Teaching on the run tips 10: giving feedback

A Structured Peer Assessment Method with Regular Reinforcement Promotes Longitudinal Self-Perceived Development of Medical Students' Feedback Skills

BACKGROUND

Given that training is integral to providing constructive peer feedback, we examined the impact of a regularly reinforced, structured peer assessment method on student-reported feedback abilities throughout a two-year preclinical Communication Skills course.

METHODS

Three consecutive 32-student medical school classes were introduced to the Observation-Reaction-Feedback method for providing verbal assessment during Year 1 Communication Skills orientation. In biweekly small-group sessions, students received worksheets reiterating the method and practiced giving verbal feedback to peers. Periodic questionnaires evaluated student perceptions of feedback delivery and the Observation-Reaction-Feedback method.

RESULTS

Biweekly reinforcement of the Observation-Reaction-Feedback method encouraged its uptake, which correlated with reports of more constructive, specific feedback. Compared to non-users, students who used the method noted greater improvement in comfort with assessing peers in Year 1 and continued growth of feedback abilities in Year 2. Comfort with providing modifying feedback and verbal feedback increased over the two-year course, while comfort with providing reinforcing feedback and written feedback remained similarly high. Concurrently, student preference for feedback anonymity decreased.

CONCLUSIONS

Regular reinforcement of a peer assessment framework can increase student usage of the method, which promotes the expansion of self-reported peer feedback skills over time. These findings support investigation of analogous strategies in other medical education settings.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01242-w.

Planning peer assisted learning (PAL) activities in clinical schools

Peer Assisted Learning (PAL) is well accepted as an educational method within health professional education, involving a process of socialisation among students. PAL activities provide a framework whereby students are permitted to practice and develop their healthcare and teaching skills. However, the success of PAL activities is dependent upon two key factors: the "agency" of the individual students, that is, their willingness to participate; and importantly, the "affordance" of the activity, that is, the invitational quality provided by the clinical school. The purpose of this paper is to assist healthcare educators and administrators responsible for curriculum design, course co-ordination, and educational research, in developing their own PAL activities. Health professional students and junior health professionals leading or participating in PAL activities may also find the paper useful. Based on the authors' collective experience, and relevant literature, we provide practical tips for the design, implementation and evaluation of PAL activities.

Resident identification of feedback and teaching on rounds

Feedback and teaching occur regularly on teaching hospital wards. Although feedback has important implications for resident learning, residents often report that they receive little feedback. The significant overlap of teaching and feedback in clinical education may contribute to resident difficulty with feedback identification. We sent a survey with seven scenarios to internal medicine residents across the country. Two of the scenarios contained teaching, two contained feedback, and three contained combined teaching and feedback. From October 2017 to April 2018, 17% of residents (392/2346) from 17 residency programs completed the survey. Participating residents correctly identified both feedback scenarios 89% of the time, both teaching scenarios 64% of the time, and all three combined teaching and feedback scenarios 38% of the time. Interns were less likely than upper-level residents to correctly identify combined teaching and feedback scenarios (P = 0.005). Residents may have difficulty identifying feedback in the context of teaching. This confusion may contribute to residents' perceptions that they receive little feedback.

Unearthing Faculty and Trainee Perspectives of Feedback in Internal Medicine: the Oral Case Presentation as a Model

BACKGROUND

The case presentation is a fundamental activity used in both patient care and trainee education, partly due to feedback from supervisor to trainee. Although feedback in medical education is well studied, prior studies have not focused on the perceptions of feedback by Internal Medicine supervisors and trainees as it relates to clinical activities like the case presentation.

METHODS

Semi-structured interviews were conducted with eight Internal Medicine physicians, and 18 Internal Medicine trainees (5 medical students, 13 residents) at the University of Toronto. Purposive sampling was used. Interviews were conducted and coded iteratively within a constructivist grounded theory approach until saturation was reached.

RESULTS

Supervisors and trainees recognized feedback as an important part of the case presentation that can be (1) explicit, labeled feedback or (2) implicit, unlabeled feedback. Both trainees and supervisors perceived that not enough feedback occurs, likely stemming from a hesitancy by supervisors to label implicit feedback, calling it an interruption instead. Although trainees were keenly aware of non-verbal feedback from their supervisors as implicit feedback, they often interpreted explicit constructive feedback negatively. Interestingly, the same feedback from senior residents was regarded as highly educational, as it was uncoupled from assessment.

