Feedback In Clinical Setting Research Articles

Exploring the Holistic Process of How Students Use Feedback in Clinical Clerkship

Effective feedback can only be achieved when students act to improve their performance based on the feedback. This becomes even more important in clinical learning as students face authentic and relevant experiences to shape them as medical doctors. However, students do not always use feedback, even with efforts to improve feedback provided by teachers. Hence, understanding how they use feedback is a step toward achieving effective feedback. This study aimed to explore the process of how students in undergraduate clinical settings use feedback. This qualitative phenomenology study involved medical students on their clinical clerkships, clinical teachers, and clinical rotation coordinators in the Faculty of Medicine, Universitas Indonesia (FMUI), selected through a maximum variation sampling approach. Triangulation was done through document study. Data were analysed using a thematic analysis approach. Seven focus groups and four in-depth interviews were conducted, and data saturation was reached. Students use feedback through a process of identifying, receiving, and acting on feedback. Performance was used as an indicator to identify feedback. Receiving feedback was found to be a process involving emotional reaction, reflection on feedback content, and reflection on performance. This process resulted in the acceptance or rejection of feedback, also memorising or disregarding the feedback. Accepted feedback was acted upon by formulating an action plan, applying feedback, note-taking, and reading further references. This study proposes a holistic process of how students use feedback in clinical settings, which should be acknowledged in taking steps toward effective feedback through faculty development, student engagement, and developing a feedback culture.

Peer feedback in graduate training: A phenomenological investigation of possibilities

Background Whilst feedback is an essential component of clinical education, it is often lacking in clinical workplaces due to competing priorities. Peer feedback has been proposed as a potential solution but remains underexplored in terms of practicality and effects. We aimed to examine the experiences of peer feedback among paediatric trainees, and the associated feedback culture. Methods Following an Interpretative Phenomenological Analysis approach, the personal experiences of 12 paediatric trainees were explored using semi-structured interviews. Interpretive themes were developed between the transcripts using processes of abstraction, subsumption, contextualisation, and cross-case analysis. Themes were subsequently subjected to member checking and peer debriefing processes. Results We found that peer feedback was influenced by three contextual factors, namely, prevalent feedback culture, interpersonal consent, and the quality of relationships. Peer feedback culture was lacking in clinical workplaces. Feedback between peers was constrained by avoiding criticism and maintaining work relationships. Social and cultural norms inhibited constructive peer feedback without explicit consent. Conclusions Enabling peer feedback in clinical settings requires attention to cultural, relational, and consent barriers. Potential approaches should include helping clinicians to develop greater cultural reflexivity, resident training in how to be peer educators, and enhancing institutional supports for peer feedback.

Undergraduate Nursing Students' Readiness to Practice: Views of the Senior Students in the United Arab Emirates.

Nursing literature identifies difficulties facing new graduates in managing their responsibilities as registered nurses. The ability of new graduates to be practice-ready upon entry to the workplace remains a challenging concern for nurse educators. This study investigated the perceptions of senior students toward their readiness to practice safely and independently and perform registered nurses' job-specific requirements upon graduation. A descriptive design using quantitative and qualitative methods was used to conduct the study. Data were collected from a sample of 117 senior nursing students in the United Arab Emirates using the Casey-Fink Readiness to Practice Survey. Senior students felt confident to manage the care of 2 to 3 patients, communicate with patients and interdisciplinary teams, solve clinical problems, prioritize patients' care, and recognize significant changes in patient conditions. Areas of concern were their ability to care for more than 3 patients, among others, such as caring for dying patients and performing catheter insertion/irrigation. Students need better learning opportunities and closer guidance, support, and on-time feedback in clinical settings.

Feedback in clinical settings: Nursing students' perceptions at the district hospital in the southern part of Namibia.

BackgroundFeedback was the backbone of educational interventions in clinical settings. However, it was generally misunderstood and demanding to convey out effectively. Nursing students were not confident and did not feel free to practise clinical skills during practical placements because of the nature of the feedback they received whilst in these placements. Moreover, they experienced feedback as a barrier to completing practical workbooks.ObjectiveThe purpose of this article was to report on a qualitative study, which explored nursing students’ perceptions of the feedback they received in clinical settings, at a district hospital.MethodThis study was conducted at a district hospital located in southern Namibia. An explorative qualitative design with an interpretivist perspective was followed. A total of 11 nursing students from two training institutions were recruited by purposive sampling and were interviewed individually. All interviews were audio recorded with a digital voice recorder followed by verbatim transcriptions, with the participants’ permission. Thereafter, data were analysed manually by qualitative content analysis.ResultsThemes that emerged as findings of this study are feedback is perceived as a teaching and learning process in clinical settings; participants perceived the different nature of feedback in clinical settings; participants perceived personal and interpersonal implications of feedback and there were strategies to improve feedback in clinical settings.ConclusionNursing students appreciated the feedback they received in clinical settings, despite the challenges related to group feedback and the emotional reactions it provoked. Nursing students should be prepared to be more receptive to the feedback conveyed in clinical settings.

Simulation-Based Mastery Learning With Virtual Coaching: Experience in Training Standardized Upper Endoscopy to Novice Endoscopists

Simulation-Based Mastery Learning With Virtual Coaching: Experience in Training Standardized Upper Endoscopy to Novice Endoscopists

A Quality of Experience assessment of haptic and augmented reality feedback modalities in a gait analysis system.

