Zwolle, The Netherlands.
- Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Centre Groningen, Groningen, The Netherlands.
| | - A Debbie C Jaarsma
- Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Centre Groningen, Groningen, The Netherlands
- Centre for Educational Development and Research (CEDAR), University Medical Centre Groningen, Groningen, The Netherlands
| | - Cees P M van der Vleuten
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Young JQ, Sugarman R, Schwartz J, O'Sullivan PS. Faculty and Resident Engagement With a Workplace-Based Assessment Tool: Use of Implementation Science to Explore Enablers and Barriers. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1937-1944. [PMID: 32568853 DOI: 10.1097/acm.0000000000003543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Implementation of workplace-based assessment programs has encountered significant challenges. Faculty and residents alike often have a negative view of these programs as "tick-box" or "jump through the hoops" exercises. A number of recommendations have been made to address these challenges. To understand the experience with a workplace-based assessment tool that follows many of these recommendations, the authors conducted a qualitative study using the Consolidated Framework for Implementation Research (CFIR) to identify enablers and barriers to engagement with the tool. METHOD The Psychopharmacotherapy-Structured Clinical Observation (P-SCO) is a direct observation tool designed to assess resident performance during a psychiatric medication management visit. From August 2017 to February 2018, the P-SCO was implemented in the outpatient continuity clinics for second- and third-year residents at Zucker Hillside Hospital/Northwell Health. In February and March 2019, the authors conducted semistructured interviews of participating faculty and residents. Interview guides based on the CFIR were used to capture the enablers and barriers to engagement. Interview transcripts were independently coded. Codes were then organized into themes relevant to the domains of the CFIR. RESULTS Ten faculty and 10 residents were interviewed. Overall, participants had a positive experience with the P-SCO. Enabling factors for faculty and residents included the ongoing training, design features of the P-SCO, predisposing beliefs, dedicated faculty time, and the perception that the P-SCO improved verbal feedback quality. Barriers for faculty included checklist length and discomfort with feedback that threatens identity, and barriers for residents included faculty variability in timeliness and quality of feedback and minimal review of the feedback after initial receipt. CONCLUSIONS This study demonstrates that the negative experience of faculty and residents with workplace-based assessment tools shown in prior studies can be overcome, at least in part, when specific implementation strategies are pursued. The findings provide guidance for future research and implementation efforts.
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Affiliation(s)
- John Q Young
- J.Q. Young is professor of psychiatry and vice chair for education, Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and Zucker Hillside Hospital at Northwell Health, Glen Oaks, New York
| | - Rebekah Sugarman
- R. Sugarman is a research assistant, Department of Psychiatry, Zucker Hillside Hospital at Northwell Health, Glen Oaks, New York
| | - Jessica Schwartz
- J. Schwartz is a resident, Department of Psychiatry, Zucker Hillside Hospital at Northwell Health, Glen Oaks, New York
| | - Patricia S O'Sullivan
- P.S. O'Sullivan is professor, Department of Medicine, and director of research and development in medical education, University of California, San Francisco, School of Medicine, San Francisco, California
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Branfield Day L, Miles A, Ginsburg S, Melvin L. Resident Perceptions of Assessment and Feedback in Competency-Based Medical Education: A Focus Group Study of One Internal Medicine Residency Program. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1712-1717. [PMID: 32195692 DOI: 10.1097/acm.0000000000003315] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE As key participants in the assessment dyad, residents must be engaged with the process. However, residents' experiences with competency-based medical education (CBME), and specifically with entrustable professional activity (EPA)-based assessments, have not been well studied. The authors explored junior residents' perceptions regarding the implementation of EPA assessment and feedback initiatives in an internal medicine program. METHOD From May to November 2018, 5 focus groups were conducted with 28 first-year internal medicine residents from the University of Toronto, exploring their experiences with facilitators and barriers to EPA-based assessments in the first years of the CBME initiative. Residents were exposed to EPA-based feedback tools from early in residency. Themes were identified using constructivist grounded theory to develop a framework to understand the resident perception of EPA assessment and feedback initiatives. RESULTS Residents' discussions reflected a growth mindset orientation, as they valued the idea of meaningful feedback through multiple low-stakes assessments. However, in practice, feedback seeking was onerous. While the quantity of feedback had increased, the quality had not; some residents felt it had worsened, by reducing it to a form-filling exercise. The assessments were felt to have increased daily workload with consequent disrupted workflow and to have blurred the lines between formative and summative assessment. CONCLUSIONS Residents embraced the driving principles behind CBME, but their experience suggested that changes are needed for CBME in the study site program to meet its goals. Efforts may be needed to reconcile the tension between assessment and feedback and to effectively embed meaningful feedback into CBME learning environments.
