Factors influencing trainers' feedback-giving behavior: a cross-sectional survey

Feedback in medical education - a workshop report with practical examples and recommendations

Background: As a teaching method, feedback is an integral part of medical education. However, there is a lack of a uniform theoretical basis or generally recognized guidelines for its specific design. Against this background, the aim of this article is to discuss conceptual considerations and empirical findings regarding feedback using various practical examples. Procedure and conceptual considerations: Building on the results of a workshop of the Committee for Communicative and Social Competences of the Society for Medical Education (GMA), this article first explains central conceptual considerations and empirical results on the topic of feedback. A particular focus is on various variables that influence the effect of feedback. This includes the feedback source, the frequency of feedback, starting points of feedback, the connection between feedback and reflection as well as the motivation and meta-cognitive skills of the feedback recipient. Practical examples: The implementation of feedback in practice is illustrated using eight examples from the field of medical and dental education. They stem from various settings and the focus is on formative oral feedback. It will become evident that the focus is more on the givers of feedback than the recipients of feedback. Instructions for recipients of feedback on how to reflect on it is still the exception. Discussion: Many of the relevant aspects for the effect of feedback described in the literature are already taken into account in the practical examples discussed. In conclusion, seven recommendations are made for implementing feedback in practice.

A systematic review of supervisory relationships in general practitioner training

OBJECTIVES

The educational alliance is argued to be at the heart of supervision in medical education. This review aims to map the research field and develop a conceptualisation of the nature of such educational alliances within postgraduate supervision for general practitioners.

METHODS

An integrative review of the international literature on supervision from 2011 to 2018 was undertaken, and papers assessed for relevance and quality. Data analysis incorporated framework analysis techniques. Bordin's working alliance-based model of supervision was used as a springboard for synthesis, as well as allowing for the emergence of new ideas, theories and concepts from the literature.

RESULTS

A total of 49 full texts were included for analysis. There was evidence of the importance of trust, agreement and bond in accordance with Bordin's model. The results also highlighted the importance of greater clarity on supervisory goals, and the tasks to support these goals, to effectively address competing priorities and roles within supervision. Non-hierarchical relationships were advocated, although supervisors must remain impartial in their assessment and monitoring roles. The influence of the wider practice community and situated learning through legitimate peripheral participation are documented. A model of General practice (GP) supervision is proposed that integrates the findings.

CONCLUSIONS

GP supervision requires a greater emphasis than is suggested by the working alliance model, both on the clarity of expectations and the appreciation of the multiple roles and competing priorities of both trainee and supervisor. Furthermore, as GP supervision develops within the rising workload of contemporary general practice, the role of the wider community of practice may become more prominent. We have adapted the working alliance model for postgraduate General practice (GP) supervision, emphasising the explicit sharing of expectations relating to goals, tasks and roles to facilitate negotiation and agreement.

Theory, a lost character? As presented in general practice education research papers

OBJECTIVES

The use of theory in research is reflected in its presence in research writing. Theory is often an ineffective presence in medical education research papers. To progress the effective use of theory in medical education, we need to understand how theory is presented in research papers. This study aims to elicit how theory is being written into general practice (GP) vocational education research papers in order to elucidate how theory might be more effectively used. This has relevance for the field of GP and for medical education more broadly.

METHODS

This is a scoping review of the presentation of theory in GP vocational education research published between 2013 and 2017. An interpretive approach is taken. We frame research papers as a form of narrative and draw on the theories of Aristotle's poetics and Campbell's monomyth. We seek parallels between the roles of theory in a research story and theories of characterisation.

RESULTS

A total of 23 papers were selected. Theories of 'reflective learning', 'communities of practice' and 'adult learning' were most used. Six tasks were assigned to theory: to align with a position; to identify a research problem; to serve as a vehicle for an idea; to provide a methodological tool; to interpret findings, and to represent an object of examination. The prominence of theory in the papers ranged from cameo to major roles. Depending on the way theory was used and the audience, theory had different impacts. There were parallels between the tasks assigned to theory and the roles of four of Campbell's archetypal characters. Campbell's typology offers guidance on how theory can be used in research paper 'stories'.

CONCLUSIONS

Theory can be meaningfully present in the story of a research paper if it is assigned a role in a deliberate way and this is articulated. Attention to the character development of theory and its positioning in the research story is important.

Pharmacy Preceptor Judgments of Student Performance and Behavior During Experiential Training

Objective. To report the findings of how Canadian preceptors perceive and subsequently evaluate diverse levels of trainees during pharmacy clerkships. Methods. Using modified Delphi technique, 17 Doctor of Pharmacy (PharmD) preceptors from across Canada categorized 16 student narrative descriptions pertaining to their perception of described student performance: exceeds, meets, or falls below their expectations. Results. Twelve (75%) student narratives profiles were categorized unanimously in the final round, six of which were below expectations. Out of 117 ratings of below expectations by responding preceptors, the majority (115, 98%) of post-baccalaureate PharmD students described would fail. Conversely, if the same narrative instead profiled a resident or an entry-to-practice PharmD student, rotation failure decreased to 95 (81%) and 89 (76%), respectively. Conclusion. Pharmacy preceptors do not uniformly judge the same described student performance and inconsistently apply failing rotation grades when they do agree that performance falls below expectations.