Gait analysis is a technique that is used to understand movement patterns and, in some cases, to inform the development of rehabilitation protocols. Traditional rehabilitation approaches have relied on expert guided feedback in clinical settings. Such efforts require the presence of an expert to inform the re-training (to evaluate any improvement) and the patient to travel to the clinic. Nowadays, potential opportunities exist to employ the use of digitized "feedback" modalities to help a user to "understand" improved gait technique. This is important as clear and concise feedback can enhance the quality of rehabilitation and recovery. A critical requirement emerges to consider the quality of feedback from the user perspective i.e. how they process, understand and react to the feedback. In this context, this paper reports the results of a Quality of Experience (QoE) evaluation of two feedback modalities: Augmented Reality (AR) and Haptic, employed as part of an overall gait analysis system. The aim of the feedback is to reduce varus/valgus misalignments, which can cause serious orthopedics problems. The QoE analysis considers objective (improvement in knee alignment) and subjective (questionnaire responses) user metrics in 26 participants, as part of a within subject design. Participants answered 12 questions on QoE aspects such as utility, usability, interaction and immersion of the feedback modalities via post-test reporting. In addition, objective metrics of participant performance (angles and alignment) were also considered as indicators of the utility of each feedback modality. The findings show statistically significant higher QoE ratings for AR feedback. Also, the number of knee misalignments was reduced after users experienced AR feedback (35% improvement with AR feedback relative to baseline when compared to haptic). Gender analysis showed significant differences in performance for number of misalignments and time to correct valgus misalignment (for males when they experienced AR feedback). The female group self-reported higher utility and QoE ratings for AR when compared to male group.

Insight into undergraduate feedback of clinical practice: Junior Doctors vs Consultants

This article was migrated. The article was not marked as recommended. Background: Constructive feedback is essential to improve clinical practice and is therefore discussed extensively in educational literature. Despite this, students regularly express dissatisfaction with their feedback at medical school. Many challenges to feedback in clinical settings have been documented but few were based on the students perspectives. This qualitative study explores the students experiences of feedback in clinical settings, in their third year at Imperial College London. Method: Seven third year medical students who were based at Hillingdon Hospital during February 2014 were interviewed in a semi-structured format on their experience of feedback in clinical settings. The interviews were transcribed and analysed using a thematic analytical approach. Results: The students claimed that they received little feedback and usually in an ad-hoc manner. Feedback was inconsistent between different clinicians, confusing some participants. There was a marked difference in quality and quantity of feedback between the consultants and junior doctors, with the majority of students preferring feedback from juniors. Junior doctors feedback focussed on medical school assessments, whilst the consultants was geared towards daily clinical practice. Discussion: Feedback provided by both clinician groups was heavily influenced by their own experiences and working environments. For consultants this was their vast clinical experience and considerable time constraints, whereas juniors had more time for students and could focus on exam techniques. Empowering students to take an active role in feedback, either seeking or clarifying the differences may be of help. Conclusion: Though feedback from consultants and junior doctors is not aligned, both are useful in shaping future clinicians.

Experiences of medical teachers about methods, types and barriers of giving feedback

Background: The aims of the research that formed the basis of the current study are as follows: Determining methods that are used by teachers for giving feedback in clinical settings. Determining types of feedback, teachers give to their students in clinical settings. Determining barriers of giving feedback and its important teachers’ experience in clinical settings. Methods: This applied research was a cross-sectional study that involved 131 medical clinical teachers. Using resources in the library and on the web, we developed a questionnaire comprising two parts: the first part of the questionnaire focused on assessing the methods and types of giving feedback used by the participants (a total of 25 items); the second part focused on determining barriers that teachers experience when giving feedback in clinical setting (8 items). Responses to each question were on a Likert Scale. The validity of the questionnaire was determined using content validity index (CVI) measures, and was confirmed by 10 experts. Reliability was evaluated with Cronbach’s alpha coefficient. Results: Most of the teachers (57.49%) in this study reported giving oral feedback to students, 39.1% reported giving nonverbal feedback and a few of them (3.41%) gave written feedback. Participants allowed to nominate more than one type of feedback. Teachers reported many barriers to giving feedback to students, including lack of knowledge and skill about giving feedback, large numbers of students, lack of time, and fear of students’ negative reaction to feedback. Also, concern about negatively impacting the relationship between students and teachers, and students feeling humiliated were considered moderately important. Conclusions: In general results show that there is considerable capacity to improve the quality and extent of feedback given to health sciences students in clinical settings.

Evaluation of robot-assisted gait training using integrated biofeedback in neurologic disorders

BackgroundNeurological disorders lead to walking disabilities, which are often treated using robot-assisted gait training (RAGT) devices such as the driven gait-orthosis Lokomat. A novel integrated biofeedback system was developed to facilitate therapeutically desirable activities during walking. The aim of this study was to evaluate the feasibility to detect changes during RAGT by using this novel biofeedback approach in a clinical setting for patients with central neurological disorders. Methods84 subjects (50 men and 34 women, mean age of 58±13years) were followed over 8 RAGT sessions. Outcome measures were biofeedback values as weighted averages of torques measured in the joint drives and independent parameters such as guidance force, walking speed, patient coefficient, session duration, time between sessions and total treatment time. ResultsJoint segmented analysis showed significant trends for decreasing hip flexion activity (p≤.003) and increasing knee extension activity (p≤.001) during RAGT sessions with an intercorrelation of r=−.43 (p≤.001). Further associations among independent variables were not statistically significant. ConclusionThis is the first study that evaluates the Lokomat integrated biofeedback system in different neurological disorders in a clinical setting. Results suggest that this novel biofeedback approach used in this study is not able to detect progress during RAGT. These findings should be taken into account when refining existing or developing new biofeedback strategies in RAGT relating to appropriate systems to evaluate progress and support therapist feedback in clinical settings.