Faculty staff perceptions of feedback to residents after direct observation of clinical skills
Open accessAbstract
Medical Education 2012: 46 : 201–215 Context Performance‐based workplace assessments are increasingly important in clinical training. Given the inaccuracy of self‐assessment, the provision of external feedback to residents about their clinical skills is necessary for the development of expertise. However, little is known about the processes used by faculty members in giving feedback to residents after observing them with patients. This study explores the factors that underpin faculty members’ decisions regarding the feedback they give to residents after directly observing them with patients and the factors that influence how feedback is delivered. Methods In 2009, 44 general internal medicine faculty staff responsible for out‐patient resident teaching from 16 internal medicine residency programmes watched four videotaped scenarios and two live scenarios of standardised residents (SRs) with standardised patients and rated the SRs using the mini‐clinical evaluation exercise (mini‐CEX) format. Faculty staff also provided feedback to the SRs after the live encounters. After each encounter, faculty staff were individually interviewed using a semi‐structured interview. Interviews were videotaped, transcribed and analysed using grounded theory methods. Results Two broad themes were identified in faculty members’ descriptions of the feedback process: variability in feedback techniques, and the factors that influence how faculty staff think and feel about delivering feedback. Multiple approaches to feedback delivery were observed. Faculty members’ tensions in balancing positive and negative feedback, their own perceived self‐efficacy, their perceptions of the resident’s insight, receptivity, skill and potential, the faculty member–resident relationship and contextual factors impacted the feedback process. Conclusions The provision of feedback by faculty staff to residents after observing resident–patient interactions is a complex and dynamic process and is influenced by many factors. Understanding these cognitive and affective factors may provide insight into potential new approaches to faculty development to improve faculty staff’s feedback skills and the effectiveness of their feedback.
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Recent literature suggests that the quality and impact of feedback may be compromised when the teacher is assigned the dual role of coach and assessor.
“Recent literature has begun to challenge this approach, suggesting that the quality and impact of feedback may be compromised when the teacher is assigned this dual role [38, 91, 92].”
From Guidelines: The do’s, don’ts and don’t knows of feedback for clinical education. (2015) · cites this paper as [92]
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Cites
Qualitative research and evaluation methods
Patton, M. Q. (1980) · Cited by 35,637 · see citing works
Basics of Qualitative Research: Grounded Theory Procedures and Techniques.
Ellis, C., Strauss, A., & Corbin, J. M. (1992) · Contemporary Sociology A Journal of Reviews · doi:10.2307/2074814 · Cited by 29,279 · see citing works
(2006) · Cited by 18,730 · see citing works
Basics of Qualitative Research: Grounded Theory Procedures and Techniques
Long, D. R., Strauss, A., & Corbin, J. M. (1993) · Modern Language Journal · doi:10.2307/328955 · Cited by 17,612 · see citing works
Hattie, J., & Timperley, H. (2007) · Review of Educational Research · doi:10.3102/003465430298487 · Cited by 12,905 · see citing works
Constructing Grounded Theory. A Practical Guide Through Qualitative Analysis
Boyle, C., & Barker, A. (2006) · QMiP Bulletin · doi:10.53841/bpsqmip.2006.1.2.36 · Cited by 11,842 · see citing works
Kluger, A. N., & DeNisi, A. (1996) · Psychological Bulletin · doi:10.1037/0033-2909.119.2.254 · Cited by 5,882 · see citing works
Shute, V. J. (2008) · Review of Educational Research · doi:10.3102/0034654307313795 · Cited by 4,631 · see citing works
Ericsson, K. A. (2004) · Academic Medicine · doi:10.1097/00001888-200410001-00022 · Cited by 2,988 · see citing works
Davis, D. A., Mazmanian, P. E., Fordis, M., Van Harrison, R., Thorpe, K. E., & Perrier, L. (2006) · JAMA · doi:10.1001/jama.296.9.1094 · Cited by 2,375 · see citing works
Theoretical Foundations of Learning Environments
Land, S. M., Jonassen, D. H., & Jonassen, D. H. (2014) · Routledge eBooks · doi:10.4324/9781410603203 · Cited by 1,364 · see citing works
Assessing professional competence: from methods to programmes
Van Der Vleuten, C. P. M., & Schuwirth, L. W. T. (2005) · Medical Education · doi:10.1111/j.1365-2929.2005.02094.x · Cited by 1,268 · see citing works
Feedback in Clinical Medical Education
Ende, J. (1983) · JAMA · doi:10.1001/jama.1983.03340060055026 · Cited by 1,259 · see citing works
State of the science in health professional education: effective feedback
Archer, J. C. (2010) · Medical Education · doi:10.1111/j.1365-2923.2009.03546.x · Cited by 783 · see citing works
Situated cognition: social, semiotic, and psychological perspectives
(1997) · Choice Reviews Online · doi:10.5860/choice.35-2415 · Cited by 699 · see citing works
What is feedback in clinical education?
