Protocol for a realist review of the influence of cultural factors on understanding the role of feedback in developing clinical competencies of health professional students in Asia.

Abstract

Background: Clinical education has moved to a competency-based model with an emphasis on workplace-based learning and assessment which, in turn, depends on feedback to be effective. Further, the understanding of feedback has changed from information about a performance directed to the learner performing the task, to a dialogue, which enables the learner to act and develop. In health professional education, feedback is a complex interaction between trainee, supervisor and the healthcare system. Most published research on feedback in health professional education originates in Europe and North America. Our interest is on the impact of culture on this process, particularly in the context of Asian cultures. A realist approach looks at complex interventions in social situations, and so would seem appropriate lens to use to examine the influence of cultural factors on utilising feedback. Methods: An initial search has been performed to define the scope of the review question and develop our candidate / best guess program theory. The formal electronic search was carried out in February 2020 and included: CINAHL, ERIC, MEDLINE, and PsycInfo, and repeated in October 2020. Retrieved articles were imported into Covidence for screening and data extraction, after which components of the Context -Mechanisms - Outcomes configurations will be sought to refine the initial program theory. Discussion: Feedback has been recognised as critically important in competency-based health professional education, yet feedback is a complex, socially based intervention. Most of the published literature on feedback originates from Western cultures. This protocol aims to provide further information that may lead to improving the usefulness of feedback in the South East Asian region. Systematic Review Registration: Registration was sought with PROSPERO and advice given was that this review was not eligible for registration as it did not have a direct and clinically-relevant health-related outcome. Keywords: Realist review, Realist Synthesis, Health professional students, Medical students, Feedback, Asia