Feedback In Clinical Education Research Articles

The interactional communication of feedback in clinical education: A focused ethnographic study in a hierarchical and collectivist culture

BackgroundThe definition of feedback in clinical education has shifted from information delivery to student-teacher dialogue. However, based on Hofstede's theory, countries with large power distance or a robust social hierarchy and collectivistic cultural dimensions can reduce the feedback dialogue to a minimum. Indonesia is classified in this group, with some Asian, African, Mediterranean, and Latin American countries. This study explores the interactional communication of feedback during clinical education in a hierarchical and collectivistic context. MethodsThe focused ethnographic approach was applied to the clinical rotation program in an Indonesian teaching hospital. Data sources included observations of feedback episodes during workplace-based assessments followed by interviews with clinical supervisors and students. The data were compiled within 16 weeks of observation in 7 groups of clinical departments, consisting of 28 field notes, audiotaped interviews including nine focus group discussions of students (N = 42), and seven in-depth interviews with clinical supervisors. Data were analyzed through transcription, coding, categorization, and thematic analysis using the symbolic interactionist perspective. ResultsWe identified four themes representing actual interactional communication and its ‘meaning’ or interpretation. The interactional communication in feedback is described in the first and second themes, such as 1) Students play the subordinate roles in a feedback dialogue; 2) The feedback content is focused on explanation and students' limitations. The third and fourth themes represent the clinical supervisors' and students' interpretation of their feedback experience, such as 3) Clinical supervisors' perspectives are mostly on dissatisfaction and teaching authority; 4) Students' acceptance of reality and negative affection. ConclusionsThis study shows that the social gap between students and clinical supervisors in Indonesia, and other countries in the same cultural classification, potentially causes communication barriers in the feedback dialogue. The adaptation of ‘feedback as a dialogue’ requires further effort and research to develop communication strategies in feedback that consider the national culture and context.

Surgical Nursing Students' Perception of Feedback in Clinical Education: A Mixed-method Study.

Feedback is a critical component of education but may not always be delivered in a useful manner. This study assessed surgical nursing students' perception of the feedback they received on a clinical rotation. This is a sequential mixed-method study. The first stage surveyed surgical nursing students in surgical units about the feedback they received. In the second stage, participants' experiences receiving feedback were explored in interviews, and analyzed by a conventional content analysis approach. The majority of nurses found that feedback was not helpful, citing a lack of constructive feedback. Negative feedback was often delivered in a public setting. Comments were frequently based on secondary information rather than direct observation. Feedback to nurses on the surgical unit is not perceived by students as constructive. Clinical teachers did not appear to be aware of the educational effect of the feedback on the learning process of students. In addition, the setting for feedback often undermined its effectiveness. Staff development on effective feedback for teachers on the surgical unit is recommended.

Complexities of Delivering Corrective Feedback in Clinical Education for Speech-Language Pathologists

Purpose: The intent of this tutorial is to promote speech-language pathology clinical educators' professional knowledge of feedback as a pedagogical intervention. This tutorial was formatted to enhance an educator's effectiveness in implementing feedback to promote professional growth for speech-language pathology students, new graduates, and those learning new skills. Special attention is given to the use of feedback in the supervisory conference. Method: Online databases were used to complete a focused literature review to identify current trends and evidence for using feedback in clinical education. Discussion: The construct of feedback, corrective feedback, and the sequencing of feedback are described. Feedback as a teaching tool in clinical education settings is often characterized as a learning conversation grounded in adult learning theory. Comparisons between feedback, adult learning theory, and various pedagogical approaches will be drawn. This tutorial highlights the interpersonal nature of feedback and explains how giving and receiving feedback are influenced by the cognitive and affective states of both the educator and the learner. Examples of utilizing feedback in various situations are provided to promote generalization between the tutorial and the reader's daily work. Conclusion: Recommendations for the use of feedback to inform the next steps in research and educational implementation are provided.

