Development of the Feedback Quality Instrument: a guide for health professional educators in fostering learner-centred discussions

Abstract

Background Face-to-face feedback plays an important role in health professionals’ workplace learning. The literature describes guiding principles regarding effective feedback but it is not clear how to enact these. We aimed to create a Feedback Quality Instrument (FQI), underpinned by a social constructivist perspective, to assist educators in collaborating with learners to support learner-centred feedback interactions. In earlier research, we developed a set of observable educator behaviours designed to promote beneficial learner outcomes, supported by published research and expert consensus. This research focused on analysing and refining this provisional instrument, to create the FQI ready-to-use. Methods We collected videos of authentic face-to-face feedback discussions, involving educators (senior clinicians) and learners (clinicians or students), during routine clinical practice across a major metropolitan hospital network. Quantitative and qualitative analyses of the video data were used to refine the provisional instrument. Raters administered the provisional instrument to systematically analyse educators’ feedback practice seen in the videos. This enabled usability testing and resulted in ratings data for psychometric analysis involving multifaceted Rasch model analysis and exploratory factor analysis. Parallel qualitative research of the video transcripts focused on two under-researched areas, psychological safety and evaluative judgement, to provide practical insights for item refinement. The provisional instrument was revised, using an iterative process, incorporating findings from usability testing, psychometric testing and parallel qualitative research and foundational research. Results Thirty-six videos involved diverse health professionals across medicine, nursing and physiotherapy. Administering the provisional instrument generated 174 data sets. Following refinements, the FQI contained 25 items, clustered into five domains characterising core concepts underpinning quality feedback: set the scene, analyse performance, plan improvements, foster learner agency, and foster psychological safety. Conclusions The FQI describes practical, empirically-informed ways for educators to foster quality, learner-centred feedback discussions. The explicit descriptions offer guidance for educators and provide a foundation for the systematic analysis of the influence of specific educator behaviours on learner outcomes.

Assessment of validity and reliability of the Feedback Quality Instrument

“…The valid instruments available regarding the feedback in medical education are not used to assess the feedback received by the learners. This study assessed the quality of feedback from the viewpoint of residents and interns by FQI means, based on Johnson's claim that the original version of FQI was the most complete version of the feedback quality assessment tool (17).…”

“…The feedback quality instrument was designed by Johnson et al (2021). The manufacturer has authorized the use of the tool.…”

Co‐designing for success: Fostering psychological safety with learners to optimise learning, collaboration and performance

“…So, how can psychological safety be fostered? Our research on feedback discussions in clinical practice identified practical ways for supervisors to collaborate with junior clinicians to promote trust, respect, inclusion, and support, as well as reduce power imbalance 8,9 . Key to this is having a growth mindset, proposed by Dweck, 10 which endorses continuing development of skills.…”

“…Our research on feedback discussions in clinical practice identified practical ways for supervisors to collaborate with junior clinicians to promote trust, respect, inclusion, and support, as well as reduce power imbalance. 8,9 Key to this is having a growth mindset, proposed by Dweck, 10 which endorses continuing development of skills. This mindset accepts that mistakes are an inevitable part of learning and provide opportunities for enabling performance improvement.…”