Renée M. van der Leeuw

Twelve tips for making the best use of feedback

Background: Feedback is generally regarded as crucial for learning. We focus on feedback provided through instruments developed to inform self-assessment and support learners to improve performance. These instruments are being used commonly in medical education, but they are ineffective if the feedback is not well received and put into practice. Methods: The authors formulated twelve tips to make the best use of feedback based on widely cited publications on feedback. To include recent developments and hands-on experiences in the field of medical education, the authors discussed the tips with their research team consisting of experts in the field of medical education and professional performance, to reach agreement on the most practical strategies. Results: When utilizing feedback for performance improvement, medical students, interns, residents, clinical teachers and practicing physicians could make use of the twelve tips to put feedback into practice. The twelve tips provide strategies to reflect, interact and respond to feedback one receives through (validated) feedback instruments. Conclusions: Since the goal of those involved in medical education and patient care is to perform at the highest possible level, we offer twelve practical tips for making the best use of feedback in order to support learners of all levels.

Frequency and determinants of residents' narrative feedback on the teaching performance of faculty: narratives in numbers.

Purpose Physicians involved in residency training often receive feedback from residents on their teaching. Research shows that learners value narrative feedback, but knowledge of the frequency and determinants of narrative feedback in teaching performance evaluation is lacking. This study aims to identifythe frequency with which residentsgave positive comments and suggestions for improvement to faculty, and the factors influencing that frequency. Method From September 2008 through May 2010, the authors collected data, using a validated formative feedback system (System for Evaluation of Teaching Qualities). The authors used univariate and multivariable analysis to investigate the associations between participants’ characteristics, including faculty members’ teaching performance, and the frequency of the two types of narrative comments. Results In total, 659 residents (79% of 839) completed 6,216 evaluations on 917 faculty (95% of 964), resulting in 11,574 positive comments and 4,870 suggestions for improvement. On average, faculty members received 13 positive comments and 5 suggestions for improvement. Multivariable analysis showed that higher teaching performance was associated with higher numbers of positive comments (regression coefficient 0.538; 95% confidence interval: 0.464 to 0.613) and with lower numbers of suggestions for improvement (−0.802; −0.911 to −0.692), both P < .0001. Nonacademic hospitals, participation in teacher training, and female residents’ evaluation were statistically significant determinants of receiving more narrative feedback. Conclusions Residents provided narrative feedback that paralleled and elaborated on quantitative evaluations they provided; therefore, faculty would be wise to attend to narrative feedback. Analysis of the quality of narrative feedback is needed to understand its effectiveness.

Clinical teaching performance improvement of faculty in residency training: A prospective cohort study

Abstract Purpose: The purpose of this study is to investigate how aspects of a teaching performance evaluation system may affect faculty’s teaching performance improvement as perceived by residents over time. Methods: Prospective multicenter cohort study conducted in The Netherlands between 1 September 2008 and 1 February 2013. Nine hundred and one residents and 1068 faculty of 65 teaching programs in 16 hospitals were invited to annually (self-) evaluate teaching performance using the validated, specialty-specific System for Evaluation of Teaching Qualities (SETQ). We used multivariable adjusted generalized estimating equations to analyze the effects of (i) residents’ numerical feedback, (ii) narrative feedback, and (iii) faculty’s participation in self-evaluation on residents’ perception of faculty’s teaching performance improvement. Results: The average response rate over three years was 69% for faculty and 81% for residents. Higher numerical feedback scores were associated with residents rating faculty as having improved their teaching performance one year following the first measurement (regression coefficient, b: 0.077; 95% CI: 0.002–0.151; p = 0.045), but not after the second wave of receiving feedback and evaluating improvement. Receiving more suggestions for improvement was associated with improved teaching performance in subsequent years. Conclusions: Evaluation systems on clinical teaching performance appear helpful in enhancing teaching performance in residency training programs. High performing teachers also appear to improve in the perception of the residents.