The Quality of Providing Feedback in Clinical Education according to Midwifery Students Participating in National Congress of Midwifery and Women’s Health

Background: Clinical education is the basis for medical sciences education, and one of the most critical criteria of professional education, playing a significant role in internalizing the teachings to students. This study aims to investigate the opinions of midwifery students about the quality of feedback provision in clinical education. Materials and Methods: This cross-sectional study was performed in 2019 in the Congress of midwifery and women’s health, Mashhad, Iran. Census method was used for selecting 98 midwifery students who had participated from all over the country in this Congress. Data collection was performed through a demographic information questionnaire and a standard feedback questionnaire with 21 items. The midwifery students were asked to specify the importance of feedback received during their clinical Results: Overall, 98 midwifery students participated in this study. According to most students, most of the time the feedback received was as expected (40.8%), clear and explicit (41.8%), constructive (50%), and was useful for correcting their attitude (49%), performance (54.1%), and behavior (50%), and related to clinical skills (55.1%), and most of them had received positive feedback (49%). Except for items 8 and 20, most midwifery students chose the options of often and most of the time for responding to items. Conclusion: More than half of the midwifery students had adequate satisfaction with the feedback they received during their clinical education (often and most of the time). It is suggested that the quality of feedback provision by midwifery professors could be enhanced for the maximum satisfaction of students.

The Status of Providing Feedback in Clinical Education from the Perspective of Medical Students in Pediatric Department of Bushehr University of Medical Services, Bushehr, Iran

Background: Clinical education is the foundation of medical science education and one of the most important criteria of professional education, which plays an important role in consolidating students’ learned materials. The aim of the present study was to evaluate the views of general medical students on the provision of feedback in clinical education in the pediatric department. Materials and Methods: The present cross-sectional study was performed in the Pediatric Department of Shohadaye- Khalije-Fars Educational Hospital of Bushehr University of Medical Sciences in 2019. Conesus sampling was used to select 58 general medical students spending their internship and apprenticeship in the Pediatric department. Data collection was carried out using baseline characteristics and the standard 21-item feedback questionnaire. Medical students were asked to indicate the importance of the feedback they received during their clinical education in the pediatric department on four-point Likert scale. Data were analyzed using SPSS software version 16.0. Results: 58 general medical students of Bushehr University of Medical Sciences participated in the present study. Twenty-eight (48.2%) of the general medical students were interns, 30 (51.8%) were apprentices, and 35 were female participants (n=60%). Most of the students believed that feedback was as expected (50.1 7%), clear (43.1%), fair (36.2%), and useful in correcting their attitude (44.8%), performance (46.6%), and behavior (39.7%). Majority of the participants received positive feedback (65.5%). Apart from propositions items 20, 10, 8, and 4, majority of medical students have selected Often as an option to answer the remaining statements. Conclusion More than half of the general medical students were satisfied with the feedback they received during their clinical education in Pediatric department.

Necessary but not sufficient: identifying conditions for effective feedback during internal medicine residents' clinical education.

Competency-based medical education and programmatic assessment intend to increase the opportunities for meaningful feedback, yet these conversations remain elusive. By comparing resident and faculty perceptions of feedback opportunities within one internal medicine residency training program, we sought to understand whether and how principles underlying meaningful feedback could be supported or constrained across a variety of feedback opportunities. Using case-study qualitative methodology, interviews and focus groups were conducted to explore 19 internal medicine residents' and 7 faculty members' perceptions of feedback across a variety of feedback opportunities: coaching, mini-CEXs, in-training evaluation reports and routine clinical supervision. Our data analysis moved iteratively between developing conceptual understandings and fine-grained analyses, while attending to both deductive and inductive analysis. Our results suggest that all feedback opportunities, including those created through formalized assessments, can foster meaningful feedback if faculty establish a trusting relationship with the resident, base their feedback on direct observation and support resident learning. However, formalized assessments were often perceived as inhibiting the conditions for meaningful feedback. A coaching program provided a context in which meaningful feedback could arise, in part because faculty were supported in shifting their focus from patient to resident. Meaningful feedback in clinical education may be fostered across a variety of feedback opportunities, however, it is often constrained by assessment. We must consider whether increasing the frequency of formative assessments may inhibit efforts to improve our feedback cultures while, in contrast, freeing up faculty to focus on supporting resident learning could improve these cultures.