Van De Ridder, J. M. M., Stokking, K. M., McGaghie, W. C., & Ten Cate, O. T. J. (2008) · Medical Education · doi:10.1111/j.1365-2923.2007.02973.x · Cited by 686 · see citing works
Tools for Direct Observation and Assessment of Clinical Skills of Medical Trainees
Kogan, J. R., Holmboe, E. S., & Hauer, K. E. (2009) · JAMA · doi:10.1001/jama.2009.1365 · Cited by 602 · see citing works
Self-citationThe Mini-CEX (Clinical Evaluation Exercise): A Preliminary Investigation
Norcini, J. J., Blank, L. L., Arnold, G. K., & Kimball, H. R. (1995) · Annals of Internal Medicine · doi:10.7326/0003-4819-123-10-199511150-00008 · Cited by 526 · see citing works
Giving feedback in medical education: Verification of recommended techniques
Hewson, M. G., & Little, M. L. (1998) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.1998.00027.x · Cited by 409 · see citing works
Faculty Development in Assessment: The Missing Link in Competency-Based Medical Education
Holmboe, E. S., Ward, D. S., Reznick, R. K., Katsufrakis, P. J., Leslie, K., Patel, V. L., Ray, D. D., & Nelson, E. A. (2011) · Academic Medicine · doi:10.1097/acm.0b013e31820cb2a7 · Cited by 324 · see citing works
Self-citationThe processes and dimensions of informed self-assessment: A conceptual model.
Sargeant, J., Armson, H., Chesluk, B., Dornan, T., Eva, K., Holmboe, E., Lockyer, J., Loney, E., Mann, K., & van der Vleuten, C. (2010) · Academic Medicine · doi:10.1097/acm.0b013e3181d85a4e · Cited by 318 · see citing works
Self-citationThe Practice of Giving Feedback to Improve Teaching
Brinko, K. T. (1993) · The Journal of Higher Education · doi:10.1080/00221546.1993.11778449 · Cited by 316 · see citing works
Govaerts, M., van der Vleuten, C. P. M., Schuwirth, L., & Muijtjens, A. M. M. (2006) · Advances in Health Sciences Education · doi:10.1007/s10459-006-9043-1 · Cited by 284 · see citing works
Opening the black box of clinical skills assessment via observation: a conceptual model
Kogan, J. R., Conforti, L. N., Bernabeo, E. C., Iobst, W. F., & Holmboe, E. S. (2011) · Medical Education · doi:10.1111/j.1365-2923.2011.04025.x · Cited by 235 · see citing works
Self-citationCianci, A. M., Klein, H. J., & Seijts, G. (2010) · Journal of Applied Psychology · doi:10.1037/a0019130 · Cited by 225 · see citing works
Why medical educators may be failing at feedback.
Bing-You, R. G. (2009) · JAMA · doi:10.1001/jama.2009.1393 · Cited by 224 · see citing works
Reconstructing educational psychology: Situated cognition and Deweyian pragmatism
Bredo, E. (1994) · Educational Psychologist · doi:10.1207/s15326985ep2901_3 · Cited by 208 · see citing works
Workplace-based assessment: effects of rater expertise
Govaerts, M., Schuwirth, L., van der Vleuten, C. P. M., & Muijtjens, A. M. M. (2010) · Advances in Health Sciences Education · doi:10.1007/s10459-010-9250-7 · Cited by 198 · see citing works
Kennedy, T. J. T., Regehr, G., Baker, G. R., & Lingard, L. (2009) · BMJ · doi:10.1136/bmj.b128 · Cited by 188 · see citing works
Durning, S. J., Cation, L. J., Markert, R. J., & Pangaro, L. N. (2002) · Academic Medicine · doi:10.1097/00001888-200209000-00020 · Cited by 185 · see citing works
Self-citationSurgery residents and attending surgeons have different perceptions of feedback.
