Feedback In Medical Education Research Articles

Navigating discourses of feedback: developing a pattern system of feedback.

Although feedback is often presented as if it were a well-understood concept in health professions education, in practice it can mean many things. For some, feedback is a conversation about defining and improving performance, while for others it is the information generated by assessments and tools. Indeed, feedback has variously been defined as a process, as data, as a conversation, and as a reflective exercise. As a result, for a concept so central to what educators do, 'feedback' is ambiguous and has multiple meanings. Pattern theory affords opportunities to examine what scholars and practitioners mean when they use the term 'feedback'. Elaborating feedback as a pattern system can connect otherwise disjointed discourses of feedback. In this paper, the authors describe the development of a pattern system of feedback in medical education. Arksey & O'Malley's 5-stages of scoping reviews were adapted to enact a 6-step pattern system development methodology that included (1) Identifying the research question and scope of inquiry; (2) elaborating a strategy for pattern identification; (3) study selection; (4) abductive pattern representation development; (5) pattern system testing; and (6) summarizing and reporting the results. A pattern system of feedback was developed based on review of 218 full text articles and testing against an additional 2833 citations. This pattern system is made up of 36 pattern representations organized under 6 domains: feedback referent, feedback intentions, feedback information, feedback processing, feedback response, and feedback meta. The pattern system was applied to two models of feedback to demonstrate its utility as a lens through which to analyze various instances of feedback and to foreshadow its potential broader applicability as a tool to facilitate knowledge synthesis in the feedback problem space.

The past, present, and future of feedback in medical education

The past, present, and future of feedback in medical education

"The feedback dilemma"-provider and learner perspectives regarding the barriers and facilitators for giving and receiving feedback in medical education: A parallel mixed methods approach.

Learning in medical education involves a multitude of practical tasks and skills that are amenable to feedback provision. Though passive feedback is given, there is a consistent gap in feedback provision and its receipt. This study aims to assess provider perspectives on feedback and learner attributes influencing the receipt of feedback in medical educational settings. A parallel mixed methods study was conducted in September 2023 at a tertiary care teaching institute. A convenience sample of 40 medical teachers comprising two faculties per department and 30 students were included. Focus group discussions (FGDs) were conducted with students from each academic year for assessing the student-level factors (facilitators and barriers) in the receipt of feedback. Among the 40 medical teachers who were interviewed, the majority of 23 (57.5%) were assistant professors and nearly half of them (18; 45.0%) were below the age of 30 years. The majority of the respondents (28; 70.0%) were females, and 34 (85.0%) of them were postgraduates. Most of them (24; 60.0%) had worked for more than 10 years at the institute. It was observed that 80.0% of the respondents had given feedback to their students at some point in their careers. The major barriers for providing feedback were lack of curricular guidelines, fear of affective responses from students, burden of clinical, administrative work, and lack of perceived need by both students and teachers. DESTEP analysis of the student-level factors governing the receipt of feedback shows the effects of institutional ethics and culture, feedback model utilized, and the influence of learner behaviors, motivations, and teacher attributes. The study elucidates mentor- and mentee-level influencers for providing and receiving feedback. Effective teacher-student partnerships along with an optimal skill set are required to recognize the need, opportunities, and processes to provide and seek feedback. Shifting the focus from feedback giving to active feedback seeking would be a step toward creating effective and pragmatic feedback systems.

The CoACH approach to receiving and using feedback effectively

There are many models for teaching how to give feedback in medical education, but little attention has been offered on how to receive feedback. It is assumed that giving effective, constructive feedback will be received well. This article offers an approach to enable learners to receive and use feedback more effectively.

More specific feedback: why “confidence” in feedback is too ambiguous

Abstract High quality feedback should be delivered in a timely manner, based on specific direct observation, and formulated to be actionable on the part of the trainee. Utilizing “confidence” as a point of feedback does not meet these criteria given the ambiguity and lack of actionable steps towards improvement. “Confidence”-based feedback makes a judgment about the trainee’s internal state leading to potentially gender or culturally biased feedback. There is a risk of emotional harm for trainees when it is integrated into feedback and it is unclear if there is a role for the use of “confidence” in medical education. We are calling for a moratorium on the utilization of the word “confidence” in feedback in medical education until further studies are performed to assess its potential place. At this time, educators should refrain from “confidence”-based feedback and shift the focus towards more specific, actionable, behavioral-based feedback.