Resident identification of feedback and teaching on rounds

Feedback and teaching occur regularly on teaching hospital wards. Although feedback has important implications for resident learning, residents often report that they receive little feedback. The significant overlap of teaching and feedback in clinical education may contribute to resident difficulty with feedback identification. We sent a survey with seven scenarios to internal medicine residents across the country. Two of the scenarios contained teaching, two contained feedback, and three contained combined teaching and feedback. From October 2017 to April 2018, 17% of residents (392/2346) from 17 residency programs completed the survey. Participating residents correctly identified both feedback scenarios 89% of the time, both teaching scenarios 64% of the time, and all three combined teaching and feedback scenarios 38% of the time. Interns were less likely than upper-level residents to correctly identify combined teaching and feedback scenarios (P = 0.005). Residents may have difficulty identifying feedback in the context of teaching. This confusion may contribute to residents’ perceptions that they receive little feedback.

The Status of Providing Feedback in Clinical Education from the Perspective of Pediatric Residents and Medical Students at Mashhad University of Medical Sciences, Iran

Introduction: Feedback is a conscious, unbiased, and objective evaluation of performance in order to improve clinical skills, not to assess students' personal talents and values. This study aims to compare the views of pediatric residents and general medical students at Mashhad University of Medical Sciences regarding method of providing feedback in clinical education.Method: This cross-sectional study was conducted in the pediatric ward of hospitals affiliated to Mashhad University of Medical Sciences in 2018. The census method was used to select 35 pediatric residents and simple random sampling method was used to select 35 general medical students who had completed internship and apprenticeship. Data collection was carried out using a standard 21-item feedback questionnaire. Pediatric residents and general medical students were asked to identify the importance of feedback received during their clinical education using a 4-point Likert scale.Results: The majority of residents believe that feedback was only sometimes expected (27.1%), clearly and explicitly outlined (17.1%), fair (21.4%), and useful in correcting their attitude (18.6%), performance (17.1%), and behavior (27.1%). Majority of general medical students believed that clear, explicit (24.3%) feedback was related with their future career (14.3%) and most of them received positive feedbacks (20). Apart from propositions items 20, 18, and 17, most medical students and residents have selected the Often and Sometimes options, respectively to respond to items.Conclusion: Pediatric residents were less satisfied with the feedback received during the clinical education as compared to the general medical students.

Anesthesia myTIPreport: A Web-Based Tool for Real-Time Evaluation of Accreditation Council for Graduate Medical Education's Milestone Competencies and Clinical Feedback to Residents.

Feedback in clinical education is essential but challenged by multiple barriers. This report describes the use of myTIPreport, a web-based tool, which streamlines the dual purpose of milestone evaluation and real-time feedback from faculty to residents in a US anesthesiology program. In a 6-month trial, faculty members and residents used myTIPreport for daily clinical feedback. We believe myTIPreport will be a valuable tool for clinical feedback given further refinement of the tool and improved faculty and resident development on program use.

Evaluation of Status of Feedback in Clinical Education from the Viewpoint of Nursing and Midwifery Professors and Students and Relevant Factors

Background and Aim: The main goal of each educational system is successful implementation of the learning process. One of the tools used to achieve this goal is providing effective feedback to students during the learning process. Since clinical education forms majority of medical sciences education (e.g., nursing and midwifery), providing feedback to students during clinical education is of paramount importance. Therefore, this study aimed to evaluate the status of feedback provision in clinical education from the viewpoint of nursing and midwifery professors and students and to determine its relevant factors. Materials and Methods: This descriptive and analytical research was performed on all BSc nursing and midwifery students (third-semester upward) and all clinical professors in 2016-2017. In total, 198 students and 50 professors were enrolled in the study. Data were collected using a researcher-made questionnaire, validity, and reliability of which were confirmed using content and face validity and test-retest, respectively. In addition, data analysis was performed in SPSS using descriptive statistics and independent t-test. Results: In this study, 73.2% of students and 74% of professors considered the status of feedback provision in clinical education as moderate, and no significant difference was in the viewpoint of them in this regard (P=0.38). According to the results, the most used type of feedback was oral and individual feedback, and the most important cause of lack of provision of effective feedback included inadequate scientific mastery in the relevant subject, lack of knowledge and skill of professors regarding feedback provision principles, high number of students, and short duration of internship. Conclusion: Despite the impact of feedback on the effectiveness of education and improvement of the teaching-learning process, the present study demonstrated the status of feedback provision in clinical education is not desirable and different factors are related to this issue. Therefore, it is necessary to design some solutions to improve the abilities of professors in the areas of providing feedback and helping the improvement of clinical education.