Effect of individual structured and qualified feedback on improving clinical performance of dental students in clinical courses-randomised controlled study

AIM

Analysis of the effect of individual structured and qualified feedback (FB) on practical skills development of dental students during clinical courses.

METHODS

Fifty-three final-year dental students at Jena University Hospital participated in this prospective randomised controlled interventional study. Two calibrated assessors evaluated 128 pre- and post-assessments of 4 different dental treatment steps performed by dental students during the integrated clinical course in restorative dentistry and prosthodontics and the clinical course paediatric dentistry. The assessment included direct observation, graded and non-grading evaluation and was documented with a specific FB assessment tool. Dental students in the intervention group (IG) received an elaborated, structured and qualified FB after the pre-assessment that focussed on individual strengths and weaknesses, providing specific suggestions for improvement and establishing a personal learning goal. Participants were randomly allocated to the IG and the control group (CG).

RESULTS

In both groups, dental students significantly enhanced their performance, but the difference was higher in the IG than in the CG. Large effect sizes (ES) were observed in all observed items, but FB had largest effect size in improving technical skills (ES = 1.6), followed by management (ES = 1.3) and communication skills (ES = 0.8). Factors with the highest influence on FB in enhancing dental students' clinical performance were their insight into their own mistakes or omissions, the observed dental treatment step and the duration of FB.

CONCLUSION

Individual structured and qualified FB is an effective method to enhance dental students' professional performances and to individually guide the learning process.

Patterns of direct observation and their impact during residency: general practice supervisors' views

CONTEXT

Direct observation (DO) of residents' performance, despite the importance that is ascribed to it, does not readily fit in with the practice of postgraduate medical education (PGME); it is infrequent and the quality of observation may be poor in spite of ongoing efforts towards improvement. In recent literature, DO is mostly portrayed as a means to gather information on the performance of residents for purposes of feedback and assessment. The role of DO in PGME is likely to be more complex and poorly understood in the era of outcome-based education. By exploring the possible complexity of DO in workplace learning, our research aims to contribute to a better use of DO in the practice of PGME.

METHODS

Constructivist grounded theory informed our data collection and analysis. Data collection involved focus group sessions with supervisors in Dutch general practice who were invited to discuss the manifestations, meanings and effects of DO of technical skills. Theoretical sufficiency was achieved after four focus groups, with a total of 28 participants being included.

RESULTS

We found four patterns of DO of technical skills: initial planned DO sessions; resident-initiated ad hoc DO; supervisor-initiated ad hoc DO, and continued planned DO sessions. Different patterns of DO related to varying meanings, such as checking or trusting, and effects, such as learning a new skill or experiencing emotional discomfort, all of them concerning the training relationship, patient safety or residents' learning.

CONCLUSIONS

Direct observation, to supervisors, means much more than gathering information for purposes of feedback and assessment. Planned DO sessions are an important routine during the initiation phase of a training relationship. Continued planned bidirectional DO sessions, although infrequently practised, potentially combine most benefits with least side-effects of DO. Ad hoc DO, although much relied upon, is often hampered by internal tensions in supervisors, residents or both.

Analysis of dental students' written peer feedback from a prospective peer assessment protocol

INTRODUCTION

Peer assessment and feedback is encouraged to enhance students' learning. The aim of this study was to quantitatively and qualitatively analyse pre-clinical and clinical dental students' written peer feedback provided as part of a continuous, formative and structured peer assessment protocol.

MATERIALS AND METHODS

A total of 309 Year-2 and Year-5 dental students were invited to participate in a peer assessment and peer feedback protocol. Consenting volunteer students were trained to observe each other whilst working in the skills laboratory (Year-2) and in the dental clinic (Year-5). Subsequently, they followed a structured protocol of peer assessment and peer feedback using specially designed work-based forms during a complete academic year. The content of their written feedback was coded according to the UK General Dental Council domain, sign (positive or negative), specificity (task specific or general), and grouped into themes.

RESULTS

A total of 108 participants (40 Year-2 and 68 Year-5) completed 1169 peer assessment work-based forms (516 pre-clinical and 653 clinical); 94% contained written feedback. The large majority (82%) of Year-2 feedback represented the clinical domain, 89% were positive, 77% were task specific, and they were grouped into 14 themes. Year-5 feedback was related mostly to Management and Leadership (37%) and Communication (32%), 64% were positive, 75% task specific, and they were clustered into 24 themes.

DISCUSSION

The content of the feedback showed notable differences between Year-2 and Year-5 students. Senior students focused more on Communication and Management and Leadership skills, whilst juniors were more concerned with clinical skills. Year-5 students provided 13% negative feedback compared to only 2% from Year-2. Regulatory focus theory is discussed to explain these differences. Both groups provided peer feedback on a wide and different range of themes. However, four themes emerged in both groups: efficiency, infection control, time management and working speed.

CONCLUSION

A structured peer assessment framework can be used to guide pre-clinical and clinical students to provide peer feedback focused on different domains, and on contrasting signs and specificities. It can also present an opportunity to complement tutors' feedback.