Feedback in the OSCE: What Do Residents Remember?

Abstract

Theory: The move to competency-based education has heightened the importance of direct observation of clinical skills and effective feedback. The Objective Structured Clinical Examination (OSCE) is widely used for assessment and affords an opportunity for both direct observation and feedback to occur simultaneously. For feedback to be effective, it should include direct observation, assessment of performance, provision of feedback, reflection, decision making, and use of feedback for learning and change. Hypotheses: If one of the goals of feedback is to engage students to think about their performance (i.e., reflection), it would seem imperative that they can recall this feedback both immediately and into the future. This study explores recall of feedback in the context of an OSCE. Specifically, the purpose of this study was to (a) determine the amount and the accuracy of feedback that trainees remember immediately after an OSCE, as well as 1 month later, and (b) assess whether prompting immediate recall improved delayed recall. Methods: Internal medicine residents received 2 minutes of verbal feedback from physician examiners in the context of an OSCE. The feedback was audio-recorded and later transcribed. Residents were randomly allocated to the immediate recall group (immediate-RG; n = 10) or the delayed recall group (delayed-RG; n = 8). The immediate-RG completed a questionnaire prompting recall of feedback received immediately after the OSCE, and then again 1 month later. The delayed-RG completed a questionnaire only 1 month after the OSCE. The total number and accuracy of feedback points provided by examiners were compared to the points recalled by residents. Results comparing recall at 1 month between the immediate-RG and the delayed-RG were also studied. Results: Physician examiners provided considerably more feedback points (M = 16.3) than the residents recalled immediately after the OSCE (M = 2.61, p < .001). There was no significant difference between the number of feedback points recalled upon completion of the OSCE (2.61) compared to 1 month later (M = 1.96, p = .06, Cohen's d = .70). Prompting immediate recall did not improve later recall. The mean accuracy score for feedback recall immediately after the OSCE was 4.3/9 or “somewhat representative,” and at 1 month the score dropped to 3.5/9 or “not representative” (ns). Conclusion: Residents recall very few feedback points immediately after the OSCE and 1 month later. The feedback points that are recalled are neither very accurate nor representative of the feedback actually provided.