Exploring Faculty Approaches to Feedback in the Simulated Setting: Are They Evidence Informed?

Feedback in clinical education and after simulated experiences facilitates learning. Although evidence-based guidelines for feedback exist, faculty experience challenges in applying the guidelines. We set out to explore how faculty approach feedback and how these approaches align with current recommendations. There is strong evidence for the following four components of feedback: feedback as a social interaction, tailoring content, providing specific descriptions of performance, and identifying actionable items. Faculty preceptors participated in feedback simulations followed by debriefing. The simulations were video recorded, transcribed, and analyzed qualitatively using template analysis to examine faculty approaches to feedback relative to evidence-informed recommendations. Recorded encounters involving 18 faculty and 11 facilitators yielded 111 videos. There was variability in the extent to which feedback approaches aligned with recommended practices. Faculty behaviors aligned with recommendations included a conversational approach, flexibly adapting feedback techniques to resident context, offering rich descriptions of observations with specific examples and concrete suggestions, achieving a shared understanding of strengths and gaps early on to allow sufficient time for problem-solving, and establishing a plan for ongoing development. Behaviors misaligned with guidelines included prioritizing the task of feedback over the relationship, lack of flexibility in techniques applied, using generic questions that did not explore residents' experiences, and ending with a vague plan for improvement. Faculty demonstrate variability in feedback skills in relation to recommended practices. Simulated feedback experiences may offer a safe environment for faculty to further develop the skills needed to help residents progress within competency-based medical education.

Providing contextually apt feedback in clinical education.

Providing contextually apt feedback in clinical education.

Feedback in clinical education: untying the Gordian knot.

Feedback is essential to clinical education, especially in the era of competencies, milestones, and entrustable professional activities. It is, however, an area where medical educators often fall short. Although educational leaders and faculty supervisors provide feedback in a variety of clinical settings, surveys show important gaps in medical student and resident satisfaction with the feedback received, suggesting lost opportunities to identify performance problems as well as to help each learner reach his or her greatest potential.In this issue of Academic Medicine, Telio and colleagues extend the empirically validated concept of a "therapeutic alliance" to propose the "educational alliance" as a framework for enhancing feedback in medical education. They highlight the importance of source credibility, which depends on the teacher-learner relationship and alignment of values, the teacher's understanding of the learner's role and goals, the teacher's direct observation of the learner, and the learner's perception of the teacher's good intentions. The author of this Commentary suggests that the educational alliance framework should prompt medical educators to reconsider feedback and explore opportunities for optimizing it. Most medical schools and graduate medical education programs are not designed in a way that supports the education alliance model, but the Commentary author offers suggestions for cultivating educational alliances, including rethinking supervisor selection criteria. Such interventions should be combined with ongoing faculty development and efforts to improve coaching and mentoring for students, residents, and fellows. Untying the Gordian knot of effective feedback will require innovative approaches, exchange of successful strategies, and continued research.

Feedback in Clinical Education, Part II: Approved Clinical Instructor and Student Perceptions of and Influences on Feedback