CONCLUSION

Feedback occurs more frequently in case presentations than previously described, particularly in an implicit, unlabeled format. Even though under-recognized, trainees identify and utilize implicit feedback from supervisors, and coaching from senior residents, to develop learned behaviors. This is reassuring in the age of Competency-Based Medical Education, as feedback has an essential role in workplace-based assessment and promotion.

Assessment of Learner Metacognition in a Professional Pharmacy Elective Course

Objective. To investigate the effect of strategic feedback and metacognitive processes on learners' ability to predict performance and improve self-awareness. Methods. Strategic faculty and peer feedback, as well as self-assessments, were implemented in a professional pharmacy elective course throughout the semester, focused on three case-based oral presentations. After each presentation, students utilized an objective rubric to determine self-predicted and peer-predicted scores. Actual scores from faculty were compared to students' predicted scores. Results. Students' ability to predict presentation scores did not improve over time; however, students were able to accurately estimate performance in certain rubric sections on individual presentations (depth of problem, presentation). Students were generally overconfident in predicting their performance. When broken down into tertiles, top performing students were more accurate in their self-assessments compared to bottom performing students. Bottom performing students were highly overconfident in their assessment. Conclusion. Self-awareness is essential for professionals, though difficult to cultivate and improve in one semester. Incorporating longitudinal, continuous feedback and metacognitive skills may help learners become more aware of their own performance and devise a plan for enhancement.

Identifying educator behaviours for high quality verbal feedback in health professions education: literature review and expert refinement

BACKGROUND

Health professions education is characterised by work-based learning and relies on effective verbal feedback. However the literature reports problems in feedback practice, including lack of both learner engagement and explicit strategies for improving performance. It is not clear what constitutes high quality, learner-centred feedback or how educators can promote it. We hoped to enhance feedback in clinical practice by distinguishing the elements of an educator's role in feedback considered to influence learner outcomes, then develop descriptions of observable educator behaviours that exemplify them.

METHODS

An extensive literature review was conducted to identify i) information substantiating specific components of an educator's role in feedback asserted to have an important influence on learner outcomes and ii) verbal feedback instruments in health professions education, that may describe important educator activities in effective feedback. This information was used to construct a list of elements thought to be important in effective feedback. Based on these elements, descriptions of observable educator behaviours that represent effective feedback were developed and refined during three rounds of a Delphi process and a face-to-face meeting with experts across the health professions and education.

RESULTS

The review identified more than 170 relevant articles (involving health professions, education, psychology and business literature) and ten verbal feedback instruments in health professions education (plus modified versions). Eighteen distinct elements of an educator's role in effective feedback were delineated. Twenty five descriptions of educator behaviours that align with the elements were ratified by the expert panel.

CONCLUSIONS

This research clarifies the distinct elements of an educator's role in feedback considered to enhance learner outcomes. The corresponding set of observable educator behaviours aim to describe how an educator could engage, motivate and enable a learner to improve. This creates the foundation for developing a method to systematically evaluate the impact of verbal feedback on learner performance.

Application of the one-minute preceptor technique by novice teachers in the gross anatomy laboratory

The one-minute preceptor (OMP) was originally developed in the ambulatory care setting as a time-efficient teaching technique for learner-centered clinical training. There are also possible advantages of using the OMP in the gross anatomy laboratory. However, in a previous study it was found that providing training to experienced gross anatomy teachers in the use of the OMP did not result in improvement in students' perceptions of their learning, probably because of the fact that the experienced teachers had already developed their own pedagogical approaches. In the current study, we examined the effects of training novice teachers with about four years of gross anatomy teaching experience, in the use of the OMP in the gross anatomy laboratory, by surveying students to collect their views on their learning experiences, by observing the teachers' teaching behaviors before and after they were trained in OMP, and then by interviewing them. More students reported a better learning experience in the session after the teachers had been trained in the OMP than reported worse, in eight out of the nine items related to their learning experiences. The novice teachers were receptive to the OMP. After the OMP training, the novice teachers were observed to engage more in getting commitments from the students and in reinforcing what the students have done right, two of the five OMP microskills. They considered the OMP to be very useful for their development as anatomy teachers.

