Quality of written feedback given to medical students after introduction of real-time audio monitoring of clinical encounters

Michael Sanatani,Kimberly Trudgeon,Kylea Potvin,Henry Conter,Andrew Warner

doi:10.1186/s12909-020-02158-6

Michael Sanatani, Kimberly Trudgeon + Show 3 more

Open Access

https://doi.org/10.1186/s12909-020-02158-6

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Abstract

BackgroundDirect observation is necessary for specific and actionable feedback, however clinicians often struggle to integrate observation into their practice. Remotely audio-monitoring trainees for periods of time may improve the quality of written feedback given to them and may be a minimally disruptive task for a consultant to perform in a busy clinic.MethodsVolunteer faculty used a wireless audio receiver during the second half of students’ oncology rotations to listen to encounters during clinic in real time. They then gave written feedback as per usual practice, as did faculty who did not use the listening-in intervention. Feedback was de-identified and rated, using a rubric, as strong/medium/weak according to consensus of 2/3 rating investigators.ResultsMonitoring faculty indicated that audio monitoring made the feedback process easier and increased confidence in 95% of encounters. Most students (19/21 respondents) felt monitoring contributed positively to their learning and included more useful comments.101 written evaluations were completed by 7 monitoring and 19 non-monitoring faculty. 22/23 (96%) of feedback after monitoring was rated as high quality, compared to 16/37 (43%) (p < 0.001) for monitoring faculty before using the equipment (and 20/78 (26%) without monitoring for all consultants (p < 0.001)). Qualitative analysis of student and faculty comments yielded prevalent themes of highly specific and actionable feedback given with greater frequency and more confidence on the part of the faculty if audio monitoring was used.ConclusionsUsing live audio monitoring improved the quality of written feedback given to trainees, as judged by the trainees themselves and also using an exploratory grading rubric. The method was well received by both faculty and trainees. Although there are limitations compared to in-the-room observation (body language), the benefits of easy integration into clinical practice and a more natural patient encounter without the observer physically present lead the authors to now use this method routinely while teaching oncology students.

Highlights

Direct observation is necessary for specific and actionable feedback, clinicians often struggle to integrate observation into their practice
Direct observation in medical education is a necessary prerequisite activity for the provision of clinical formative feedback [1, 2], and it is thought that the main contribution to enhanced learning from direct observation occurs based on its facilitation of constructive and valid feedback, or “coaching” The combination of initially observing a trainee perform a clinical task, and having a faculty-trainee dialogue about the current performance, comparing it to an ideally attainable goal and exploring ways to move towards that level, can be called coaching and is a commonly used conceptual framework of clinical and bedside teaching [3]
Feedback quality For evaluations with included audio monitoring of the trainee, 22/23 (96%) evaluations were rated as high quality, as compared to 20/78 (26%) for all evaluations completed without the consultant having listened in via the audio monitor (p < 0.001) (Fig. 1)

Summary

Introduction

Direct observation is necessary for specific and actionable feedback, clinicians often struggle to integrate observation into their practice. Direct observation in medical education is a necessary prerequisite activity for the provision of clinical formative feedback [1, 2], and it is thought that the main contribution to enhanced learning from direct observation occurs based on its facilitation of constructive and valid feedback, or “coaching” The combination of initially observing a trainee perform a clinical task, and having a faculty-trainee dialogue about the current performance, comparing it to an ideally attainable goal and exploring ways to move towards that level, can be called coaching and is a commonly used conceptual framework of clinical and bedside teaching [3] It is an integral part of competency based medical education (CBME) and introducing it to clinical teaching is one of the main challenges in the transition to CBME. Trainees value feedback of high quality, yet surveys consistently demonstrate a low rate of feedback felt to be of good quality according to the framework outlined above

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