Clinical Practice Feedback Research Articles

Discerning and acknowledging diverse types of feedback in clinical practice – a way to develop feedback literacy

Feedback literacy includes students’ abilities to understand, use and benefit from feedback processes; it is important for the development of self-directed learning, SDL. Considering all of the places where students can potentially learn, especially the clinic, we would argue that feedback has been too narrowly defined. This study aims to explore the different shapes feedback can take for students in their clinical practice. Nursing students at different educational levels were interviewed about their learning after completing a five-week clinical placement within elderly care. Their narratives were explored using a qualitative content analysis of both the manifest and latent content. Interestingly, feedback was shown to be generated by the students themselves: Noticing what others do and what happens on site; Active participation providing first-hand experiences; Getting and taking responsibility; and Understanding what you know and what you need to learn. Although not termed feedback by the students, comparison with their own thoughts, feelings, and behaviours as they observed, participated, and reflected emerged as important to their learning. For this internal feedback to become useful in the development of feedback literacy and SDL, students’ reflections are paramount.

A Clinical Leadership Lens on Implementing Progress Feedback in Three Countries: Development of a Multidimensional Qualitative Coding Scheme.

Progress feedback, also known as measurement-based care (MBC), is the routine collection of patient-reported measures to monitor treatment progress and inform clinical decision-making. Although a key ingredient to improving mental health care, sustained use of progress feedback is poor. Integration into everyday workflow is challenging, impacted by a complex interrelated set of factors across patient, clinician, organizational, and health system levels. This study describes the development of a qualitative coding scheme for progress feedback implementation that accounts for the dynamic nature of barriers and facilitators across multiple levels of use in mental health settings. Such a coding scheme may help promote a common language for researchers and implementers to better identify barriers that need to be addressed, as well as facilitators that could be supported in different settings and contexts. Clinical staff, managers, and leaders from two Dutch, three Norwegian, and four mental health organizations in the USA participated in semi-structured interviews on how intra- and extra-organizational characteristics interact to influence the use of progress feedback in clinical practice, supervision, and program improvement. Interviews were conducted in the local language, then translated to English prior to qualitative coding. A team-based consensus coding approach was used to refine an a priori expert-informed and literature-based qualitative scheme to incorporate new understandings and constructs as they emerged. First, this hermeneutic approach resulted in a multi-level coding scheme with nine superordinate categories and 30 subcategories. Second-order axial coding established contextually sensitive categories for barriers and facilitators. The primary outcome is an empirically derived multi-level qualitative coding scheme that can be used in progress feedback implementation research and development. It can be applied across contexts and settings, with expectations for ongoing refinement. Suggestions for future research and application in practice settings are provided. Supplementary materials include the coding scheme and a detailed playbook.

Systematic Client Feedback in Youth Mental Health and Addiction Care: A Controlled Study Comparing Two Treatment Cohorts

Introduction: We investigated the value of systematic client feedback in youth mental health and addiction care. In the present study, we examined whether a client feedback intervention would result in improved therapeutic alliance and treatment outcomes. Methods: Two hundred and four adolescents participated in the study using a – non-randomized – between-group A/B design. In the first study group, 127 patients were offered 4 months of treatment as usual (TAU), and in the second study group, 77 patients received the client feedback intervention as an add-on to TAU during 4 months. Results: Youths who received systematic client feedback in addition to TAU did not show better treatment outcomes or better alliance ratings after 4 months than youths receiving TAU only. Sensitivity analyses, in which we compared the more adherent patients of the second study group with patients receiving TAU, did not show significant beneficial effects of client feedback either. Also, the client feedback intervention did not result in lower rates of early treatment drop-out. Discussion/Conclusion: Our results cautiously suggest that client feedback does not have incremental effects on alliance and the treatment outcome for youth in mental health and addiction treatment. Moreover, our study highlights the challenges of implementing client feedback in clinical practice and the need for additional research addressing these challenges.

Special Report: Measurement-Based Care—Using Data to Augment Psychotherapy

Special Report: Measurement-Based Care—Using Data to Augment Psychotherapy

Multisource feedback in medical students’ workplace learning in primary health care