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Affiliation(s)
- Leora Branfield Day
- L. Branfield Day is a fourth-year chief medical resident, internal medicine training program, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amy Miles
- A. Miles is a fourth-year resident, geriatric medicine subspecialty training program, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shiphra Ginsburg
- S. Ginsburg is staff physician, Division of Respirology, Mount Sinai Hospital and University Health Network, professor, Department of Medicine, Faculty of Medicine, University of Toronto, and scientist, Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada
| | - Lindsay Melvin
- L. Melvin is assistant professor, Department of Medicine, Faculty of Medicine, University of Toronto, and staff physician, Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada
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Young JQ, Sugarman R, Schwartz J, O'Sullivan PS. Overcoming the Challenges of Direct Observation and Feedback Programs: A Qualitative Exploration of Resident and Faculty Experiences. TEACHING AND LEARNING IN MEDICINE 2020; 32:541-551. [PMID: 32529844 DOI: 10.1080/10401334.2020.1767107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Problem: Prior studies have reported significant negative attitudes amongst both faculty and residents toward direct observation and feedback. Numerous contributing factors have been identified, including insufficient time for direct observation and feedback, poorly understood purpose, inadequate training, disbelief in the formative intent, inauthentic resident-patient clinical interactions, undermining of resident autonomy, lack of trust between the faculty-resident dyad, and low-quality feedback information that lacks credibility. Strategies are urgently needed to overcome these challenges and more effectively engage faculty and residents in direct observation and feedback. Otherwise, the primary goals of supporting both formative and summative assessment will not be realized and the viability of competency-based medical education will be threatened. Intervention: Toward this end, recent studies have recommended numerous strategies to overcome these barriers: protected time for direct observation and feedback; ongoing faculty and resident training on goals and bidirectional, co-constructed feedback; repeated direct observations and feedback within a longitudinal resident-supervisor relationship; utilization of assessment tools with evidence for validity; and monitoring for engagement. Given the complexity of the problem, it is likely that bundling multiple strategies together will be necessary to overcome the challenges. The Direct Observation Structured Feedback Program (DOSFP) incorporated many of the recommended features, including protected time for direct observation and feedback within longitudinal faculty-resident relationships. Using a qualitative thematic approach the authors conducted semi-structured interviews, during February and March, 2019, with 10 supervisors and ten residents. Participants were asked to reflect on their experiences. Interview guide questions explored key themes from the literature on direct observation and feedback. Transcripts were anonymized. Two authors independently and iteratively coded the transcripts. Coding was theory-driven and differences were discussed until consensus was reached. The authors then explored the relationships between the codes and used a semantic approach to construct themes. Context: The DOSFP was implemented in a psychiatry continuity clinic for second and third year residents. Impact: Faculty and residents were aligned around the goals. They both perceived the DOSFP as focused on growth rather than judgment even though residents understood that the feedback had both formative and summative purposes. The DOSFP facilitated educational alliances characterized by trust and respect. With repeated practice within a longitudinal relationship, trainees dropped the performance orientation and described their interactions with patients as authentic. Residents generally perceived the feedback as credible, described feedback quality as high, and valued the two-way conversation. However, when receiving feedback with which they did not agree, residents demurred or, at most, would ask a clarifying question, but then internally discounted the feedback. Lessons Learned: Direct observation and structured feedback programs that bundle recent recommendations may overcome many of the challenges identified by previous research. Yet, residents discounted disagreeable feedback, illustrating a significant limitation and the need for other strategies that help residents reconcile conflict between external data and one's self-appraisal.
