Medical Education 2012: 46:604–612
Objectives Feedback in workplace‐based clinical settings often relies on expert trainers’ judgements of directly observed trainee performance. There is ample ...literature on effective feedback, but in practice trainees in workplace‐based training are not regularly observed. We aimed to examine external conditions that impact feedback in observational workplace‐based assessment (WBA).
Methods Interviews were conducted and the resulting data analysed using a qualitative, phenomenological approach. Between October 2009 and January 2010, we interviewed 22 postgraduate general practice trainees at two institutions in the Netherlands. Three researchers analysed the transcripts of the interviews.
Results A three‐step scheme emerged from the data. Feedback as part of WBA is of greater benefit to trainees if: (i) observation and feedback are planned by the trainee and trainer; (ii) the content and delivery of the feedback are adequate, and (iii) the trainee uses the feedback to guide his or her learning by linking it to learning goals. Negative emotions reported by almost all trainees in relation to observation and feedback led to different responses. Some trainees avoided observation, whereas others overcame their apprehension and actively sought observation and feedback. Active trainers were able to help trainees overcome their fears. Four types of trainer–trainee pairs were distinguished according to their engagement in observation and feedback. External requirements set by training institutions may stimulate inactive trainers and trainees.
Conclusions In line with the literature, our results emphasise the importance of the content of feedback and the way it is provided, as well as the importance of its incorporation in trainees’ learning. Moreover, we highlight the step before the actual feedback itself. The way arrangements for feedback are made appears to be important to feedback in formative WBA. Finally, we outline several factors that influence the success or failure of feedback but precede the process of observation and feedback.
Discuss ideas arising from this article at ‘discuss’
Research has shown that narrative feedback, (self) reflections and a plan to undertake and evaluate improvements are key factors for effective feedback on clinical performance. We investigated the ...quantity of narrative comments comprising feedback (by trainers), self-reflections (by trainees) and action plans (by trainer and trainee) entered on a mini-CEX form that was modified for use in general practice training and to encourage trainers and trainees to provide narrative comments. In view of the importance of specificity as an indicator of feedback quality, we additionally examined the specificity of the comments.
We collected and analysed modified mini-CEX forms completed by GP trainers and trainees. Since each trainee has the same trainer for the duration of one year, we used trainer-trainee pairs as the unit of analysis. We determined for all forms the frequency of the different types of narrative comments and rated their specificity on a three-point scale: specific, moderately specific, not specific. Specificity was compared between trainee-trainer pairs.
We collected 485 completed modified mini-CEX forms from 54 trainees (mean of 8.8 forms per trainee; range 1-23; SD 5.6). Trainer feedback was more frequently provided than trainee self-reflections, and action plans were very rare. The comments were generally specific, but showed large differences between trainee-trainer pairs.
The frequency of self-reflection and action plans varied, all comments were generally specific and there were substantial and consistent differences between trainee-trainer pairs in the specificity of comments. We therefore conclude that feedback is not so much determined by the instrument as by the users. Interventions to improve the educational effects of the feedback procedure should therefore focus more on the users than on the instruments.
The literature provides some insight into the role of feedback givers, but little information about within-trainer factors influencing 'feedback-giving behaviours'. We looked for relationships ...between characteristics of feedback givers (self-efficacy, task perception, neuroticism, extraversion, agreeableness and conscientiousness) and elements of observation and feedback (frequency, quality of content and consequential impact).
We developed and tested several hypotheses regarding the characteristics and elements in a cross-sectional digital survey among GP trainers and their trainees in 2011 and 2012. We conducted bivariate analysis using Pearson correlations and performed multiple regression analysis.
Sixty-two trainer-trainee couples from three Dutch institutions for postgraduate GP training participated in the study. Trainer scores on 'task perception' and on a scale of the trait 'neuroticism' correlated positively with frequency of feedback and quality of feedback content. Multiple regression analysis supported positive correlations between task perception and frequency of feedback and between neuroticism and quality of feedback content. No other correlations were found.
This study contributes to the literature on feedback giving by revealing factors that influence feedback-giving behaviour, namely neuroticism and task perception. Trainers whose task perception included facilitation of observation and feedback (task perception) and trainers who were concerned about the safety of their patients during consultations with trainees (neuroticism) engaged more frequently in observation and feedback and gave feedback of higher quality.
Much research on teacher written feedback has focused on the teacher's role in giving the written commentary. What these studies fail to provide is a description of if and how students are reading, ...interpreting and using this feedback in their revisions. Some research has explored how students feel about the feedback they receive, but few studies have investigated the interplay between teacher and student in the actual process of feedback and revision. Those studies that have looked at feedback and revision in the classroom context are few in both first and second language writing research. Further, these few studies fall short of making explicit connections between student revision and student learning. This dissertation argues that the key to describing how and why students revise is determining the level of understanding with which students read and interpret teacher comments. This level of understanding is then also essential when considering what students have learned versus what they have just copied from the teacher. I conducted a qualitative case study of four first-year writing students and two writing instructors at a two-year college with a diverse population of students. Two of my participants were non-traditional students, one was a non-native speaker of English and one was a 'traditional' student. This diversity gave the study a rich look at both what about teacher feedback promotes student learning, and what may confuse students. Using Bloom's Revised Taxonomy, I described the different levels of cognitive processes students experienced as they read the feedback and revised. The taxonomy helped me differentiate between students' automated revisions and students' metacognitive awareness of the revision strategies they employed. Also, these cases evidenced the interplay of teacher appropriation and student agency in the process of feedback interpretation and revision. These findings suggest that teachers may need to explicitly train students to read feedback, and may need to open up new avenues for feedback negotiation in the writing classroom.
In The Candidate's
Dilemma , Elisabeth Kramer tells the story of
how three political candidates in Indonesia made decisions to
resist, engage in, or otherwise incorporate money politics into
their ...electioneering strategies over the course of their
campaigns.
As they campaign, candidates encounter pressure from the
institutional rules that guide elections, political parties, and
voters, and must also negotiate complex social relationships to
remain competitive. For anticorruption candidates, this context
presents additional challenges for building and maintaining their
identities. Some of these candidates establish their campaign
parameters early and are able to stay their course. For others, the
campaign trail results in an avalanche of compromises, each one
eating away at their sense of what constitutes "moral" and
"acceptable" behavior. The Candidate's Dilemma delves into
the lived experiences of candidates to offer a nuanced study of how
the political and personal intersect when it comes to money
politics, anticorruptionism, and electoral campaigning in
Indonesia.
In The Candidate's Dilemma, Elisabeth Kramer tells the story of how three political candidates in Indonesia made decisions to resist, engage in, or otherwise incorporate money politics into their ...electioneering strategies over the course of their campaigns. As they campaign, candidates encounter pressure from the institutional rules that guide elections, political parties, and voters, and must also negotiate complex social relationships to remain competitive. For anticorruption candidates, this context presents additional challenges for building and maintaining their identities. Some of these candidates establish their campaign parameters early and are able to stay their course. For others, the campaign trail results in an avalanche of compromises, each one eating away at their sense of what constitutes "moral" and "acceptable" behavior. The Candidate's Dilemma delves into the lived experiences of candidates to offer a nuanced study of how the political and personal intersect when it comes to money politics, anticorruptionism, and electoral campaigning in Indonesia.
PDF