Sender Liberman, A., Liberman, M., Steinert, Y., McLeod, P., & Meterissian, S. (2005) · Medical Teacher · doi:10.1080/0142590500129183 · Cited by 184 · see citing works
Teaching compassion and respect
Burack, J. H., Irby, D. M., Carline, J. D., Root, R. K., & Larson, E. B. (1999) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.1999.00280.x · Cited by 180 · see citing works
Feedback and the mini clinical evaluation exercise
Holmboe, E. S., Yepes-Rios, M., Williams, F. K., & Huot, S. J. (2004) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2004.30134.x · Cited by 171 · see citing works
Self-citation“Directed” self-assessment: Practice and feedback within a social context
Sargeant, J., Mann, K., van der Vleuten, C., & Metsemakers, J. (2008) · Journal of Continuing Education in the Health Professions · doi:10.1002/chp.155 · Cited by 158 · see citing works
The rotational approach to medical education: time to confront our assumptions?
Holmboe, E., Ginsburg, S., & Bernabeo, E. (2011) · Medical Education · doi:10.1111/j.1365-2923.2010.03847.x · Cited by 154 · see citing works
Self-citationThe Practice of Giving Feedback to Improve Teaching: What Is Effective?
Brinko, K. T. (1993) · The Journal of Higher Education · doi:10.2307/2959994 · Cited by 149 · see citing works
Durning, S. J., Artino, A. R., Pangaro, L. N., van der Vleuten, C. P. M., & Schuwirth, L. (2010) · Academic Medicine · doi:10.1097/acm.0b013e3181d7427c · Cited by 141 · see citing works
Self-citationPerceptions of medical school faculty members and students on clinical clerkship feedback
Gil, D. H., Heins, M., & Jones, P. (1984) · Academic Medicine · doi:10.1097/00001888-198411000-00003 · Cited by 110 · see citing works
Milan, F. B., Parish, S. J., & Reichgott, M. J. (2005) · Teaching and Learning in Medicine · doi:10.1207/s15328015tlm1801_9 · Cited by 99 · see citing works
Kogan, J. R., Hess, B., Conforti, L. N., et al. (2010) · Academic Medicine · doi:10.1097/acm.0b013e3181ed1aa3 · Cited by 90 · see citing works
Self-citationNutrition assessment and counseling practices
Glanz, K., Tziraki, C., Albright, C. L., & Fernandes, J. (1995) · Journal of General Internal Medicine · doi:10.1007/bf02600234 · Cited by 74 · see citing works
Skeff, K. M., Stratos, G. A., Bergen, M. R., et al. (1992) · Teaching and Learning in Medicine · doi:10.1080/10401339209539559 · Cited by 68 · see citing works
"Sandwiching" Complex Interpersonal Feedback
Davies, D., & Jacobs, A. (1985) · Small Group Behavior · doi:10.1177/0090552685163008 · Cited by 62 · see citing works
An Exploration of Faculty Perspectives on the In-Training Evaluation of Residents
Watling, C., Kenyon, C. F., Schulz, V. N., Goldszmidt, M. A., Zibrowski, E. M., & Lingard, L. A. (2010) · Academic Medicine · doi:10.1097/acm.0b013e3181e19722 · Cited by 61 · see citing works
To call or not to call: a judgement of risk by pre‐registration house officers
Stewart, J. (2008) · Medical Education · doi:10.1111/j.1365-2923.2008.03123.x · Cited by 51 · see citing works
Which Factors, Personal or External, Most Influence Studentsʼ Generation of Learning Goals?