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Affiliation(s)
- John Q Young
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Rebekah Sugarman
- Department of Psychiatry, The Zucker Hillside Hospital at Northwell Health, Glen Oaks, New York, USA
| | - Jessica Schwartz
- Department of Psychiatry, The Zucker Hillside Hospital at Northwell Health, Glen Oaks, New York, USA
| | - Patricia S O'Sullivan
- Office of Medical Education, University of California San Francisco, San Francisco, California, USA
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Sharma N. Providing Effective Feedback in Breast Imaging to Improve Trainee Performance. JOURNAL OF BREAST IMAGING 2020; 2:390-397. [PMID: 38424963 DOI: 10.1093/jbi/wbaa036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Indexed: 03/02/2024]
Abstract
While feedback is an essential component of medical education, feedback to trainees is frequently nonspecific and not focused on performance improvement. Providing specific feedback to trainees helps them to reflect, develop self-assessment skills, and recalibrate. In light of increasing clinical volumes, stresses related to modern healthcare delivery, and high physician burnout, instructors need efficient methods to provide actionable feedback to trainees. For breast imaging radiologists involved in education, improving feedback skills can help their learners develop expertise in breast imaging while also attracting and inspiring the next generation of radiologists.
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Affiliation(s)
- Nidhi Sharma
- University of Texas at Austin, Department of Diagnostic Radiology, Austin, TX
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MacNeil K, Cuncic C, Voyer S, Butler D, Hatala R. Necessary but not sufficient: identifying conditions for effective feedback during internal medicine residents' clinical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:641-654. [PMID: 31872326 DOI: 10.1007/s10459-019-09948-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 12/12/2019] [Indexed: 06/10/2023]
Abstract
Competency-based medical education and programmatic assessment intend to increase the opportunities for meaningful feedback, yet these conversations remain elusive. By comparing resident and faculty perceptions of feedback opportunities within one internal medicine residency training program, we sought to understand whether and how principles underlying meaningful feedback could be supported or constrained across a variety of feedback opportunities. Using case-study qualitative methodology, interviews and focus groups were conducted to explore 19 internal medicine residents' and 7 faculty members' perceptions of feedback across a variety of feedback opportunities: coaching, mini-CEXs, in-training evaluation reports and routine clinical supervision. Our data analysis moved iteratively between developing conceptual understandings and fine-grained analyses, while attending to both deductive and inductive analysis. Our results suggest that all feedback opportunities, including those created through formalized assessments, can foster meaningful feedback if faculty establish a trusting relationship with the resident, base their feedback on direct observation and support resident learning. However, formalized assessments were often perceived as inhibiting the conditions for meaningful feedback. A coaching program provided a context in which meaningful feedback could arise, in part because faculty were supported in shifting their focus from patient to resident. Meaningful feedback in clinical education may be fostered across a variety of feedback opportunities, however, it is often constrained by assessment. We must consider whether increasing the frequency of formative assessments may inhibit efforts to improve our feedback cultures while, in contrast, freeing up faculty to focus on supporting resident learning could improve these cultures.