BackgroundIn medical students’ workplace learning, feedback is important for effective learning regarding communication and clinical skills. The provision of multisource feedback (MSF) in clinical practice with focus on the patient’s perspective is rarely addressed in the literature. The overall objective was to explore the experience of MSF in medical students’ clinical learning in primary healthcare (PHC).MethodsIn the study, patients provided feedback by use of the Patient Feedback in Clinical Practice (PFCP) questionnaire. By use of adapted PFCP questionnaire versions peers and clinical supervisors provided feedback and students performed a self-evaluation. The MSF learning activity was evaluated using surveys (4-point Likert scale/open-ended questions), (students (n = 26), peers (n = 9) and clinical supervisors (n = 7)). Data were analysed using descriptive and qualitative content analysis.ResultsResults (mean 4-point Likert scale) from participants evaluation of the MSF learning activity visualises the value of feedback in terms of patient-centred communication (students 3.50, peers 2.44 and clinical supervisors 3.57), guidance for further training (students 3.14, peers 2.89 and clinical supervisors 3.00) and clarification of pedagogical assignment (students 3.14, peers 2.89 and clinical supervisors 3.00). Thematic analysis of participants’ free-text answers in the evaluation surveys resulted in three themes: (1) applicability of the MSF, (2) MSF – collaborative learning process and (3) MSF as a facilitator in students’ clinical skills development. The participants experienced that the written MSF provided multi-facetted perspectives, which contributed to students’ and peers’ clinical and communication learning. MSF experience also enhanced clinical supervisors’ feedback regarding communication skills, targeting the supervisors’ pedagogical assignment.ConclusionOur findings indicate that MSF provided directly after a patient encounter, using the PFCP questionnaire as feedback provider, could be an adequate learning activity for medical students’ workplace learning. The MSF, provided through the PFCP questionnaire, was experienced to neutralise and operationalise the provision of concrete feedback, facilitating peers’ learning and clinical supervisors’ tuition. The results visualise the importance of patients in MSF, as a valuable resource in students’ workplace learning. Our study implies that this learning activity could be an applicable tool to facilitate learning and pedagogic development in clinical education in PHC.

Let\u2019s ask the patient \u2013 composition and validation of a questionnaire for patients\u2019 feedback to medical students

BackgroundAdequate communication and maintaining a patient-centered approach throughout patient encounters are important skills for medical students to develop. Feedback is often provided by clinical teachers. Patients are seldom asked to provide feedback to students that systematically addresses knowledge and skills regarding communication and patient-centeredness during an encounter. One way for patients to provide feedback to students is through a questionnaire; there is, however, a lack of such validated feedback questionnaires. This study aimed to compose and validate a feedback questionnaire for patients’ feedback to medical students regarding students’ ability to communicate and apply patient-centeredness in clinical practice.MethodThis study comprises (a) composition of the questionnaire and (b) validation of the questionnaire. The composition included (1) literature review, (2) selection and composition of items and construction of an item pool, (3) test of items’ content, and (4) test of the applicability of the questionnaire. The items originated from the Calgary-Cambridge Guide (Kurtz S, Silverman J, Benson J and Draper J, Acad Med 78:802-809, 2003), the ‘Swedish National Patient Survey’ (National Patient Survey, Primary Health Care, 2020), patient evaluation form by Braend et al. (Tidsskr Nor Laegeforen 126:2122–5, 2006), and additional developed items. The items were further developed after feedback from 65 patients, 22 students, eight clinical supervisors, and six clinical teachers. The validation process included 246 patients who provided feedback to 80 students. Qualitative content analysis and psychometric methods were used and exploratory factor analysis assessed internal validity. Cronbach’s alpha was used to test the reliability of the items.ResultsThe process resulted in the 19-item ‘Patient Feedback in Clinical Practice’ (PFCP) questionnaire. Construct validity revealed two dimensions: consultational approach and transfer of information. Internal consistency was high. Thematic analysis resulted in three themes: ability to capture the personal agenda of the consultation, alignment with the consultation, and constructs and characteristics. Students reported that the PFCP questionnaire provided useful feedback that could facilitate their learning in clinical practice.ConclusionsThe results of this study indicate that the questionnaire is a valid, reliable, and internally consistent instrument for patients’ feedback to medical students. The participants found the questionnaire to be useful for the provision of feedback in clinical practice. However, further studies are required regarding the PFCP questionnaire applicability as a feedback tool in workplace learning.

Measuring the teamwork performance of operating room teams: a systematic review of assessment tools and their measurement properties

ABSTRACT Teamwork is fundamental to surgical patient safety but is inconsistently measured. While many tools have been developed for elective intraoperative situations, it is unclear which is the most robust. This systematic review aimed to identify tools to measure the teamwork of operating room teams. Studies were included if they examined the measurement properties of these tools. PsycINFO, Embase (via OVID), CINAHL, ERIC, Medline and Medline in Process (via OVID) were searched through to May 3, 2019, as were reference lists of included studies and previously published relevant reviews. Retrieved articles were screened and data extracted in duplicate by two independent reviewers. Quality was assessed using the COSMIN checklist. Of the 2121 references identified, 14 studies of six assessment tools were included. Tools were validated across various specialties, mostly in clinical rather than simulated settings. The Observational Teamwork Assessment for Surgery (OTAS) and Operating Theater Team Non-Technical Skills Assessment Tool (NOTECHS) were the most frequently investigated tools. Though acceptable for assessing teamwork, both NOTECHS and OTAS rely on the questionable assumption that the teamwork of a team is equivalent to the sum of individual performances. Future studies may investigate other assessment tools that assess the whole team as the unit of analysis along with the potential of these tools to provide healthcare providers with meaningful feedback in clinical practice.

Designing Tailored Displays for Clinical Practice Feedback: Developing Requirements with User Stories.

