Investigating conditions for meaningful feedback in the context of an evidence-based feedback programme

Abstract

We conclude that the conditions established within our pilot feedback programme influenced the learning culture for first-year internal medicine residents by grounding direct observation in authentic clinical work and setting the observations in the context of a longitudinal, non-assessment-based relationship between a faculty member and resident. These conditions appeared to influence residents' participation in the feedback process, their ways of approaching their daily clinical work, their emotional well-being and their engagement in their own learning.

Assessment, feedback and the alchemy of learning

“…Increasingly, the feedback literature advocates a coaching approach, which places the emphasis firmly on learner development . Coaching models thrive on longitudinal, trusting relationships between teachers and learners, where both are clear about the developmental intent of the interaction …”

“…Yet, investing teachers with this difficult dual role evokes discomfort in both learners and the teachers themselves . Some have suggested that we should look for opportunities to divorce the roles of assessor and coach, and emerging evidence suggests that doing so may yield benefits in terms of perceived feedback quality . However, models of programmatic assessment, if not implemented with care, risk blurring the lines between assessor and coach further, with their seeming embrace of the notion that the same information, and experiences, can serve both summative and formative purposes.…”

“…Simulation in postgraduate training may be distinctly set up as not being about assessment, but rather as offering an opportunity for practice, with the benefit of post‐event debriefing to support more effective learning . Coaching programmes in which faculty members pair with learners to observe them work, in order to offer reflections on what they have seen and to make recommendations for future development, can be successfully implemented in ways that allow learners to let their guard down and engage with the process of continuous improvement …”

Where philosophy meets culture: exploring how coaches conceptualise their roles

“…Medicine's chronic frustration with the state of its feedback practices may contribute to coaching's new‐found popularity. But in fact, some contemporary models of feedback explicitly emphasise relationship, honest conversation and learner safety in efforts to overcome some of the feedback challenges and render it more useful to learners . What remains unclear is exactly what coaching approaches are expected to add, and how – or whether – coaching differs from feedback performed with care.…”

Good educators and orphans: the case of direct observation and feedback

“…Recent research provides us with examples of such new ways. Voyer and colleagues investigated the delivery of feedback through extensive direct observation sessions of a few hours every 2 or 3 months, within a prolonged training relationship and devoid of summative assessment. First‐year internal residents were observed while performing usual clinical duties on typical internal medicine inpatient rotations.…”