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Affiliation(s)
- Kimberley MacNeil
- Department of Educational & Counselling Psychology, and Special Education, Faculty of Education, University of British Columbia, Vancouver, Canada
| | - Cary Cuncic
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Stéphane Voyer
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Deborah Butler
- Department of Educational & Counselling Psychology, and Special Education, Faculty of Education, University of British Columbia, Vancouver, Canada
| | - Rose Hatala
- Centre for Health Education Scholarship and Department of Medicine, St. Paul's Hospital, University of British Columbia, Suite 5907 Burrard Bldg, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
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Ginsburg S, Kogan JR, Gingerich A, Lynch M, Watling CJ. Taken Out of Context: Hazards in the Interpretation of Written Assessment Comments. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1082-1088. [PMID: 31651432 DOI: 10.1097/acm.0000000000003047] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE Written comments are increasingly valued for assessment; however, a culture of politeness and the conflation of assessment with feedback lead to ambiguity. Interpretation requires reading between the lines, which is untenable with large volumes of qualitative data. For computer analytics to help with interpreting comments, the factors influencing interpretation must be understood. METHOD Using constructivist grounded theory, the authors interviewed 17 experienced internal medicine faculty at 4 institutions between March and July, 2017, asking them to interpret and comment on 2 sets of words: those that might be viewed as "red flags" (e.g., good, improving) and those that might be viewed as signaling feedback (e.g., should, try). Analysis focused on how participants ascribed meaning to words. RESULTS Participants struggled to attach meaning to words presented acontextually. Four aspects of context were deemed necessary for interpretation: (1) the writer; (2) the intended and potential audiences; (3) the intended purpose(s) for the comments, including assessment, feedback, and the creation of a permanent record; and (4) the culture, including norms around assessment language. These contextual factors are not always apparent; readers must balance the inevitable need to interpret others' language with the potential hazards of second-guessing intent. CONCLUSIONS Comments are written for a variety of intended purposes and audiences, sometimes simultaneously; this reality creates dilemmas for faculty attempting to interpret these comments, with or without computer assistance. Attention to context is essential to reduce interpretive uncertainty and ensure that written comments can achieve their potential to enhance both assessment and feedback.
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Affiliation(s)
- Shiphra Ginsburg
- S. Ginsburg is professor of medicine, Department of Medicine, Faculty of Medicine, University of Toronto, scientist, Wilson Centre for Research in Education, University Health Network, University of Toronto, Toronto, Ontario, Canada, and Canada Research Chair in Health Professions Education; ORCID: http://orcid.org/0000-0002-4595-6650. J.R. Kogan is professor of medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. A. Gingerich is assistant professor, Northern Medical Program, University of Northern British Columbia, Prince George, British Columbia, Canada; ORCID: http://orcid.org/0000-0001-5765-3975. M. Lynch is postdoctoral fellow, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. C.J. Watling is professor, Department of Clinical Neurological Sciences, scientist, Centre for Education Research and Innovation, and associate dean of postgraduate medical education, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; ORCID: http://orcid.org/0000-0001-9686-795X
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Ramani S, Könings KD, Ginsburg S, van der Vleuten CPM. Relationships as the Backbone of Feedback: Exploring Preceptor and Resident Perceptions of Their Behaviors During Feedback Conversations. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1073-1081. [PMID: 31464736 DOI: 10.1097/acm.0000000000002971] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Newer definitions of feedback emphasize learner engagement throughout the conversation, yet teacher and learner perceptions of each other's behaviors during feedback exchanges have been less well studied. This study explored perceptions of residents and faculty regarding effective behaviors and strategies during feedback conversations and factors that affected provision and acceptance of constructive feedback. METHOD Six outpatient internal medicine preceptors and 12 residents at Brigham and Women's Hospital participated (2 dyads per preceptor) between September 2017 and May 2018. Their scheduled feedback conversations were observed by the lead investigator, and one-on-one interviews were conducted with each member of the dyad to explore their perceptions of the conversation. Interviews were transcribed and analyzed for key themes. Because participants repeatedly emphasized teacher-learner relationships as key to meaningful feedback, a framework method of analysis was performed using the 3-step relationship-centered communication model REDE (relationship establishment, development, and engagement). RESULTS After participant narratives were mapped onto the REDE model, key themes were identified and categorized under the major steps of the model. First, establishment: revisit and renew established relationships, preparation allows deeper reflection on goals, set a collaborative agenda. Second, development: provide a safe space to invite self-reflection, make it about a skill or action. Third, engagement: enhance self-efficacy at the close, establish action plans for growth. CONCLUSIONS Feedback conversations between longitudinal teacher-learner dyads could be mapped onto a relationship-centered communication framework. Our study suggests that behaviors that enable trusting and supportive teacher-learner relationships can form the foundation of meaningful feedback.
