An autoethnographic exploration of the use of goal oriented feedback to enhance brief clinical teaching encounters

Abstract

Supervision in the outpatient context is increasingly in the form of single day interactions between students and preceptors. This creates difficulties for effective feedback, which often depends on a strong relationship of trust between preceptor and student. Building on feedback theories focusing on the relational and dialogic aspects of feedback, this study explored the use of goal-oriented feedback in brief encounters with learners. This study used autoethnography to explore one preceptor's feedback interactions over an eight-month period both in the ambulatory setting and on the wards. Data included written narrative reflections on feedback interactions with twenty-three learners informed by discussions with colleagues and repeated reading of feedback literature. Thematic and narrative analyses of data were performed iteratively. Data analysis emphasized four recurrent themes. (1) Goal discussions were most effective when initiated early and integrated throughout the learning experience. (2) Both learner and preceptor goals were multiple and varied, and feedback needed to reflect this complexity. (3) Negotiation or co-construction of goals was important when considering the focus of feedback discussions in order to create safer, more effective interactions. (4) Goal oriented interactions offer potential benefits to the learner and preceptor. Goal oriented feedback promotes dialogue as it requires both preceptor and learner to acknowledge and negotiate learning goals throughout their interaction. In doing so, feedback becomes an explicit component of the preceptor-learner relationship. This enhances feedback interactions even in relatively brief encounters, and may begin an early educational alliance that can be elaborated with longer interactions.

Challenging feedback myths: Values, learner involvement and promoting effects beyond the immediate task

“…The focus on goals and iterative loops within and across encounters offers structure but is not prescriptive. Through establishing shared goals and activities, an educational alliance is strengthened and can then be leveraged for behaviour change . The three components interplay in the sense that if an educator takes the time to discuss and negotiate goals and an agreement about how to work towards the goals, this demonstrates that the supervisor is invested in the learner and thereby strengthens perceptions of trust and respect (ie the bond).…”

“…Shared educational principles across these two approaches include acknowledgement of the importance of establishing (and re‐establishing) relationships, discussion and setting of goals, the active engagement of the learner, iterative feedback loops and a focus on learner development. Neither is prescriptive in flavour, but they offer structure, which is appreciated by educators . When feedback conversations are oriented towards improvement, the ritualised hang‐ups around positive and negative content and the myriad of behaviours (such as avoidance or sugar‐coating) described above are broken.…”

“…“Feedback as telling” has a backward‐facing orientation that lingers on the past and leaves the learner with little agency. Even within brief encounters, research highlights that a focus on effects such as “acting as a consultant” or future career specialty choices are possible through feedback dialogue and in reference to co‐constructed goals . If feedback were to be better designed as an iterative process involving nested tasks whereby both parties offer perspectives and strategies, there might well be less of an imperative for linguistic gymnastics on the part of the educator, and less risk of threat to learner identity.…”

When I say … autoethnography

“…For example, the others in my journey included other participants in my culture, my research team and relevant literature. 5 'Travel companions' help to provide different angles and perspectives on a study and deepen what is discovered along the way. They allow the focus of research to be on what is experienced or lived by the self and others in that culture, not on the researcher alone.…”

“…I found that during my journey, the self-reflective process strengthened my understanding of the culture in which I worked, resulting in the evolution and strengthening of my personal practice. 5 Furthermore, the sharing of narratives and their analysis and interpretation of the interconnectivity of self and others in a particular culture ideally will resonate with readers. They may then be motivated to reflect on how the findings fit within their own teaching or learning environments.…”