Janet Lefroy

Guidelines: the do's, don'ts and don't knows of feedback for clinical education

IntroductionThe guidelines offered in this paper aim to amalgamate the literature on formative feedback into practical Do’s, Don’ts and Don’t Knows for individual clinical supervisors and for the institutions that support clinical learning.MethodsThe authors built consensus by an iterative process. Do’s and Don’ts were proposed based on authors’ individual teaching experience and awareness of the literature, and the amalgamated set of guidelines were then refined by all authors and the evidence was summarized for each guideline. Don’t Knows were identified as being important questions to this international group of educators which if answered would change practice. The criteria for inclusion of evidence for these guidelines were not those of a systematic review, so indicators of strength of these recommendations were developed which combine the evidence with the authors’ consensus.ResultsA set of 32 Do and Don’t guidelines with the important Don’t Knows was compiled along with a summary of the evidence for each. These are divided into guidelines for the individual clinical supervisor giving feedback to their trainee (recommendations about both the process and the content of feedback) and guidelines for the learning culture (what elements of learning culture support the exchange of meaningful feedback, and what elements constrain it?)ConclusionFeedback is not easy to get right, but it is essential to learning in medicine, and there is a wealth of evidence supporting the Do’s and warning against the Don’ts. Further research into the critical Don’t Knows of feedback is required. A new definition is offered: Helpful feedback is a supportive conversation that clarifies the trainee’s awareness of their developing competencies, enhances their self-efficacy for making progress, challenges them to set objectives for improvement, and facilitates their development of strategies to enable that improvement to occur.

Grades in formative workplace-based assessment: a study of what works for whom and why.

Grades are commonly used in formative workplace‐based assessment (WBA) in medical education and training, but may draw attention away from feedback about the task. A dilemma arises because the self‐regulatory focus of a trainee must include self‐awareness relative to agreed standards, which implies grading.

Minding the gap between communication skills simulation and authentic experience.

Concurrent exposure to simulated and authentic experiences during undergraduate medical education is increasing. The impact of gaps or differences between contemporaneous experiences has not been adequately considered. We address two questions. How do new undergraduate medical students understand contemporaneous interactions with simulated and authentic patients? How and why do student perceptions of differences between simulated and authentic patient interactions shape their learning?

Some like it hot: medical student views on choosing the emotional level of a simulation

Medical Education 2011: 45: 354–361

Some like it hot: Medical student views on choosing the emotional level of a simulation

Medical Education 2011: 45: 354–361

Embracing complexity theory can clarify best practice frameworks for simulation education

In this issue, Cross-cutting Edge authors Fenwick and Abrandt Dahlgren assert that simulationbased education (SBE) contains inherent socio-material contradictions. For educators and practitioners making use of SBE, this may initially make for uncomfortable reading. The raison d’être of SBE is to provide learners with opportunities to develop knowledge, skills and behaviours that transfer into ‘real-world’ clinical practices. Contradictions, with implied gaps within and between simulation scenarios, may be considered very unwelcome. However, we encourage readers to refrain from falling into defensive mode and instead to read the article by Fenwick and Abrandt Dahlgren in full in order to gain understanding of how the use of complexity theory provides a good example of the possibilities that can be opened up by using socio-material approaches to improve design, delivery and potential outcomes in SBE.

Designing whole-task learning opportunities for integrated end-of-life care: a practitioner-derived enquiry.

INTRODUCTION Knowledge and skills to contribute to high-quality patient-centred end-of-life care are essential for newly qualified doctors. End-of-life care is a multifaceted complex task but learning opportunities are often fragmented in undergraduate curricula. Wholetask models provide a framework for delivery of learning activities which equips students to function in variable complex contexts. OBJECTIVES To create learning experiences that would help students to integrate the knowledge, skills and behaviours needed when encountering patients near the end-of-life, including during transitions between primary and secondary care settings. METHODS We describe the development, implementation, content and evaluation of an educational intervention for undergraduate medical students. This comprised a study day offering whole-task learning opportunities for integrated end-of-life care combined with a longitudinal placement. Our research drew on two data sources: reflective summaries and end-of-semester, online, anonymous student questionnaires. Thematic analysis of student reflective writing demonstrated learning in multiple domains. RESULTS AND DISCUSSION Our intervention formed an important link between classroom learning and clinical practice due to its design according to whole-task models: learners were engaged in solving real-world problems, new knowledge was applied and integrated in practice, students built on existing knowledge longitudinally, and experienced professionals supported putting knowledge into action. Although set in the UK the issues we address are of relevance worldwide.

Medical students' perceptions of bedside teaching.

Bedside teaching is recognised as a valuable tool in medical education by both students and faculty members. Bedside teaching is frequently delivered by consultants; however, junior doctors are increasingly engaging in this form of clinical teaching, and their value in this respect is becoming more widely recognised. The aim of this study was to supplement work completed by previous authors who have begun to explore students’ satisfaction with bedside teaching, and their perceptions of the relationship with the clinical teachers. Specifically, we aimed to identify how students perceive bedside teaching delivered by junior doctors compared with consultants.

Skilled communication: comments further to 'Creativity in clinical communication: from communication skills to skilled communication'.

Editor – Salmon and Young have built a straw man by claiming that communication skills teachers reduce clinical communication to a set of rules. They then shoot down this monstrosity in favour of the creative art of skilled communication. However, all teachers of clinical communication and consultation skills of our acquaintance would contend that, just as Salmon and Young desire, skilled communication is exactly what we aim to teach. The skills we teach do indeed represent a toolkit and what matters is learning to use them, learning to pick the tools appropriate for each consultation task and learning to use these tools to work with patients to produce the best outcome for those patients. Assessment should indeed have a holistic feel about it and should refer to the success with which a task is completed, rather than to the ticking of boxes on behaviours. UK medical schools do aim to teach what Salmon and Young wish they would. It may, however, be true that researchers into clinical communication have been reductionist in their attempts to measure our subject.

Should I ask my patient with cancer to teach students

A s clinical teachers, we want to provide access for our students to people living with and dying from cancer. A recent survey of British medical schools by the Centre for Cancer and Palliative Care Studies, of the Institute of Cancer Research, London found that some schools involved terminally ill patients directly in their teaching and most included hospice participation. The effect on people with cancer of telling others about their experience is of great concern to health care professionals who expose their patients in this way.