The Perception of Feedback and Strengthening the Feedback Process. A Qualitative Thematic Analysis Among Residents and Supervisors in Anaesthesia and Intensive Care

BackgroundMedical education worldwide is currently undergoing a shift through the implementation of Competency Based Medical Education (CMBE). Feedback is a key factor for implementation of CBME as well as an important element in the process of continuous learning for healthcare professionals. We have investigated the perception of feedback and how to strengthen feedback processes among residents and supervisors in five anaesthesia and intensive care departments in Stockholm, Sweden. MethodA survey was sent out to 101 residents and 168 supervisors in anaesthesia and intensive care in Stockholm. The data was analysed using thematic analysis. Results Our results show that both residents and supervisors had similar mental models of feedback. Feedback was considered to enhance teamwork, create positive reinforcement and support professional development. Our material provides insights to factors that inhibit feedback, such as psychological unsafety, lack of feedback culture and shortage of knowledge regarding feedback processes. ConclusionAn organizational and systematic approach is needed to empower the use of feedback within the anaesthesia and critical care environment. Establishing good learning environments and strong feedback cultures is an investment for the future of medical education.

Using a Delphi Technique to Define a Feedback Culture in Graduate Medical Education

Background and Objectives: Experts in medical education hypothesize that programs with a robust culture of feedback foster learning and growth for learners and educators, yet the literature shows no consensus for what defines a feedback culture in graduate medical education. Methods: Using a two-round, modified Delphi technique in summer and fall of 2019, the authors asked a panel of experts to identify essential elements to a feedback culture. The research team compiled a list of experts and a list of 29 descriptors of a highly functioning feedback culture. Experts rated the items as an essential, compatible, or not important aspect of a highly functioning culture of feedback. Researchers set a minimum threshold of 80% agreement and used comments from panelists to revise elements that did not meet agreement during round one. Experts then rerated the elements using information on their initial ratings, aggregate panelist ratings, and comments from all panelists. Results: The response rates from our panel of experts were 68% (17/25) for round one and 88% (15/17) for round two. Seventeen elements were rated as essential to a feedback culture. Conclusions: An expert panel endorsed essential elements that can be used to assess feedback culture in graduate medical education programs.

Seek and Ye Shall Learn

“Seek and Ye Shall Learn: Exploring the Multiple Links of Learning Agility and Feedback Seeking” describes multiple pathways through which learning agility and feedback relate. Every feedback event is seen as providing an opportunity for experienced-based learning to occur. The chapter reviews research demonstrating that those with strong learning agility are more likely to actively seek feedback—and in particular the most useful types of feedback—and are more likely to incorporate the lessons of the feedback received in order to improve their performance. It also suggests ways that organizations can leverage feedback to nurture stronger learning agility in their leaders. The chapter identifies areas for further research and implications for fostering a stronger feedback culture.

Trust in Intensive Care Patients, Family, and Healthcare Professionals: The Development of a Conceptual Framework Followed by a Case Study

Intensive care patients experience anxiety, pain, uncertainty, and total dependency. In general, it is important to develop trust between the healthcare professionals (HCPs), patients, and their family. Trust building in the ICU setting is challenging because of the time sensitivity of decision making and the dependency of patients on health care professionals. The objectives of this study are the development of a trust framework and then to use this framework in a case study in the intensive care. In three steps we developed a comprehensive trust framework from the literature concerning trust. First, we identified the elements of trust. Second, we adapted and integrated the dimensions to six concepts to construct the trust framework. Third, these concepts are incorporated into a comprehensive trust framework. In a case study we explored the facilitators and barriers within this framework in eight semi-open interviews with healthcare professionals and eight patients or partners. Trust was first explored inductively and then deductively. We showed that HCPs, patients, and family have largely the same perspective regarding the facilitators of trust, in which communication emerged as the most important one. Other facilitators are maintaining an open feedback culture for HCPs and being aware of patients’ physical and informational privacy. Patients want to be approached as an individual with individual needs. Dishonesty and differences in values and norms were the most important barriers. To contribute to a positive perception of health delivery and to avoid conflicts between HCP and patients or their family we formulated five practical recommendations.

Student Feedback on Teaching in Schools: Current State of Research and Future Perspectives

The aim of this volume was to give a comprehensive overview of the current state of the research on student perceptions of and student feedback on teaching. This chapter provides a resume of the important theoretical considerations and empirical evidence the authors contributed to this volume. First, evidence concerning the validity of student perceptions of teaching quality is discussed, highlighting the quality of the questionnaires used and accompanying materials provided by their authors. In the next step, empirical findings are summarized on student and teacher characteristics that can influence important processes within the feedback cycle. Subsequently, it is emphasized that the effectiveness of student feedback on teaching is significantly related to the nature of the individual school’s feedback culture. Furthermore, it is argued that the efficacy of student feedback depends on whether teachers are provided with a high level of support, when making use of the feedback information to improve their teaching practices. As the literature review impressively documents‚ teachers, teaching, and ultimately students can benefit substantially from student feedback on teaching in schools.

Relevant Conditions for Teachers’ Use of Student Feedback

Based on the findings from research on organizational feedback and data use in schools, this chapter systematizes relevant factors influencing the use of student feedback by teachers in three domains: (1) personal characteristics of feedback recipients (teachers), (2) characteristics of the organization (school), and (3) characteristics of feedback information (data). We identified teachers’ self-efficacy, attribution styles, goal orientations, and age or professional experience as relevant individual characteristics. In addition, teachers’ attitude toward students’ trustworthiness or competence as a feedback provider appeared to be relevant for the use of student feedback. Beyond that, findings on organizational characteristics for teachers’ successful dealing with feedback pointed to the importance of a feedback culture and organizational safety, leadership, supportive measures, and perceived function of feedback as control vs. development. Furthermore, relevant characteristics of feedback information were identified as comprehensibility, valence, and specificity. Although such findings from other fields of research have been known for some time, studies on student feedback concerning these aspects are rare. Finally, practical measures are derived for each of the three domains in order to increase the use of student feedbacks by teachers.

Driving lesson or driving test?

Although there is consensus in the medical education world that feedback is an important and effective tool to support experiential workplace-based learning, learners tend to avoid the feedback associated with direct observation because they perceive it as a high-stakes evaluation with significant consequences for their future. The perceived dominance of the summative assessment paradigm throughout medical education reduces learners’ willingness to seek feedback, and encourages supervisors to mix up feedback with provision of ‘objective’ grades or pass/fail marks. This eye-opener article argues that the provision and reception of effective feedback by clinical supervisors and their learners is dependent on both parties’ awareness of the important distinction between feedback used in coaching towards growth and development (assessment for learning) and reaching a high-stakes judgement on the learner’s competence and fitness for practice (assessment of learning). Using driving lessons and the driving test as a metaphor for feedback and assessment helps supervisors and learners to understand this crucial difference and to act upon it. It is the supervisor’s responsibility to ensure that supervisor and learner achieve a clear mutual understanding of the purpose of each interaction (i.e. feedback or assessment). To allow supervisors to use the driving lesson—driving test metaphor for this purpose in their interactions with learners, it should be included in faculty development initiatives, along with a discussion of the key importance of separating feedback from assessment, to promote a feedback culture of growth and support programmatic assessment of competence.