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Effective Feedback Conversations in Clinical Practice

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Clinical Education for the Health Professions

Abstract

Feedback plays a crucial role in health professionals’ training in clinical practice. The aim of feedback is to help learners improve their performance using an interactive learning conversation. This offers learners the opportunity to understand more about the desired standard and the standard of their own work, and to problem solve difficulties with an expert (or another collaborator). In this chapter, we discuss the core components of effective feedback and the key literature that supports it. As our objective is to assist health professionals to make the most of feedback opportunities, the chapter focuses on practical strategies with multiple illustrative examples of dialogue.

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References

  • Bangert-Drowns RL, Kulik C-LC, Kulik JA, Morgan M. The instructional effect of feedback in test-like events. Rev Educ Res. 1991;61(2):213–38.

    Article  Google Scholar 

  • Bing-You RG, Paterson J, Levine MA. Feedback falling on deaf ears: residents’ receptivity to feedback tempered by sender credibility. Med Teach. 1997;19(1):40–4.

    Article  Google Scholar 

  • Boud D, Molloy E. What is the problem with feedback? In: Boud D, Molloy E, editors. Feedback in higher and professional education. London: Routledge; 2013. p. 1–10.

    Google Scholar 

  • Butler DL, Winne PH. Feedback and self-regulated learning: a theoretical synthesis. Rev Educ Res. 1995;65(3):245–81.

    Article  Google Scholar 

  • Bynum WE, Artin AR. Why we should strive for emotional candour in medical education, too. Med Educ. 2019;53(7):745–6.

    Article  Google Scholar 

  • Carless D. Trust and its role in facilitating dialogic feedback. In: Boud D, Molloy E, editors. Feedback in higher and professional education. London: Routledge; 2013. p. 90–103.

    Google Scholar 

  • Carless D, Boud D. The development of student feedback literacy: enabling uptake of feedback. Assess Eval High Educ. 2018;43(8):1315–25.

    Article  Google Scholar 

  • Cook DA, Artino AR Jr. Motivation to learn: an overview of contemporary theories. Med Educ. 2016;50(10):997–1014.

    Article  Google Scholar 

  • Dawson P, Ajjawi R, Boud D, Tai J. Introduction: what is evaluative judgement? In: Boud D, Ajjawi R, Dawson P, Tai J, editors. Developing evaluative judgement in higher education assessment for knowing and producing quality work. London: Routledge; 2018. p. 1–4.

    Google Scholar 

  • Deci EL, Ryan RM. The ‘what’ and ‘why’ of goal pursuits: human needs and the self-determination of behavior. Psychol Inq. 2000;11:227–68.

    Article  Google Scholar 

  • Dweck CS. Motivational processes affecting learning. Am Psychol. 1986;41:1040.

    Article  Google Scholar 

  • Dweck CS, Yeager DS. Mindsets: a view from two eras. Perspect Psychol Sci. 2019;14(3):481–96.

    Article  Google Scholar 

  • Edmondson AC. Learning from mistakes is easier said than done: group and organizational influences on the detection and correction of human error. J Appl Behav Sci. 1996;32(1):5–28.

    Article  Google Scholar 

  • Edmondson AC. Psychological safety and learning behavior in work teams. Adm Sci Q. 1999;44(2):350–83.

    Article  Google Scholar 

  • Ende J. Feedback in clinical medical education. J Am Med Assoc. 1983;250(6):777–81.

    Article  Google Scholar 

  • Ende J, Pomerantz A, Erickson F. Preceptors’ strategies for correcting residents in an ambulatory care medicine setting: a qualitative analysis. Acad Med. 1995;70(3):224–9.

    Article  Google Scholar 

  • Ericsson KA. Acquisition and maintenance of medical expertise: a perspective from the expert-performance approach with deliberate practice. Acad Med. 2015;90(11):1471–86.

    Article  Google Scholar 

  • Epstein RM, Siegel DJ, Silberman J. Self-Monitoring in Clinical Practice: A Challenge for Medical Educators J Contin Educ Health Prof 2008;28(1):5–13

    Google Scholar 

  • Fernando N, Cleland J, McKenzie H, Cassar K. Identifying the factors that determine feedback given to undergraduate medical students following formative mini-CEX assessments. Med Educ. 2008;42(1):89–95.

    Google Scholar 

  • Fraser KL, Ayres P, Sweller J. Cognitive load theory for the design of medical simulations. Simulation in Healthcare. 2015;10(5):295–307.

    Google Scholar 

  • Hattie J, Timperley H. The power of feedback. Rev Educ Res. 2007;77(1):81–112.

    Article  Google Scholar 

  • Hewson MG, Little ML. Giving feedback in medical education: verification of recommended techniques. J Gen Intern Med. 1998;13(2):111–6.

    Article  Google Scholar 

  • Johnson CE, Molloy EK. Building evaluative judgement through the process of feedback. In: Boud D, Ajjawi R, Dawson P, Tai J, editors. Developing evaluative judgement in higher education assessment for knowing and producing quality work. London: Routledge; 2018. p. 166–75.