(429) A Pilot Assessment of Urologic Surgery Resident Attitudes on Utilization of MyTipReport Feedback Software in Inflatable Penile Prosthesis Placement Surgery- A single-site pilot study

Abstract Introduction MyTipReport is an innovative online software that allows for capturing, sharing, and reviewing feedback in medical education amongst students, residents, and educators. There has been extensive research into the utilization and integration of this software into medical residency programs to evaluate and provide feedback to learners. However, there is a paucity of literature regarding evaluation of resident attitudes and beliefs in the role this software plays to establish surgical competency. Objective At a single, high-volume institution performing Inflatable Penile Prosthesis cases, our objective is to evaluate resident attitudes regarding utilization of MyTipReport in their competency assisting and performing Inflatable Penile Prosthesis operations. Methods From December 2021 to May 2022, residents were evaluated using MyTipReport during all resident staffed penile prosthesis surgeries. Residents were evaluated through a number of crucial steps during Inflatable Penile Prosthesis placement. Trainees who have utilized MyTipReport then completed a standardized survey to assess if the feedback system provided by MyTipReport has provided benefit in their training, specifically in regard to Inflatable Penile Prosthesis placement surgery, Figure 1. Two-tailed t-test was used to determine difference in mean survey response score between sub-groups. P value <0.05 was used to define significance. Results A total of 7 residents performed 44 penile implant surgeries at a single Urology residency program and utilized MyTipReport for feedback. All 7 completed the survey. Of the included cohort, 28.6% of respondents (n=2) were senior residents, and 71.4% were junior residents (n=5). Additionally, 57.1% (n=4) respondents were male and 42.9% (n=3) were female. Mean survey responses for the cohort are summarized in Figure 2. All 7 respondents answered Question 9 and Question 10 with “5 - Overall Positive”, with a mean response of 5. For Questions 1-8 of the survey, no statistically significant difference in mean response was noted between senior residents and junior residents (p>0.05), as depicted in Table 1. When stratified between male and female residents, there was a statistically significant difference in mean response for Question 2, “How do you feel MyTipReport feedback has impacted your confidence as a resident on Inflatable Penile Prosthesis placement surgeries?”, with a mean response of 3.5 for the male residents versus 5 for the female residents, respectively (p<0.05), shown in Table 1. Conclusions Initial incorporation of the MyTipReport feedback software in a single-site Urology Residency program as a means of evaluating and providing feedback in IPP placement operations shows promising early results. Resident attitudes toward using the MyTipReport software to receive feedback are overall positive. Understanding ways to improve and optimize the utilization of MyTipReport in Urology residency program education should be the focus of future studies prior to expanded application and implementation. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Run Wang, MD, FACS is a consultant for Boston Scientific and Teleflex.

Utilizing Natural Language Processing of Narrative Feedback to Develop a Predictive Model of Pre-Clerkship Performance: Lessons Learned.

Natural language processing is a promising technique that can be used to create efficiencies in the review of narrative feedback to learners. The Feinberg School of Medicine has implemented formal review of pre-clerkship narrative feedback since 2014 through its portfolio assessment system but this process requires considerable time and effort. This article describes how natural language processing was used to build a predictive model of pre-clerkship student performance that can be utilized to assist competency committee reviews. The authors took an iterative and inductive approach to the analysis, which allowed them to identify characteristics of narrative feedback that are both predictive of performance and useful to faculty reviewers. Words and phrases were manually grouped into topics that represented concepts illustrating student performance. Topics were reviewed by experienced reviewers, tested for consistency across time, and checked to ensure they did not demonstrate bias. Sixteen topic groups of words and phrases were found to be predictive of performance. The best-fitting model used a combination of topic groups, word counts, and categorical ratings. The model had an AUC value of 0.92 on the training data and 0.88 on the test data. A thoughtful, careful approach to using natural language processing was essential. Given the idiosyncrasies of narrative feedback in medical education, standard natural language processing packages were not adequate for predicting student outcomes. Rather, employing qualitative techniques including repeated member checking and iterative revision resulted in a useful and salient predictive model.

