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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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Koch R, Braun J, Joos S. Feedback in family medicine clerkships: a qualitative interview study of stakeholders in community-based teaching. MEDICAL EDUCATION ONLINE 2022; 27:2077687. [PMID: 35583293 PMCID: PMC9122355 DOI: 10.1080/10872981.2022.2077687] [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] [Received: 11/12/2021] [Revised: 03/27/2022] [Accepted: 05/11/2022] [Indexed: 05/29/2023]
Abstract
Feedback is an important aspect of teaching and learning in medical education. Irrespective of the training environment, too little effective dialogic feedback occurs. Community-based outpatient learning environments, such as general practitioner practices, have heterogeneous framework conditions regarding feedback that decrease feedback quality. To improve feedback in this setting, characteristics of feedback in such learning environments must be considered. This study aims to reveal such characteristics from different perspectives and derive ideas for improving feedback in community-based learning environments. Three stakeholder groups in family medicine clerkships as an example of community-based learning environments (n = 15 students, n = 12 faculty and administrative staff, n = 13 general physician trainers) were interviewed for this study. Transcripts of the interviews were analysed with qualitative content analysis. All stakeholders interviewed note a lack of feedback between groups. Feedback in primary care practices takes place in specific contexts (e.g., during vs after a consultation, during vs at the end of the clerkship) and is provided in different ways (e.g., verbal vs nonverbal). Barriers of effective feedback in community-based settings are: lack of opportunity/initiation, fear of giving feedback, unawareness (of correct feedback and/or lack of prior experience with feedback), and little basis for feedback. Currently, the exchange between the university and community-based learning environments is limited to grading and report writing, with little sharing of meaningful information. The potential of a better exchange between those within community-based learning environments and the university to improve feedback processes is not reached. This exchange and the framework conditions specific for the community-based learning environment should be considered as parts of the structural dimension of feedback. Teachers and course managers of family medicine institutes are in an important position to shape these factors actively, working together with stakeholders of community-based teaching.
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Affiliation(s)
- Roland Koch
- Universitätsklinikum Tübingen, Institute for General Practice and Interprofessional Health Care, Tübingen, Germany
| | - Julia Braun
- Universitätsklinikum Tübingen, Institute for General Practice and Interprofessional Health Care, Tübingen, Germany
| | - Stefanie Joos
- Universitätsklinikum Tübingen, Institute for General Practice and Interprofessional Health Care, Tübingen, Germany
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Roberts A, Jellicoe M, Fox K. How does a move towards a coaching approach impact the delivery of written feedback in undergraduate clinical education? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:7-21. [PMID: 34518963 PMCID: PMC8938375 DOI: 10.1007/s10459-021-10066-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 08/22/2021] [Indexed: 06/13/2023]
Abstract
Feedback uptake relies on interactions between learners and educators Winstone (Educ Psychol 52: 17-37, 2017). Feedback that coaches using a feedforward approach, is considered to be more personal and emotionally literate Bussey (Bull R Coll Surg Engl 99: 180-182, 2017), Hattie (Rev Educ Res 77: 81-112, 2007). Many modes of feedback are employed in clinical teaching environments, however, written feedback is particularly important, as a component of feedback discourse, as significant time may elapse before a similar clinical situation is encountered. In practice, time constraints often result in brief or descriptive written feedback rather than longer coaching feedback. This study aimed to explore whether a change in ethos and staff development would encourage clinical dental tutors to utilise a coaching approach in their written feedback. Across two time-points, written feedback was categorised into either descriptive, evaluative or coaching approaches. Cross-sections of data from 2017 to 2019 were examined to determine whether changes in practice were noted and whether there were any alterations in the affective nature of the language used. Feedback moved significantly towards coaching and away from a descriptive approach. A shift towards the use of more positive language was seen overall, although this was solely driven by a change in the evaluative feedback category. Descriptive feedback generally used neutral language with coaching feedback using marginally more positive language. Both categories employed significantly lower levels of affective language than evaluative feedback. These data indicate a move towards feedback approaches and language that may support increased uptake and utilisation of feedback.
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Affiliation(s)
- Amanda Roberts
- Education Research and Scholarship Group, The School of Dentistry, The University of Liverpool, Pembroke Place, Liverpool, L3 5PS, United Kingdom.
| | - Mark Jellicoe
- Education Research and Scholarship Group, The School of Dentistry, The University of Liverpool, Pembroke Place, Liverpool, L3 5PS, United Kingdom
| | - Kathryn Fox
- Education Research and Scholarship Group, The School of Dentistry, The University of Liverpool, Pembroke Place, Liverpool, L3 5PS, United Kingdom
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Huq AJ, Healy L, Gorelik A, Forrest LE, Winship IM. Mainstreaming genomics: training experience of hospital medical officers at the Royal Melbourne Hospital. Intern Med J 2021; 51:268-271. [PMID: 33631848 DOI: 10.1111/imj.15185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 10/20/2020] [Accepted: 10/27/2020] [Indexed: 01/09/2023]
Abstract
The rapid evolution and wide applicability of genomic testing means that medical practitioners outside the field are not appropriately skilled to understand the utility of genomics for their patients. Rotating junior doctors through genomic medicine provides them with the hands-on experience necessary to understand the complexities in this field. In this study, we analysed the training experience of 12 hospital medical officers who rotated through genomic medicine at the Royal Melbourne Hospital. Here, we demonstrate that immersion in clinical genomics aids in mainstreaming genomics knowledge.