The positive impact of structured teaching in the operating room

BACKGROUND

A survey of obstetric and gynaecology trainees in Australia found the trainee's opinion of the consultants' teaching ability for laparoscopic procedures and procedures dealing with complications as 'poor' in 21.2% and 23.4% of responses, respectively (Aust NZ J Obstet Gynaecol 2009; 49: 84). Surgical caseload per trainee is falling for a variety of reasons. Strategies need to be adopted to enhance the surgical learning experience of trainees in the operating room.

AIMS

We describe the use of a structured encounter template to facilitate the teaching of surgery in the operating room and report the response of the trainees to this intervention.

METHODS

Trainees attached to a gynaecologic surgery unit all underwent surgical training using a set format based on the surgical encounter template, including briefing, goal setting and intra-operative teaching aims as well as debriefing. Data on the trainees' experience and perception of their learning experience were then collected and analysed as quantitative and qualitative data sets.

RESULTS

The trainees reported satisfaction with the use of a structured encounter template to facilitate the surgical teaching in the operating room. Some trainees had not received such clarity of feedback or the opportunity to complete a procedure independently prior to using the structured encounter template.

CONCLUSIONS

A structured surgical encounter template based on andragogy principles to focus consultant teaching in the operating room is highly acceptable to obstetric and gynaecology trainees in Australia. Allowing the trainee the opportunity to set objectives and receive feedback empowers the trainee and enhances their educational experience.

Engaging Medical Students in the Basic Science Years with Clinical Teaching

Education of future medical practitioners involves the stewarding of knowledge and skills, and the development of values required for responsible practice. Students must not only master a vast amount of knowledge and theory but also understand how to apply it. A key challenge for medical educators is to approach this in a balanced and integrated manner, particularly within the basic science years of the medical program. The purpose of this article is to consider how the clinical environment, teaching methods, assessment, and feedback impact on the engagement of junior medical students.

Senior medical student perceived ability and experience in giving peer feedback in formative long case examinations

BACKGROUND

Learning to provide feedback on a peer's performance in formative clinical assessments can be a valuable way of enriching the students' own learning experience. Students are often reluctant to provide honest, critical feedback to their peers. Nevertheless, it is an area of practice that is important to develop as students report feeling ill prepared in feedback techniques when entering the medical workforce. We sought to investigate students' perceptions of their ability to provide feedback to their peers using the positive critique method, and their perceived benefits and challenges during the experience.

METHODS

Over a two year period (2011 to 2012), senior medical students assessed and gave feedback to their peers alongside academic examiners during formative long case clinical examinations. Rating scales, open ended questions and focus group discussions were used to evaluate student perceptions.

RESULTS

Of the 94 participants, 89/94 (95%) completed the questionnaire, and 39/94 (41%) participated in focus groups. Students found the positive critique method provided a useful framework. Some students raised concerns about the accuracy of their feedback, and felt that further training was required. A substantial number of respondents (42%) did not report feeling confident providing negative feedback to their peers, and qualitative analysis indicated concerns around potential impacts on social relationships. Despite these concerns, the majority (90%) of respondents found the exercise useful, identifying several benefits, including development in the understanding of knowledge content; development of professionalism skills, and increased responsibility.

CONCLUSION

Students identified several challenging aspects to providing feedback to their peers. While the experience of giving feedback to peers was perceived by students to provide a valuable learning experience, further training in this area may help to improve the learning experience for students and better prepare them for their future careers.

Training the endoscopy trainer: from general principles to specific concepts

Endoscopy instruction has progressed a great deal in recent years, evolving from the age-old dictum of 'see one, do one' to the current skillful application of sound educational principles. Some of these educational principles are generic and applicable to the teaching of any content at all levels, while others are quite specific to technical skills training. The present review summarizes these important principles under the following headings: creating a learner-centred curriculum; delivering an achievable learning task; and moving from theory to practice. The present article challenges national gastroenterology organizations to embrace these concepts in structured, outcome-based educational programs.