Mindset and Reflection-How to Sustainably Improve Intra- and Interpersonal Competences in Medical Education.

Intra- and interpersonal competences (IICs) are essential for medical expertise. However, the effects of current medical curricula seem to not be sustainable enough, even though poorly trained IICs have negative effects on medical practice. A defensive attitude towards openly addressing personal-professional challenges seems to hinder a sustainable implementation of IICs training. Therefore, this study asks about the changeability of IICs and target factors of their implementation in medical education. The aim was to detect factors for the sustainable implementation of IICs in medical education from medical and non-medical perspectives. For this purpose, a total of 21 experts were interviewed. The interview material was analysed according to grounded theory principles to generate core categories to answer the research questions. As a first result, analysis revealed that IICs are changeable and developable, not in all, but in many students. It also showed four central prerequisites for successful implementation: the longitudinal integration of reflection and feedback in medical education and practice; a clear framework and individual path of education; the students' mindset to develop themselves on a personal level; as well as the superiors' mindset to openly deal with personal challenges in low hierarchies. Contrasting Carol Dweck's mindset concept with our findings supports our theory that the development of a mindset which allows an open approach to personal deficits and challenges seems to be of central importance for both students and teachers. Two key factors in this process might be teaching about the impact of mindsets on learning and the willingness of superiors to openly address their personal challenges. To improve IICs in medical professionals, it seems helpful to pay more attention to the development of mindsets. Educating teachers and superiors about targeting factors could be a feasible direction for sustainable implementation.

Balancing responsibility-sharing in the simulated clinical skills setting: A strategy to remove barriers to feedback engagement as a new concept to promote a growth-enhancing process

Background. When feedback is provided in a formative context, it must be used effectively by learners. Many barriers prevent medical students from meaningfully engaging with feedback in the clinical learning environment.Objective. To explore how medical students engage with feedback in preclinical skills training.Methods. Using an exploratory qualitative methodology, data from five focus groups, including 25 purposively selected third-year medical students, were iteratively analysed and identified and key themes were clarified.Results. The data revealed barriers that inhibit the use of feedback, ranging from students’ difficulties with decoding feedback, to their unwillingness to expend effort. Thematic analysis revealed four major themes related to the barriers to feedback receptivity and utilisation.Conclusion. Without collaboration, neither clinical educators nor students are empowered to fully remove the abovementioned barriers. Promoting a student’s learning is often framed as predominantly the task of their clinical educators. With a move towards constructivism, competency-based medical education claims that effective learning requires students to complement and significantly share in their educator’s responsibilities for their academic growth. Developing a responsibility-sharing culture in the giving and receiving of feedback ensures that students benefit fully from the feedback received through proactive engagement, leading to effective and sustainable clinical educator’s feedback practices. With minimal discussion on the concept ofresponsibility-sharing in the context of assessment feedback in medical education, it is necessary to further analyse and discuss this critical issue by considering certain expectations that should reinforce such a culture, along with the practicalities of creating this cultural shift within the preclinical skills setting.

Feedback in Medical Education: A Neglected Domain

Feedback in Medical Education: A Neglected Domain

Feedback in Medical Education

A number of learning competencies have to be attained by the medical students during their training period, as very limited time is available for them. This calls for the need to help medical students in their journey to become competent by facilitating the process of acquisition of knowledge and skills. The purpose of the current review was to explore the importance of feedback in medical education, identify the potential barriers to its effective delivery, and identify the strategies to overcome them. An extensive search of all materials related to the topic was carried out on the PubMed search engine, and a total of 17 articles were selected based on their suitability with the current review objectives. Keywords used in the search include feedback and medical education in the title alone only. Feedback in medical education is one of the most essential strategies to enhance learning. The findings of some of the studies have shown that feedback is not always beneficial and that students feel that feedback is not that much important as medical educators believe about it. In conclusion, acknowledging the significance and scope of feedback in medical education, the need of the hour is to include the same in every stage of the teaching–learning process. However, the effectiveness of feedback is significantly influenced by a wide range of teacher-, student-, and environment-related factors, and there is a definite need to take appropriate measures to address the challenges posed by these factors.

