Giving feedback to medical students and trainees: rules and realities

Improving feedback literacy in a primary care rotation

Primary care education is a unique clinical experience for medical students. It is community-based and provides an opportunity for students to learn consultation skills with multiple sources of workplace-based feedback. Meaningful and demonstrable utilisation of this feedback by students remains an educational challenge. We showcase achievable changes to educational tasks in an established curriculum, which aim to improve student feedback literacy and create a feedback loop which improves on previous provision of unidirectional, terminal feedback. The changes have been well-received, with student and educator engagement being positive. Students have demonstrated critical reflection on feedback, and development in consultation and clinical reasoning skills.

Strengthening the feedback culture in a postgraduate residency program

BACKGROUND

Feedback is defined as specific information presented to a learner that facilitates professional development through the process of reflection. Timely provision of constructive feedback to learner is important in optimizing the learning curve. The aim of the current study was to see the effectiveness of various interventions on feedback practices of faculty members.

METHODS

This is a quasi-experimental study (pre- and postdesign). It was conducted from November 2009 to March 2011 at The Aga Khan University, Pakistan. Faculty development workshops, allotment of specified feedback time, and restructuring of residency feedback forms were done as interventions. Data collection was done pre- and postintervention. Resident's and faculty satisfaction regarding the feedback process were evaluated using a prepiloted questionnaire. Paired t-test was applied to assess the effect of interventions on faculty and resident's satisfaction.

RESULTS

The mean satisfaction scores of residents were significantly improved (P < 0.05). Pre- and postintervention faculty satisfaction score also demonstrated significant difference in overall satisfaction level, from 47.88 ± 13.92 to 63.40 ± 8.72 (P < 0.05).

DISCUSSION

This study showed improved faculty engagement and satisfaction for the provision of feedback to the trainee resident. Strengthening this, culture requires continuous reinforcement, individualized feedback to the faculty members regarding their feedback practices, and continuing faculty development initiatives.

Reflecting on exchange students' learning: Structure, objectives and supervision

Background and aim: The increasing opportunities for medical students to participate in international electives may improve students' professionalism and cultural competence. However, the students' overall experiences may be unpredictable, unstructured and lack supervision. There is scant evidence with respect to their learning outcomes. These reflections demonstrate that short-term supervised elective can provide students with structured learning experiences to achieve specific learning objectives.Methods: We carried out daily debriefs and a weekly summary with seven Curtin Medical School students from Perth, Australia during an 18-days supervised elective in the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. The daily debriefs and the weekly summary in different disciplines become the content of the reflections discussed in this article.Results: The main themes identified in the feedback were as follows: Skills in history taking and physical examination; clinical reasoning; diagnosis and management of diseases rarely seen in Australia; awareness of clinical ethics; merits and demerits of different systems of healthcare; sensitivity to issues in doctor-patient relationships; work ethics; enhancement of cultural competence; and personal development.Conclusions: These reflections provide insight into how overseas electives may be structured to improve students' clinical reasoning skills in this hospital. These students achieved their learning outcomes under joint supervision from both institutions. The clinical skills learned from these experiences enhanced the students' professionalism and cultural competence, giving students the opportunities to appreciate the multitude healthcare model of bio-psycho-social-political-economical-spiritual dimensions.

Multiprofessional in situ simulation is an effective method of identifying latent patient safety threats on the gastroenterology ward

OBJECTIVE

In situ simulation (ISS) is an effective training method for multiprofessional teams dealing with emergencies in high pressured environments. A regular ISS programme was organised for the multiprofessional gastroenterology team with a primary objective of identifying, classifying and addressing latent patient safety threats and secondary objectives of improving team confidence and individual role recognition.

METHOD

22 unannounced ISS sessions (averaging approximately one session every 6 weeks and four participants per session) were conducted between February 2017 and August 2019 involving multiprofessional team members. The sessions centred around the following four common gastrointestinal emergency scenarios: massive upper gastrointestinal haemorrhage; biliary sepsis (cholangitis) and shock; postendoscopic retrograde cholangiopancreatography complications including perforation and cardiac arrest. Following the simulation, the faculty, which included nurses and doctors, facilitated a structured debrief session and action plan to identify and address latent errors.

RESULTS

96 participants from nursing, medical, physician associate and pharmacy backgrounds took part in the simulation programme. Analysis of collected latent safety threats identified the following four themes: education and training; equipment; medication and team working. Analysis of anonymously completed questionnaires identified that 95% of participants had a perceived better understanding of their role and 86% felt more confident in assessing an unwell patient. 96% of participants felt comfortable during the debrief.

CONCLUSION

ISS provides a unique opportunity to train the multiprofessional gastroenterology team in their own high-pressured environment, helping identify and address latent patient safety threats and improve perceived participant confidence and role recognition.