    Chapter  Google Scholar 

  • Johnson CE, Keating JL, Boud DJ, Dalton M, Kiegaldie D, Hay M, et al. Identifying educator behaviours for high quality verbal feedback in health professions education: literature review and expert refinement. BMC Med Educ. 2016;16(1):96.

    Article  Google Scholar 

  • Johnson CE, Keating JL, Farlie MK, Kent F, Leech M, Molloy EK. Educators’ behaviours during feedback in authentic clinical practice settings: an observational study and systematic analysis. BMC Med Educ. 2019;19(1):129.

    Article  Google Scholar 

  • Johnson CE, Keating JL, Molloy EK. Psychological safety in feedback: what does it look like and how can educators work with learners to foster it? Med Educ. 2020a;54(6):559–70.

    Article  Google Scholar 

  • Johnson CE, Weerasuria MP, Keating JL. Effect of face-to-face verbal feedback compared with no or alternative feedback on the objective workplace task performance of health professionals: a systematic review and meta-analysis. BMJ Open. 2020b;10(3):e030672.

    Article  Google Scholar 

  • Kaufman DM. Applying educational theory in practice. In: Cantillon P, Wood D, editors. ABC of learning and teaching in medicine. Oxford: Blackwell Publishing; 2010.

    Google Scholar 

  • Kluger AN, DeNisi A. The effects of feedback interventions on performance: a historical review, a meta-analysis, and a preliminary feedback intervention theory. Psychol Bull. 1996;119(2): 254–84.

    Article  Google Scholar 

  • Kolbe M, Eppich W, Rudolph J, Meguerdichian M, Catena H, Cripps A, et al. Managing psychological safety in debriefings: a dynamic balancing act. BMJ Simul Technol Enhanc Learn. 2019. https://doi.org/10.1136/bmjstel-2019-000470.

  • Locke EA, Latham GP. Building a practically useful theory of goal setting and task motivation. A 35-year odyssey. Am Psychol. 2002;57(9):705–17.

    Article  Google Scholar 

  • Molloy E. Time to pause: feedback in clinical education. In: Delany C, Molloy E, editors. Clinical education in the health professions. Sydney: Elsevier; 2009. p. 128–46.

    Google Scholar 

  • Molloy E, Bearman M. Embracing the tension between vulnerability and credibility: ‘intellectual candour’ in health professions education. Med Educ. 2019;53(1):32–41.

    Article  Google Scholar 

  • Molloy E, Boud D. Changing conceptions of feedback. In: B D, Molloy E, editors. Feedback in higher and professional education. London: Routledge; 2013. p. 11–33.

    Google Scholar 

  • Molloy E, Denniston C. The role of feedback in surgical education. In: Nestel D, Dalrymple K, Paige P, Aggarwha R, editors. Advancing surgical education: theory, evidence and practice. New York: Springer; 2018.

    Google Scholar 

  • Molloy E, Borrell-Carrio F, Epstein R. The impact of emotions in feedback. In: Boud D, Molloy E, editors. Feedback in higher and professional education. London: Routledge; 2013. p. 50–71.

    Google Scholar 

  • Molloy E, Ajjawi R, Bearman M, Noble C, Rudland J, Ryan A. Challenging feedback myths: values, learner involvement and promoting effects beyond the immediate task. Med Educ. 2019;54(1):33–9.

    Article  Google Scholar 

  • Nicol DJ, Macfarlane-Dick D. Formative assessment and self-regulated learning: a model and seven principles of good feedback practice. Stud High Educ. 2006;31(2):199–218.

    Article  Google Scholar 

  • Noble C, Billett S, Armit L, Collier L, Hilder J, Sly C, et al. “It’s yours to take”: generating learner feedback literacy in the workplace. Adv in Health Sci Educ 2020;25:55–74. https://doi.org/10.1007/s10459-019-09905-5

  • Pelgrim EA, Kramer AW, Mokkink HG, van der Vleuten CP. The process of feedback in workplace-based assessment: organisation, delivery, continuity. Med Educ. 2012;46(6):604–12.

    Article  Google Scholar 

  • Ramani S, Post SE, Könings K, Mann K, Katz JT, van der Vleuten C. “It’s just not the culture”: a qualitative study exploring residents’ perceptions of the impact of institutional culture on feedback. Teach Learn Med. 2017;29(2):153–61.

    Article  Google Scholar 

  • Ramani S, Konings KD, Ginsburg S, van der Vleuten CPM. Twelve tips to promote a feedback culture with a growth mindset: Swinging the feedback pendulum from recipes to relationships, Medical Teacher, 2019;41(6)625–631. https://doi.org/10.1080/0142159X.2018.1432850

  • Rudolph JW, Simon R, Rivard P, Dufresne RL, Raemer DB. Debriefing with good judgment: combining rigorous feedback with genuine inquiry. Anesthesiol Clin. 2007;25:361.

    Article  Google Scholar 

  • Rudolph JW, Raemer DB, Simon R. Establishing a safe container for learning in simulation: the role of the presimulation briefing. Simul Healthc. 2014;9(6):339–49.