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Affiliation(s)
- Subha Ramani
- S. Ramani is associate professor of medicine, Harvard Medical School, director, Scholars in Medical Education Pathway, Internal Medicine Residency Program, Brigham and Women's Hospital, and leader of research and scholarship, Harvard Macy Institute, Boston, Massachusetts; ORCID: https://orcid.org/0000-0002-8360-4031. K.D. Könings is associate professor, Department of Educational Development and Research and School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0003-0063-8218. S. Ginsburg is professor of medicine (respirology) and scientist, Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada. C.P.M. van der Vleuten is director, School of Health Professions Education, and professor of education, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0001-6802-3119
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Bakke BM, Sheu L, Hauer KE. Fostering a Feedback Mindset: A Qualitative Exploration of Medical Students' Feedback Experiences With Longitudinal Coaches. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1057-1065. [PMID: 32576764 DOI: 10.1097/acm.0000000000003012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE Feedback is important for medical students' development. Recent conceptualizations of feedback as a dialogue between feedback provider and recipient point to longitudinal relationships as a facilitator of effective feedback discussions. This study illuminates how medical students experience feedback within a longitudinal relationship with a physician coach. METHOD In this qualitative study, second-year medical students from the University of California, San Francisco, School of Medicine participated in semistructured interviews that explored their experiences discussing feedback within longitudinal, nonevaluative coaching relationships. Interviews occurred between May and October 2018. Interview questions addressed students' experiences receiving feedback from their coach, how and when they used this feedback, and how their relationship with their coach influenced engagement in feedback discussions. Interviews were analyzed using constructivist grounded theory. RESULTS Seventeen students participated. The authors identified 3 major themes. First, students' development of a feedback mindset: Over time, students came to view feedback as an invaluable component of their training. Second, setting the stage for feedback: Establishing feedback routines and a low-stakes environment for developing clinical skills were important facilitators of effective feedback discussions. Third, interpreting and acting upon feedback: Students described identifying, receiving, and implementing tailored and individualized feedback in an iterative fashion. As students gained comfort and trust in their coaches' feedback, they reported increasingly engaging in feedback conversations for learning. CONCLUSIONS Through recurring feedback opportunities and iterative feedback discussions with coaches, students came to view feedback as essential for growth and learning. Longitudinal coaching relationships can positively influence how students conceptualize and engage in feedback discussions.