Desperately Seeking Feedback: a phenomenographic study of medical students’ experiences during a 4-year longitudinal feedback curriculum

Introduction: The focus of feedback in medical education recently shifted to a dialogic partnership between teachers and learners, co-creating effective feedback exchanges. We previously described a prototype, longitudinal 4-year curriculum for medical students to develop feedback-seeking behaviors. We explored the students’ experiences as participants in this novel program. Methods: Beginning in academic year 2017-2018, we assessed the 4-year experiences of 14 medical students with a phenomenographic, qualitative approach. Three waves of semi-structured, individual interviews were conducted during the first 3 years. Focus groups were conducted in the final year of the program. Meaning units were identified, and categories were determined by such units. An outcome space was created based on an ordered set of categories. Results: Based on students’ early experience with the curriculum, 4 categories formed the outcome space: prior or lack of experience, factors impacting experience, learning artifice and techniques, and improving feedback skills. A heavy emphasis was placed on the feedback experience related to the climate of the learning environment and the relationship with the feedback-giver. Learning different feedback techniques was important. As the students progressed through medical school while experiencing the feedback curriculum, the outcome space clearly evolved, with a greater emphasis on refining feedback-seeking skills. Students had a stronger growth mindset in tailoring the feedback they sought. Feedback-seeking became a natural and routine habit. Conclusions: Medical students experienced an evolving emphasis on feedback-seeking. They increasingly recognized the value of effective feedback and confidently embraced feedback-seeking, using a range of techniques and refined approaches.

The Use of Feedback in Improving the Knowledge, Attitudes and Skills of Medical Students: a Systematic Review and Meta-analysis of Randomized Controlled Trials.

This study aims to investigate the effectiveness of the use of different feedback modalities in improving the knowledge, attitudes, and skills of medical students compared to students receiving no feedback or unstructured feedback. A systematic review and meta-analysis of randomized controlled trials was conducted based on a search of the Cochrane, ERIC, PubMed, Scopus, and Web of Science databases. A total of 26 studies were included for the systematic review and 13 for the meta-analysis. The meta-analysis revealed that the use of feedback was associated with better results compared to control groups (SMD = 0.80 [0.56-1.04], p < 0.001), and also when only high-quality studies were included (SMD = 0.86 [0.56-1.16], p < 0.001). Our findings revealed high heterogeneity in the use of feedback in medical education. However, the results of most of the studies and of the meta-analysis were positive, showing that feedback had a positive influence on the education-learning process of the students. PROSPERO registration: CRD42018112688.

Exploring how differently patients and clinical tutors see the same consultation: building evidence for inclusion of real patient feedback in medical education

BackgroundUndergraduate medical education recognises that patient feedback is potentially valuable for student learning and development as a component of multi-source feedback. However greater exploration of how patient feedback perspectives differ to clinical educators is required for curriculum development and improving student feedback literacy. This study aimed to determine how two sources of feedback, patients and clinical tutors, compare on the same patient-centred, interpersonal criteria.MethodsA patient feedback instrument designed for the undergraduate medical education setting was used to compare patients’ feedback with clinical tutors’ feedback following a student-patient consultation in the learning context. Assessments from 222 learning consultations involving 40 medical students were collected. Descriptive statistics for tutors and patients for each question were calculated and correlations between patient and tutor were explored using Spearman’s rank-order correlation. Mixed effects ordered logistic regression was used to compare each question with an overall rating for tutor and patients in addition to comparing patient with tutor ratings.ResultsClinical tutor and patient assessments had a weak but significant positive correlation in all areas except questions related to respect and concern. When making judgements compared with overall assessment, patients’ ratings of respect, concern, communication and being understood in the consultation have a greater effect. After eliminating the effect of generally higher ratings by patients compared with tutors using comparative ordered logistic regression, patients rated students relatively less competent in areas of personal interaction.ConclusionThis study provides insight about patient feedback, which is required to continue improving the use and acceptability of this multisource feedback to students as a valuable component of their social learning environment. We have revealed the different perspective-specific judgement that patients bring to feedback. This finding contributes to building respect for patient feedback through greater understanding of the elements of consultations for which patients can discriminate performance.