    Article  Google Scholar 

  • Rudolph JW, Simon R, Dufresne RL, Raemer DB. There’s no such thing as “nonjudgmental” debriefing: a theory and method for debriefing with good judgment. Simul Healthc. 2016;1(1):49–55.

    Article  Google Scholar 

  • Sadler DR. Formative assessment and the design of instructional systems. Instr Sci. 1989;18(2):119–44.

    Article  Google Scholar 

  • Sargeant J, Mann K, Ferrier S. Exploring family physicians’ reactions to multisource feedback: perceptions of credibility and usefulness. Med Educ. 2005;39(5):497–504.

    Article  Google Scholar 

  • Sargeant J, Mann K, Sinclair D, Van der Vleuten C, Metsemakers J. Understanding the influence of emotions and reflection upon multi-source feedback acceptance and use. Adv Health Sci Educ. 2008;13(3):275–88.

    Article  Google Scholar 

  • Sargeant J, Lockyer J, Mann K, Holmboe E, Silver I, Armson H, et al. Facilitated reflective performance feedback: developing an evidence- and theory-based model that builds relationship, explores reactions and content, and coaches for performance change (R2C2). Acad Med. 2015;90(12):1698–706.

    Article  Google Scholar 

  • Sargeant J, Lockyer JM, Mann K, Armson H, Warren A, Zetkulic M, et al. The R2C2 model in residency education: how does it Foster coaching and promote feedback use? Acad Med. 2018;93(7):1055–63.

    Article  Google Scholar 

  • Silverman J, Kurtz S. The Calgary-Cambridge approach to communication skills teaching II: the set-go method of descriptive feedback. Educ Gen Pract. 1997;8(7):288–99.

    Google Scholar 

  • Silverman J, Kurtz S, Draper J. Building the relationship. Skills for communicating with patients. 3rd ed. London: Radcliffe Publishing; 2013. p. 118–48.

    Google Scholar 

  • Tai J, Molloy E, Haines T, Canny B. Same-level peer-assisted learning in medical clinical placements: a narrative systematic review. Med Educ. 2016a;50(4):469–84.

    Article  Google Scholar 

  • Tai JH, Canny BJ, Haines TP, Molloy EK. The role of peer-assisted learning in building evaluative judgement: opportunities in clinical medical education. Adv Health Sci Educ. 2016b;21(3):659–76.

    Article  Google Scholar 

  • Tai JH, Ajjawi R, Boud D, Dawson P, Panadero E. Developing evaluative judgement: enabling students to make decisions about the quality of work. High Educ. 2017;76:467. https://doi.org/10.1007/s10734-017-0220-3.

    Article  Google Scholar 

  • Telio S, Ajjawi R, Regehr G. The “educational alliance” as a framework for reconceptualizing feedback in medical education. Acad Med. 2015;90(5):609–14.

    Article  Google Scholar 

  • Telio S, Regehr G, Ajjawi R. Feedback and the educational alliance: examining credibility judgements and their consequences. Med Educ. 2016;50(9):933–42.

    Article  Google Scholar 

  • Ten Cate TJ, Kusurkar RA, Williams GC. How self-determination theory can assist our understanding of the teaching and learning processes in medical education. AMEE guide no. 59. Med Teach. 2011;33(12):961–73.

    Article  Google Scholar 

  • van der Leeuw RM, Teunissen PW, van der Vleuten CPM. Broadening the scope of feedback to promote its relevance to workplace learning. Acad Med. 2018;93(4):556–9.

    Article  Google Scholar 

  • Van Merrienboer JJG, Sweller J. Cognitive load theory in health professional education: design principles and strategies. Medical Education. 2010;44(44):85–93

    Google Scholar 

  • Voyer S, Cuncic C, Butler DL, MacNeil K, Watling C, Hatala R. Investigating conditions for meaningful feedback in the context of an evidence-based feedback programme. Med Educ. 2016;50(9):943–54.

    Article  Google Scholar 

  • Wadsworth BJ. Piaget’s theory of cognitive and affective development: foundations of constructivism. 5th ed. White Plains: Longman Publishing; 1996.

    Google Scholar 

  • Watling C, Ginsburg S. Assessment, feedback and the alchemy of learning. Med Educ. 2019;53(1):76–85.

    Article  Google Scholar 

  • Watling C, LaDonna KA, Lingard L, Voyer S, Hatala R. ‘Sometimes the work just needs to be done’: socio-cultural influences on direct observation in medical training. Med Educ. 2016;50(10):1054–64.

    Article  Google Scholar 

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Correspondence to C. E. Johnson .

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Johnson, C.E., Watling, C.J., Keating, J.L., Molloy, E.K. (2021). Effective Feedback Conversations in Clinical Practice. In: Nestel, D., Reedy, G., McKenna, L., Gough, S. (eds) Clinical Education for the Health Professions. Springer, Singapore. https://doi.org/10.1007/978-981-13-6106-7_53-1

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  • DOI: https://doi.org/10.1007/978-981-13-6106-7_53-1

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