Effect of feedback from standardized patients on medical students' performance and perceptions of the neurological examination

BACKGROUND

Feedback can have a powerful influence on the performance of learners, and has traditionally been provided by faculty.

AIM

This study set out to explore whether feedback from a standardized patient (SP) can improve students' performance of the neurological examination.

METHODS

A randomized controlled design was used with final year medical students. The control group did not receive any feedback. The intervention groups received either written feedback or a combination of written and verbal feedback. A written test was given prior to the intervention to assess comparability of the three groups. Pretest and post-test scores on the neurological examination were compared. Attitudinal questionnaires were administered at the time of the posttest, and 6 months later.

RESULTS

Students receiving feedback from the SPs had significantly greater scores on the posttest than the control group. In the intervention groups, students receiving both verbal and written feedback scored significantly higher than those who received only written feedback. More positive perceptions of learning outcomes and the value of SP feedback were noted in the intervention groups.

CONCLUSION

SP feedback was associated with a significant increase in student scores on the neurological examination, as well as more favorable perceptions of the experience.

Spaced education improves the feedback that surgical residents give to medical students: a randomized trial

BACKGROUND

Surgery residents teach medical students; feedback is one critical teaching skill. We investigated whether feedback given by surgery residents to students could be improved through an online spaced education program.

METHODS

Surgery residents were randomized to receive either a weekly spaced education e-mail during a 9-month period containing teaching bullets on how to provide effective feedback, or no intervention. Medical students rated the frequency and quality of feedback they received from the residents.

RESULTS

Students reported 45% (67 of 149) of the spaced education residents gave frequent feedback, compared with 31% (55 of 175) of control residents (relative risk [RR], 1.43; P = .016). Students reported resident feedback was "helpful in their learning" in 92% (132 of 143) of their evaluations of spaced education residents, compared with 82% (132 of 161) of their evaluations of control residents (RR, 1.13; P = .01).

CONCLUSIONS

Educational programs using feedback bullets e-mailed weekly can significantly improve the frequency and quality of feedback that surgical residents provide medical students.

Optimizing training: what clinicians have to offer and how to deliver it

Since experienced clinicians spend a substantial proportion of their time teaching and supervising trainees, a working knowledge of adult learning is of value. This knowledge will not only make you a more effective teacher, but will be of benefit to you when you are learning new information. There are a number of important issues to keep in mind when teaching your adult trainees. For example, recognize the short attention span of adult learners (10-15 min only!); keep your teaching and learning in context (i.e. clinically relevant); set clear, achievable learning objectives; give regular, constructive feedback to your trainees; and be aware your trainees will have different learning styles and no single teaching method is best for all. Assessment of your trainees needs to cover many different domains, including; knowledge, clinical competence, communication skills (written and verbal), procedural skills, teamwork and professionalism. Clearly, multiple methods of assessment will be essential. Further, a number of observers will be required to improve the validity of these assessment activities.

What is feedback in clinical education?

OBJECTIVE

Feedback is important in clinical education. However, the medical education literature provides no consensual definition of feedback. The aim of this study is to propose a consensual, research-based, operational definition of feedback in clinical education. An operational definition is needed for educational practice and teacher training, and for research into the effectiveness of different types of feedback.

METHODS

A literature search about definitions of feedback was performed in general sources, meta-analyses and literature reviews in the social sciences and other fields. Feedback definitions given from 1995 to 2006 in the medical education literature are also reviewed.

RESULTS

Three underlying concepts were found, defining feedback as 'information'; as 'reaction', including information, and as a 'cycle', including both information and reaction. In most medical education and social science literature, feedback is usually conceptualised as information only. Comparison of feedback definitions in medical education reveals at least 9 different features. The following operational definition is proposed. Feedback is: 'Specific information about the comparison between a trainee's observed performance and a standard, given with the intent to improve the trainee's performance.'

CONCLUSIONS

Different conceptual representations and the use of different key features might be a cause for inconsistent definitions of feedback. The characteristics, strengths and weaknesses of this research-based operational definition are discussed.