Reimagining Feedback for the Milestones Era.

Reimagining Feedback for the Milestones Era.

Encouraging feedback-seeking behavior among medical students

In the field of medical education, the role of feedback in imparting effective curriculum delivery and making of a lifelong and self-directed learner has been acknowledged for a long period of time. Feedback seeking behavior is an important area which the administrators and teachers should aim to strengthen as it is ideal to have students as active seekers of feedback rather than passive recipients of the same. Feedback-seeking creates a platform for the effective exchange of information and plays an important role in eliminating the uncertainty related to the course and the desired competencies. In conclusion, feedback in medical education is an effective tool to promote learning among medical students. However, the overall effectiveness and teaching-learning can be enhanced if we can succeed in creating an atmosphere where the students develop a feedback seeking behavior to monitor their own professional growth.

Overcoming barriers to effective feedback: a solution-focused faculty development approach.

Overcoming barriers to effective feedback: a solution-focused faculty development approach.

Feedback in medical education - a workshop report with practical examples and recommendations.

Background: As a teaching method, feedback is an integral part of medical education. However, there is a lack of a uniform theoretical basis or generally recognized guidelines for its specific design. Against this background, the aim of this article is to discuss conceptual considerations and empirical findings regarding feedback using various practical examples.Procedure and conceptual considerations: Building on the results of a workshop of the Committee for Communicative and Social Competences of the Society for Medical Education (GMA), this article first explains central conceptual considerations and empirical results on the topic of feedback. A particular focus is on various variables that influence the effect of feedback. This includes the feedback source, the frequency of feedback, starting points of feedback, the connection between feedback and reflection as well as the motivation and meta-cognitive skills of the feedback recipient.Practical examples: The implementation of feedback in practice is illustrated using eight examples from the field of medical and dental education. They stem from various settings and the focus is on formative oral feedback. It will become evident that the focus is more on the givers of feedback than the recipients of feedback. Instructions for recipients of feedback on how to reflect on it is still the exception.Discussion: Many of the relevant aspects for the effect of feedback described in the literature are already taken into account in the practical examples discussed. In conclusion, seven recommendations are made for implementing feedback in practice.

Flipped Feedback: Can Medical Students Elicit Quality Feedback? [14G

INTRODUCTION: The purpose of this study is to investigate medical students’ knowledge and perception of feedback and to provide training on how they may elicit quality feedback. The majority of research and instruction regarding feedback in medical education relies upon the perspective of the individual who provides feedback rather than the learner. METHODS: After obtaining IRB approval, a preliminary questionnaire was sent to medical students in their clinical years to assess their knowledge of feedback and their perception of its quality. The SNIPER method, a formal methodology to elicit quality feedback from the learners’ perspective, was taught in an interactive session. A survey assessing knowledge of and participation in feedback was sent at three timepoints: before, immediately after, and one to two weeks after the session. RESULTS: 67 of 118 (58%) session participants indicated they received feedback at least half of the time during their clinical rotations. 100 (88%) responded that future students would benefit from the SNIPER method. 104 (94.5%) participants felt this feedback session was worthwhile. When self-evaluating their ability to elicit quality feedback, the average score of participants increased 26.4% (P&lt;.05). 25 (64%) of 39 respondents indicated they were able to obtain feedback utilizing the SNIPER method. CONCLUSION: Medical students feel that information on feedback is not emphasized in the current curriculum. Student satisfaction increases with knowledge of how to elicit quality feedback and empowers them to improve their clinical skills.

A Script for What Ails Your Learners: Feedback Scripts to Promote Effective Learning.

Thirty-five years ago, Jack Ende published a seminal article on feedback in medical education describing barriers and guidelines for improving upon the feedback process.1 While his guidelines are a staple of faculty development programs, gaps remain in the quality of feedback and comfort in its delivery.2,3