Improving visualizations in clinical quality reports and dashboards may improve the visualization influence on clinical practice. Tailored displays could accommodate individual and situational differences, but these diplays introduce complex requirements across healthcare professionals and teams. We applied user stories, a method for managing complex software requirements, to a user-centered design process for tailored visual displays about postpartum contraception care. We mapped user stories to tailored displays to identify the quantity of displays that were supported by each user story. We developed 9 tailored displays and 11 user stories. Displays varied in their mappings to user stories (mean 5, max 9, min 0), revealing differences in healthcare professionals and teams preferences and information needs. User stories and user-centered design may be useful for healthcare organizations to manage complex requirements of tailored displays in clinical practice feedback.

Delivering feedback in clinical practice- the models which assist your clinical practice

Feedback offers great promise but most clinicians find it challenging in practice. This session will cover practical tips on quality feedback for clinicians, building on the evidence base for quality feedback, outlined in the previous session.

The role and purpose of feedback in clinical practice- the current theory and practices

Feedback plays a critical role in quality training in clinical practice. But what are the ‘essential ingredients’ of quality feedback? This session will focus on clarifying the key building blocks of effective feedback, using evidence drawn from health professions, education, psychology and business literature.

Feedback in clinical practice: Enhancing the students' experience through action research.

Feedback within clinical practice is known to be central to the learning and development of student nurses and midwives. A study that focused on student experience of assessment identified that a high proportion of students reported that they had received insufficient feedback whilst on clinical placement. In response to this academics and members of the clinical education team set out to explore this with a view to improving the student experience using action research. Key findings indicated that responsibility for feedback on clinical placement lies with both students and mentors, distinct factors can enable effective feedback and that positive outcomes for mentors and students resulted through engaging with the project. The process, outcomes and actions taken to improve practice are the focus of this paper.

Identifying educator behaviours for high quality verbal feedback in health professions education: literature review and expert refinement.

BackgroundHealth professions education is characterised by work-based learning and relies on effective verbal feedback. However the literature reports problems in feedback practice, including lack of both learner engagement and explicit strategies for improving performance. It is not clear what constitutes high quality, learner-centred feedback or how educators can promote it. We hoped to enhance feedback in clinical practice by distinguishing the elements of an educator’s role in feedback considered to influence learner outcomes, then develop descriptions of observable educator behaviours that exemplify them.MethodsAn extensive literature review was conducted to identify i) information substantiating specific components of an educator’s role in feedback asserted to have an important influence on learner outcomes and ii) verbal feedback instruments in health professions education, that may describe important educator activities in effective feedback. This information was used to construct a list of elements thought to be important in effective feedback. Based on these elements, descriptions of observable educator behaviours that represent effective feedback were developed and refined during three rounds of a Delphi process and a face-to-face meeting with experts across the health professions and education.ResultsThe review identified more than 170 relevant articles (involving health professions, education, psychology and business literature) and ten verbal feedback instruments in health professions education (plus modified versions). Eighteen distinct elements of an educator’s role in effective feedback were delineated. Twenty five descriptions of educator behaviours that align with the elements were ratified by the expert panel.ConclusionsThis research clarifies the distinct elements of an educator’s role in feedback considered to enhance learner outcomes. The corresponding set of observable educator behaviours aim to describe how an educator could engage, motivate and enable a learner to improve. This creates the foundation for developing a method to systematically evaluate the impact of verbal feedback on learner performance.

Effective student feedback in clinical practice

This article, the third in a series aimed at providing veterinary staff and students with tips and tools to enhance teaching and learning, considers how to give feedback to students...

Understanding the differential impact of outcome monitoring: Therapist variables that moderate feedback effects in a randomized clinical trial

Providing outcome monitoring feedback to therapists seems to be a promising approach to improve outcomes in clinical practice. This study aims to examine the effect of feedback and investigate whether it is moderated by therapist characteristics. Patients (n=413) were randomly assigned to either a feedback or a no-feedback control condition. There was no significant effect of feedback in the full sample, but feedback was effective for not-on-track cases for therapists who used the feedback. Internal feedback propensity, self-efficacy, and commitment to use the feedback moderated the effects of feedback. The results demonstrate that feedback is not effective under all circumstances and therapist factors are important when implementing feedback in clinical practice.

Book review: Lambert, M., Prevention of Treatment Failure. The Use of Measuring, Monitoring, and Feedback in Clinical Practice

Book review: Lambert, M., Prevention of Treatment Failure. The Use of Measuring, Monitoring, and Feedback in Clinical Practice

Feedback in psychotherapy

Feedback is defined as a response to an action that shapes or adjusts that action in subsequent performance. Though its pervasiveness in human behavior is noted, feedback in clinical practice is a deliberate psychological intervention that has two essential functions, information and influence. Feedback can be descriptive, evaluative, emotional, and interpretive. The role of feedback in promoting change through interpersonal influence and the role of resistance in the feedback process are discussed. We present practical examples and suggestions for maximizing the effectiveness of feedback and responding therapeutically to resistance. Current outcome research on feedback as a major component of treatment is reviewed and discussed. Implications of the feedback literature for practice are provided.