Sharing is caring: dealing with feedback and difficult feelings

Learning situations can elicit great feelings of achievement, but also uncertainty or even shame if a learner feels he or she is incompetent. As making mistakes is an irrevocable part of the learning process, it is important to provide a safe learning environment for students in which feelings can be discussed. The tension among learning, making mistakes and feelings of shame or guilt is even stronger in clinical practice and the need to openly discuss these issues in safety is greater. The tasks of a supervisor include ensuring a safe learning environment for learners and taking responsibility for the safeguarding of patient well-being. Consequently, supervisors will be confronted with learners’ mistakes, but they cannot exclude the possibility that they too will make errors. As reported in the literature, even expert clinicians experience difficult feelings such as shame or guilt following errors or adverse events. For this reason, learners at all stages of their careers must (learn to) deal with difficult feelings. Inspired by the article ‘Shame, guilt and the medical learner: ignored connections and why we should care’ by Bynum and Goodie, published in this issue of the journal, my aim is to broaden this scope to learners at any stage of their careers, all of whom experience feelings of shame and guilt triggered by different causes. Additionally, we should better understand our emotional reactions and gain insight into dealing with difficult feelings in order to work towards establishing constructive ways of acknowledging and learning from these feelings.

Residents’ narrative feedback on teaching performance of clinical teachers: analysis of the content and phrasing of suggestions for improvement

Objectives High-quality teaching performance is important to ensure patient safety and encourage residents’ learning. This study aims to explore the content and phrasing of suggestions for improvement that residents provide to support excellent teaching performance of their supervisors. Methods From February 2010 to November 2011, 577 residents were invited to evaluate 501 teachers from both surgical and medical residency training programmes from 20 hospitals. Feedback was collected through a validated formative feedback system named System for Evaluation of Teaching Qualities. Two researchers independently coded the suggestions for improvement with literature-based coding schemes on (1) content and (2) linguistic characteristics. Besides these qualitative outcomes, descriptive statistics were calculated using SPSS. Results In total, 422 residents (73%) evaluated 488 teachers (97%), yielding 4184 evaluations. Of all teachers, 385 (79%) received suggestions for improvement focusing on teaching skills (TS), 390 (80%) on teaching attitude (TA) and 151 (31%) on personal characteristics. For 13%–47% of the suggestions for improvement, residents added (1) the location or situation where the observed TS or TA had taken place, (2) concrete examples of what teachers could do to improve or (3) (expected) effects of what the change in TS or TA would mean for residents. Conclusions Residents provide mainly relevant suggestions for improvement that mirror important aspects of teaching performance. However, these comments often lack specific phrasing limiting their value for performance improvement. Therefore, residents are recommended to increase the specificity of the suggestions for improvement. The paper provides directions to phrase narrative feedback.

Team Communication amongst Clinical Teachers in a Formal Meeting of Post Graduate Medical Training.

The importance of team communication, or more specifically speaking up, for safeguarding quality of patient care is increasingly being endorsed in research findings. However, little is known about speaking up of clinical teachers in postgraduate medical training. In order to determine how clinical teachers demonstrate speaking up in formal teaching team meetings and what factors influence this, the authors carried out an exploratory study based on ethnographic principles. The authors selected 12 teaching teams and observed, audio recorded and analysed the data. Subsequently, during an interview, the program directors reflected on speaking up of those clinical teachers present during the meeting. Finally, the authors analysed iteratively all data, using a template analysis, based on Edmondson’s behaviours of speaking up. The study was conducted from October 2013 to July 2014 and ten teams participated. During the teaching team meetings, the clinical teachers exhibited most of the behaviours of speaking up. “Sharing information” strongly resembles providing information and “talking about mistakes” occurs in a general sense and without commitment of improvement activities. “Asking questions” was often displayed by closed questions and at times several questions simultaneously. The authors identified factors that influence speaking up by clinical teachers: relational, cultural, and professional. The clinical teachers exhibit speaking up, but there is only limited awareness to discuss problems or mistakes and the discussion centred mainly on the question of blame. It is important to take into account the factors that influence speaking up, in order to stimulate open communication during the teaching team meetings.