Eva, K. W., Munoz, J., Hanson, M. D., et al. (2010) · Academic Medicine · doi:10.1097/acm.0b013e3181ed42f2 · Cited by 51 · see citing works
McIlwrick, J., Nair, B., & MONTGOMERY, G. E. (2006) · Academic Psychiatry · doi:10.1176/appi.ap.30.2.130 · Cited by 39 · see citing works
Conceptual Frameworks in the Study of Duty Hours Changes in Graduate Medical Education: A Review
Schwartz, A., Pappas, C., Bashook, P. G., Bordage, G., Edison, M. I., Prasad, B., & Swiatkowski, V. (2010) · Academic Medicine · doi:10.1097/acm.0b013e3181ff81dd · Cited by 23 · see citing works
The Role of Assessment in a Learning Culture
Shepard, L. A. (2009) · Journal of Education · doi:10.1177/0022057409189001-207 · Cited by 23 · see citing works
Teaching and learning : the essential readings
Desforges, C., & Fox, R. (2002) · Medical Entomology and Zoology · Cited by 22 · see citing works
Kaprielian, V. S., & Gradison, M. (1998) · PubMed · Cited by 21 · see citing works
Brooks, B. (1935) · Academic Medicine · doi:10.1097/00001888-193503000-00002 · Cited by 7 · see citing works
On the Pedagogic Integration of the Divisions of Anatomy
Kampmeter, O. F. (1935) · Academic Medicine · doi:10.1097/00001888-193503000-00008 · Cited by 4 · see citing works
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Cited by
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Standards for Reporting Qualitative Research: A Synthesis of Recommendations
O’Brien, B. C., Harris, I. B., Beckman, T. J., Reed, D. A., & Cook, D. A. (2014) · Academic Medicine · doi:10.1097/acm.0000000000000388 · Cited by 12,211 · see citing works
The “educational alliance” as a framework for reconceptualizing feedback in medical education.
Telio, S., Ajjawi, R., & Regehr, G. (2015) · Academic Medicine · doi:10.1097/acm.0000000000000560 · Cited by 572 · see citing works
Guidelines: The do’s, don’ts and don’t knows of feedback for clinical education.
Lefroy, J., Watling, C., Teunissen, P. W., & Brand, P. (2015) · Perspectives on Medical Education · doi:10.1007/s40037-015-0231-7 · Cited by 347 · see citing works
Learning culture and feedback: an international study of medical athletes and musicians
Watling, C., Driessen, E., van der Vleuten, C. P. M., & Lingard, L. (2014) · Medical Education · doi:10.1111/medu.12407 · Cited by 162 · see citing works
- Authors
- Kogan, J. R., Conforti, L. N., Bernabeo, E. C., Durning, S. J., Hauer, K. E., & Holmboe, E. S.
- Affiliations
- University of Pennsylvania (US)
- American Board of Internal Medicine (US)
- Uniformed Services University of the Health Sciences (US)
- University of California, San Francisco (US)
- Corresponding author
- Kogan, Jennifer R
- Venue
- Medical Education
- Publisher
- Wiley
- Published
- 2012-01-12
- Volume
- 46
- Issue
- 2
- Pages
- 201-215
- ISSN
- 0308-0110 (ISSN-L)
- 1365-2923
- OpenAlex
- W1891930587
- Cited by
- 180
- References
- 53
- Citations by year
- 2026: 1 · 2025: 10 · 2024: 11 · 2023: 10 · 2022: 19 · 2021: 13 · 2020: 11 · 2019: 14 · 2018: 12 · 2017: 17 · 2016: 20 · 2015: 12 · 2014: 16 · 2013: 10 · 2012: 3
- FWCI
- 12.66
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Medical Education (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Rehabilitation › Musculoskeletal Disorders and Rehabilitation
- Keywords
- feedback delivery, teacher perceptions, clinical skills assessment, Mini-CEX, internal medicine residency, standardized patients, faculty development, faculty-student relationships, self-efficacy, positive and negative feedback, workplace-based assessment
- MeSH terms
- Adult, Clinical Competence, Communication, Educational Measurement, Faculty, Feedback, Female, Humans, Internal Medicine, Internship and Residency, Male, Medical Staff, Middle Aged, Perception, Teaching
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