Providing contextually apt feedback in clinical education

The American Journal of Surgery, 2003

Background: Students consistently identified inadequate feedback as a deficiency in our third-year clerkship. Methods: We asked students to solicit one faculty and one resident every 2 weeks for written feedback on a "feedback prescription pad." Each prescription requested four comments: two things the student did well and two things the student needs to improve. Students rated feedback using a five-point scale. A three-point categorization scheme was employed to assess the quality of feedback. Results: Students' rating of feedback improved significantly compared with a previous time period (3.5 Ϯ 1.2 versus 2.6 Ϯ 1.2, P Ͻ0.01). Interrater reliability of our categorization scheme was high (kappa Ն0.75, P Ͻ0.01) and demonstrated that only 10% of comments were specific enough to qualify as effective feedback. Conclusions: Feedback prescription pads were a simple method to facilitate feedback. Although students appreciated feedback, most feedback was inadequate. Faculty development programs to enhance student feedback should be a priority of clinical medical education.

Journal of general internal medicine, 1998

We investigated naturally occurring feedback incidents to substantiate literature-based recommended techniques for giving feedback effectively. A faculty development course for improving the teaching of the medical interview, with opportunities for participants to receive feedback. Seventy-four course participants (clinician-educators from a wide range of medical disciplines, and several behavioral scientists). We used qualitative and quantitative approaches. Participants provided narratives of helpful and unhelpful incidents experienced during the course and then rated their own narratives using a semantic-differential survey. We found strong agreement between the two approaches, and congruence between our data and the recommended literature. Giving feedback effectively includes: establishing an appropriate interpersonal climate; using an appropriate location; establishing mutually agreed upon goals; eliciting the learner's thoughts and feelings; reflecting on observed behavior...

JPMA. The Journal of the Pakistan Medical Association, 2017

Feedback is considered as a dynamic process in which information about the observed performance is used to promote the desirable behaviour and correct the negative ones. The importance of feedback is widely acknowledged, but still there seems to be inconsistency in the amount, type and timing of feedback received from the clinical faculty. No significant effort has been put forward from the educator end to empower the learners with the skills of receiving and using the feedback effectively. Some institutions conduct faculty development workshops and courses to facilitate the clinicians on how best to deliver constructive feedback to the learners. Despite of all these struggles learners are not fully satisfied with the quality of feedback received from their busy clinicians. The aim of this paper is to highlight what actually feedback is, type and structure of feedback, the essential components of a constructive feedback, benefits of providing feedback, barriers affecting the provisi...

The Clinical Teacher, 2015

Feedback involves much more than providing potentially useful information to learners about their work. The challenge is now on how to engage with learners in ways likely to result in discernable change and the nature of the conditions necessary to ensure that feedback discussions are likely to be acted upon. The main aspects of assessment and feedback drawn on here are those that focus on how assessment and feedback can contribute to the ongoing learning of students (and indeed all health professionals) and the need for feedback to actually influence what students do. Defining feedback Higher education programmes are more frequently criticised in student surveys for deficiencies in assessment and feedback than any other aspect. This has resulted in renewed interest in what feedback is and how it can work effectively. In particular, it has led to recognition that feedback in clinical settings, just like feedback in any other context, must be characterised not solely in terms of inputs that are made, but effects that result. The definition of feedback 1 in Box 1 highlights this change in thinking. Teachers, or others offering feedback information, can therefore only confirm that learning has resulted from information provided if students act on it, to complete a feedback loop. 2 Box 1: Definition of feedback '…a process whereby learners obtain information about their work in order to appreciate the similarities and differences between the appropriate standards for any given work, and the qualities of the work itself, in order to generate improved work.' 1

Teaching and Learning in Medicine, 2006

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BMC Medical Education, 2016

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.

Medical Education, 2013

ELT Journal, 2013

The conclusive statement of this reflective study regarding feedback strategies recommends a mixed-methods approach that is tailored to the type of formative assessment and the individual learner requirements. It should be timely and communicate in a manner that is accessible to all learners and therefore should not be over congested or descriptive. In. classroom environments, where timely feedback is required to address issues within the class, oral feedback is recommended, as it offers the most direct form of communication though which mutual dialogue can take place. The most commonly appropriated feedback strategies framework employed within this session was the medal and mission approach, this reflective study does not suggest that this is the sole approach warranted within the learning environment, although it recommends using one through which constructive criticism and praise can be utilised. Although it has been acknowledge praise must be used sparingly it has been indicated to promote confidence, self-efficacy and motivation within learners which serves as a vital tool for all learners if they are to progress. Peer feedback and peer assessment has its pitfalls as well as being a valuable tool within our teaching arsenal. Managing how this formative assessment tool however is complex but vital to promote group cohesion, mutual learning, and autonomy within learners. We should encourage learners to invest time in a ‘critical friend’ and view their methodology and performance from a new perspective if we are to support them in their progress to autonomy.

Medical Education, 2014