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Affiliation(s)
- Brian M Bakke
- B.M. Bakke is a third-year medical student, University of California, San Francisco, School of Medicine, San Francisco, California. L. Sheu is assistant professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. K.E. Hauer is professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California; ORCID: https://orcid.org/0000-0002-8812-4045
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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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Schut S, van Tartwijk J, Driessen E, van der Vleuten C, Heeneman S. Understanding the influence of teacher-learner relationships on learners' assessment perception. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:441-456. [PMID: 31664546 PMCID: PMC7210223 DOI: 10.1007/s10459-019-09935-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 10/21/2019] [Indexed: 05/26/2023]
Abstract
Low-stakes assessments are theorised to stimulate and support self-regulated learning. They are feedback-, not decision-oriented, and should hold little consequences to a learner based on their performance. The use of low-stakes assessment as a learning opportunity requires an environment in which continuous improvement is encouraged. This may be hindered by learners' perceptions of assessment as high-stakes. Teachers play a key role in learners' assessment perceptions. By investigating assessment perceptions through an interpersonal theory-based perspective of teacher-learner relationships, we aim to better understand the mechanisms explaining the relationship between assessment and learning within medical education. First, twenty-six purposefully selected learners, ranging from undergraduates to postgraduates in five different settings of programmatic assessment, were interviewed about their assessment task perception. Next, we conducted a focussed analysis using sensitising concepts from interpersonal theory to elucidate the influence of the teacher-learner relationship on learners' assessment perceptions. The study showed a strong relation between learners' perceptions of the teacher-learner relationship and their assessment task perception. Two important sources for the perception of teachers' agency emerged from the data: positional agency and expert agency. Together with teacher's communion level, both types of teachers' agency are important for understanding learners' assessment perceptions. High levels of teacher communion had a positive impact on the perception of assessment for learning, in particular in relations in which teachers' agency was less dominantly exercised. When teachers exercised these sources of agency dominantly, learners felt inferior to their teachers, which could hinder the learning opportunity. To utilise the learning potential of low-stakes assessment, teachers are required to stimulate learner agency in safe and trusting assessment relationships, while carefully considering the influence of their own agency on learners' assessment perceptions. Interpersonal theory offers a useful lens for understanding assessment relationships. The Interpersonal Circumplex provides opportunities for faculty development that help teachers develop positive and productive relationships with learners in which the potential of low-stakes assessments for self-regulated learning is realised.
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Affiliation(s)
- Suzanne Schut
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, 6229 ER, Maastricht, The Netherlands.
| | - Jan van Tartwijk
- Department of Education, Utrecht University, Utrecht, The Netherlands
| | - Erik Driessen
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, 6229 ER, Maastricht, The Netherlands
| | - Cees van der Vleuten
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, 6229 ER, Maastricht, The Netherlands
| | - Sylvia Heeneman
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
- Department of Pathology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Robins L, Smith S, Kost A, Combs H, Kritek PA, Klein EJ. Faculty Perceptions of Formative Feedback from Medical Students. TEACHING AND LEARNING IN MEDICINE 2020; 32:168-175. [PMID: 31523994 DOI: 10.1080/10401334.2019.1657869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Phenomenon: Feedback given by medical students to their teachers during a clerkship has the potential to improve learning by communicating students' needs and providing faculty with information on how to adjust their teaching. Aligning student learning needs and faculty teaching approach could result in increased student understanding and skill development before a clerkship's end. However, little is known about faculty perceptions of formative feedback from medical students and how faculty might respond to such feedback. Approach: In this qualitative study, semistructured interviews of 24 third-year clerkship faculty were conducted to explore faculty opinions about receiving formative feedback from students. Transcripts of these interviews were reviewed, and content analysis was performed. Findings: Faculty endorsed the idea of obtaining formative feedback from medical students. However, probing revealed factors that would significantly influence their receptivity and response to the feedback provided, including (a) who would be giving the feedback, (b) what content was included in the feedback, (c) how the feedback was framed, and (d) why the feedback was given. Although participants endorsed the concept of receiving formative feedback from medical students, their accounts of how they might respond to it presented a mixed picture of receptivity, acceptance, and response. Insights: These findings have practical implications. If formative feedback from medical students to faculty is to be encouraged, institutions need to find ways of creating a feedback culture in which more dialogic models become "the norm" and work with faculty to increase their receptivity to and acceptance of student feedback. This is essential for students to feel safe and be safe from retribution when providing insights into how faculty can better meet their learning needs.
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Affiliation(s)
- Lynne Robins
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Sherilyn Smith
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Amanda Kost
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Heidi Combs
- Department of Psychiatry, University of Washington, Seattle, Washington, USA
| | - Patricia A Kritek
- Department of Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Eileen J Klein
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
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