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Affiliation(s)
- Aamira J Huq
- Department of Genomic Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Lachlan Healy
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Alexandra Gorelik
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia
| | - Laura E Forrest
- Department of Genomic Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ingrid M Winship
- Department of Genomic Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Thai TTN, Pham TT, Nguyen KT, Nguyen PM, Derese A. Can a family medicine rotation improve medical students' knowledge, skills and attitude towards primary care in Vietnam? A pre-test-post-test comparison and qualitative survey. Trop Med Int Health 2019; 25:264-275. [PMID: 31674702 DOI: 10.1111/tmi.13326] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Well-designed studies on the impact of a family medicine rotation on medical students are rare, and very few studies include a qualitative component. This study aimed to determine the improvement of medical students' knowledge, communication skills and attitude towards primary care and explore their perceptions after rotations, in comparison with a control group. METHODS We used a mixed-methods design, comprising a pre-test-post-test comparison between a sample of trained students who took family medicine rotations and a control group and a qualitative survey. The measurement of improvement included (i) multiple choice question testing, (ii) objective structured checklist examinations, (iii) self-reporting and (iv) interviews and focus group discussions. Data were collected from August 2017 to June 2018. RESULTS There were 696 students in the trained group and 617 controls. The two groups' baseline scores in knowledge, communication skills and attitude were not significantly different. Knowledge covering five domains of family medicine (Pearson's r from 0.6 to 0.9) improved significantly, as did attitudes towards primary care in the trained group. There were no differences in communication and counselling skills between the two groups for four situations, but for two-health check-ups and mental health care-skills were significantly improved (Pearson's r from 0.28 to 0.43). The qualitative survey showed highly positive feedback from trained students. CONCLUSIONS The family medicine rotation significantly improved students' knowledge and attitude towards primary care and some communication skills. Further studies should investigate students' interest in and career choice for this discipline.
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Affiliation(s)
- Thuy T N Thai
- Department of Family Medicine, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Tam T Pham
- Faculty of Public Health, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Kien T Nguyen
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Phuong M Nguyen
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam.,Skills Training Unit, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Anselme Derese
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Oliveira Franco RL, Martins Machado JL, Satovschi Grinbaum R, Martiniano Porfírio GJ. Barriers to outpatient education for medical students: a narrative review. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2019; 10:180-190. [PMID: 31562805 PMCID: PMC6773369 DOI: 10.5116/ijme.5d76.32c5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 09/09/2019] [Indexed: 06/01/2023]
Abstract
OBJECTIVES This study surveys medical education literature published over the last 25 years (1993-2018) to identify the factors scholars consider deleterious to outpatient teaching for medical students. METHODS This study conducts a review of medical education literature published between 1993 and 2018 using Medline, Lilacs, Ibecs, Cochrane Library, and Scielo databases. The following search terms were utilized: "Education, Medical, Undergraduate" AND "Ambulatory Care" AND "Teaching/methods" OR "Clinical Clerkship" OR "Preceptorship." This study focuses on papers describing deleterious factors for outpatient teaching with medical students and analyzes their results, discussions, and conclusions sections. RESULTS Of the 363 articles obtained, this study selected 33 for analysis. These papers identify numerous factors as barriers to outpatient education. For didactic purposes, these factors are categorized into four barrier groups: environment-institution, academic staff, students, and patients. Academic staff-related teaching barrier was the most frequently mentioned obstacle. Intense care schedule with little teaching time was considered the most common and relevant barrier to outpatient medical education, followed by inappropriate teaching environment and inadequate supervision model. CONCLUSIONS There is a lack of recent literature on studies focusing on barriers to effective outpatient medical education. Factors identified as harmful to outpatient education have been pointed out by course directors, academic staff, and students in the literature. However, many of these factors remain overlooked by educators, who can use these factors to modify their academic activities for more effective results.
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Affiliation(s)
- Ricardo Luiz Oliveira Franco
- Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), Pós Graduação em Ciências da Saúde, Brazil
| | - José Lúcio Martins Machado
- Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), Pós Graduação em Ciências da Saúde, Brazil
| | - Renato Satovschi Grinbaum
- Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), Pós Graduação em Ciências da Saúde, Brazil
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