The development of a feedback quality instrument to guide verbal feedback for health professionals in the workplace

Abstract

Health professional education is based on an apprenticeship model, where a novice gradually transforms into a skilled, independent practitioner under the tuition and supervision of an expert in the workplace. A key component of this education involves an educator observing a learner undertaking a clinical task, followed by feedback. Many influential authorities argue that feedback is the key to developing mastery. However, despite the promise of feedback offering valuable benefits, the literature exposes that it is fraught with problems for both the giver and receiver. Poor feedback can result in negative emotions (anger, humiliation, demotivation), damaged relationships and deterioration in performance. Therefore it is important to establish those elements of feedback that improve learner motivation, learning and performance. The specific focus of this thesis is on the health professional educator's contribution to high quality feedback during scheduled, face-to face meetings that follow observation of a learner performing a task in the workplace. It focuses on the educator's role in facilitating the learner to improve their skills. This thesis has two sections. The first section explores the literature to identify verbal feedback quality instruments, and evidence or argument for elements concerning an educator's contribution to high quality verbal feedback. The comprehensive literature review involved health professions, education, psychology and business literature. Ten instruments (or parts of instruments) or modifications of these instruments were found that assessed verbal feedback quality in health professional education. None of them were based on a comprehensive literature review and designed to assess the quality of a health professional educator's contribution to feedback following observation of a learner performing a task in the workplace. Eighteen elements for optimising the educator's role in feedback were developed from the literature review. The second section of this thesis describes the development and refinement of an instrument to assess and guide a health professional educator's contribution to feedback following observation of a learner performing a task in the workplace. Initial items were developed by the research team through thematic analysis; they evolved from the 18 elements through an iterative process of item refinement and reduction. This initial set of items for the Feedback Quality Instrument (FQI) was then tested using a Delphi technique involving a panel of experts, who rated the importance and phrasing of the items, to establish an expert consensus over three rounds. The first round of panel feedback and subsequent item refinement are presented in this thesis. At that stage, the FQI contained 27 items that describe observable educator behaviour in feedback. The FQI is designed to promote best practice by drawing educator and learner attention to features of effective feedback. Although the instrument analyses the educator's performance, the items describe educator behaviour that facilitates learner engagement in feedback and learning. It invites multiple perspectives on the educator's performance as it can be completed by the educator themselves (selfappraisal), the learner, or an independent observer. The development of the FQI has continued beyond the stages reported in this minor thesis. The items have been refined with two additional Delphi rounds and the process is being prepared for publication. Future plans to continue the evolution of the FQI have been developed. This includes organising a focus group involving the expert panel to further refine the instrument before testing; cost associated with assembling the panel has been funded by a grant. When items and a rating scale are finalised, comprehensive testing of the instrument will enable refinement and establish acceptability, feasibility and reliability. Finally external funding will be sought to conduct a randomised controlled trial to test the impact of the instrument on the quality of an educator's feedback and, most importantly, the impact of high quality feedback on a learner's performance.