Using peer feedback in a formative objective structured clinical examination

Abstract

Context and setting With the increasing emphasis on learner autonomy, the use of self- and peer feedback may be viewed as preparation for lifelong learning and as an essential generic professional skill. Its potential in the learning setting implies a need to explore ways of training people to provide immediate feedback that is constructive, is delivered with sensitivity and can encourage insight into personal performance. Why the idea was necessary Key needs identified were: (i) to support student practice and learning in professional communication skills and feedback, and (ii) to maximise feedback opportunities even in a culture that might thwart attempts owing to the pressures of a high student : staff ratio. What was done Students in graduate-entry programmes in medicine and nursing took part in a formative objective structured clinical examination (OSCE) consisting of three 5-minute stations (based on their problem-based learning cases) in which actors were used as simulated patients. Students developed their own marking schemes using a constructivist approach. These were compared with pre-prepared mark sheets and any variations were discussed. Each student took part in three iterations of the three-station OSCE as either the ‘candidate’, ‘examiner’ or ‘observer’. In the introductory session, students watched a DVD on giving feedback, and then rehearsed ways of phrasing responses on good practice and areas for improvement. Students in the role of candidate rotated through each of the OSCE stations; those in the roles of either examiner or observer remained at the same station for the duration of the circuit. Students in the role of candidate received immediate feedback that they could use in the other two stations on the circuit, where they received more feedback from different peers. The defined criteria within the OSCE format offered guidance to feedback novices on the elements to consider in order to convey constructive feedback to their peers. Evaluation of results and impact To evaluate the perceived merit of this method, a questionnaire (containing 20 statement items scored on a 4-point Likert scale) and focus group sessions (the nominal group technique) were used. The participants agreed/strongly agreed (range 82–100%) with positively framed statements about feedback, and generally disagreed/strongly disagreed with negatively framed statements about feedback (range 88–100%). A question on whether they valued peer feedback as much as tutor feedback produced divided opinion (48% versus 52%). Although 94% of participants felt they could be honest, they found it difficult to give negative feedback owing to relationship issues and the perceived potential adverse impact on the recipient. Hence, students sought ‘permission’ from faculty members to give opinions on areas to be commended and specifically areas in which improvement was required. Particular educational features of these sessions were the transparency of learner goals through the OSCE marking schemes and the opportunity for multiple practices with immediate feedback, as well as the active engagement of students and the fact that they were made responsible for giving feedback to peers. The project resulted in a robust method by which health professional students can learn how to give constructive feedback on performance and which also supports the development of clinical communication skills.