Approved Clinical Instructors (ACIs; now known as preceptors) are expected to provide feedback to athletic training students (ATSs) during clinical education experiences. Researchers in other fields have found that clinical instructors and students often have different perceptions of actual and ideal feedback and that several factors may influence the feedback exchanges between instructors and students. However, understanding of these issues in athletic training education is minimal. To investigate the current characteristics and perceptions of and the influences on feedback exchanges between ATSs and ACIs. Qualitative study. One entry-level master's degree program accredited by the Commission on Accreditation of Athletic Training Education. Four ACIs and 4 second-year ATSs. Individual, semistructured interviews were conducted with participants and integrated with field notes and observations for analysis. We used the constant comparative approach to inductively analyze data and develop codes and categories. Member checking, triangulation, and peer debriefing were used to promote trustworthiness of the study. Participants described that feedback plays an important role in clinical education and has several purposes related to improving performance. The ACIs and ATSs also discussed several preferred characteristics of feedback. Participants identified 4 main influences on their feedback exchanges, including the ACI, the ATS, personalities, and the learning environment. The ACIs and ATSs had similar perceptions of ideal feedback in addition to the actual feedback that was provided during their clinical education experiences. Most of the preferences for feedback were aligned with recommendations in the literature, suggesting that existing research findings are applicable to athletic training clinical education. Several factors influenced the feedback exchanges between ACIs and ATSs, which clinical education coordinators should consider when selecting clinical sites and training ACIs.

Feedback in Clinical Education, Part I: Characteristics of Feedback Provided by Approved Clinical Instructors

Providing students with feedback is an important component of athletic training clinical education; however, little information is known about the feedback that Approved Clinical Instructors (ACIs; now known as preceptors) currently provide to athletic training students (ATSs). To characterize the feedback provided by ACIs to ATSs during clinical education experiences. Qualitative study. One National Collegiate Athletic Association Division I athletic training facility and 1 outpatient rehabilitation clinic that were clinical sites for 1 entry-level master's degree program accredited by the Commission on Accreditation of Athletic Training Education. A total of 4 ACIs with various experience levels and 4 second-year ATSs. Extensive field observations were audio recorded, transcribed, and integrated with field notes for analysis. The constant comparative approach of open, axial, and selective coding was used to inductively analyze data and develop codes and categories. Member checking, triangulation, and peer debriefing were used to promote trustworthiness of the study. The ACIs gave 88 feedback statements in 45 hours and 10 minutes of observation. Characteristics of feedback categories included purpose, timing, specificity, content, form, and privacy. Feedback that ACIs provided included several components that made each feedback exchange unique. The ACIs in our study provided feedback that is supported by the literature, suggesting that ACIs are using current recommendations for providing feedback. Feedback needs to be investigated across multiple athletic training education programs to gain more understanding of certain areas of feedback, including frequency, privacy, and form.

Seeking a different angle on feedback in clinical education: the learner as seeker, judge and user of performance information

Seeking a different angle on feedback in clinical education: the learner as seeker, judge and user of performance information

Questions Posed within Written Feedback in Clinical Education: A Research Note

Clinical educators use a variety of methods to facilitate student development of critical thinking. One method is the use of effective questioning within written feedback. High level questions help to facilitate critical thinking by requiring the student to evaluate or make judgment on a clinical situation. As students progress through a continuum of competency from novice to graduate, the nature of feedback changes from directives to questions in response to the students' developing critical thinking abilities. This research notes details aspects in written feedback within a speech pathology educational setting. Novice students received lower level questions and more directives compared to advanced students. Suggestions for monitoring the ways in which questions are presented within written feedback are discussed.

What is feedback in clinical education?

Feedback is important in clinical education. However, the medical education literature provides no consensual definition of feedback. The aim of this study is to propose a consensual, research-based, operational definition of feedback in clinical education. An operational definition is needed for educational practice and teacher training, and for research into the effectiveness of different types of feedback. A literature search about definitions of feedback was performed in general sources, meta-analyses and literature reviews in the social sciences and other fields. Feedback definitions given from 1995 to 2006 in the medical education literature are also reviewed. Three underlying concepts were found, defining feedback as 'information'; as 'reaction', including information, and as a 'cycle', including both information and reaction. In most medical education and social science literature, feedback is usually conceptualised as information only. Comparison of feedback definitions in medical education reveals at least 9 different features. The following operational definition is proposed. Feedback is: 'Specific information about the comparison between a trainee's observed performance and a standard, given with the intent to improve the trainee's performance.' Different conceptual representations and the use of different key features might be a cause for inconsistent definitions of feedback. The characteristics, strengths and weaknesses of this research-based operational definition are discussed.