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Exploring the influence of context on feedback at medical school: a video-ethnography study

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Abstract

Feedback in medical education is complicated by the multiple contexts within which learning occurs. However, feedback research in medical education has typically focused on information provided by tutors to students with limited exploration of the influence of context. This research seeks to address this gap by exploring the influence of multiple contexts upon feedback processes. Employing video-ethnography methodology we explored feedback in two common contexts for medical student learning: the simulated clinical environment and the medical workplace. Learning and teaching sessions were filmed in each of these contexts, capturing diverse feedback processes. Data were analysed for key themes using a Framework Analysis approach and similarities and differences between the two contexts identified. In total 239 distinct feedback episodes across 28 different teaching and learning sessions were captured, with feedback processes relating to the patient, practice, educational and institutional contexts observed. In this paper, we concentrate on key similarities and differences in feedback processes between the two contexts with respect to six themes: feedback interlocutors, interlocutor positioning, feedback types, feedback foci, feedback styles and feedback milieu. We argue that feedback is inextricably linked to the multiple contexts in which feedback is enacted. It is only by exploring these contextual influences that feedback can be understood more fully. With such understanding we should be better placed to develop interventions capable of improving the long elusive experience of successful feedback.

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Notes

  1. This is by no means an exhaustive list as the literature on feedback is vast but seeks to provide a few examples of differing perspectives in feedback.

References

  • Ajjawi, R. (2012). Going beyond ‘received and understood’ as a way of conceptualising feedback. Medical Education, 46, 1018–1019.

    Article  Google Scholar 

  • Ajjawi, R., Molloy, E., Bearman, M., & Rees, C. E. (2017). Contextual influences on feedback practices: An ecological perspective. In D. Carless, S. M. Bridges, C. K. Y. Chan, & R. Glofcheski (Eds.), Scaling up assessment for learning in higher education (pp. 129–143). Singapore: Springer.

    Chapter  Google Scholar 

  • Ajjawi, R., & Rees, C. E. (2012). Theories of Communication. In J. Higgs, R. Ajjawi, L. McAllister, F. Trede, & S. Loftus (Eds.), Communicating in the Health Sciences (3rd ed.). Melbourne: Oxford University Press.

    Google Scholar 

  • Argyle, M., & Dean, J. (1965). Eye-contact, distance and affiliation. Sociometry, 28(3), 289–302.

    Article  Google Scholar 

  • Askew, S., & Lodge, C. (2000). Gifts, ping-pong and loops-linking feedback and learning. In S. Askew (Ed.), Feedback for learning. London: Routledge Falmer.

    Google Scholar 

  • Bates, J., & Ellaway, R. H. (2016). Mapping the dark matter of context: a conceptual scoping review. Medical Education, 50, 807–816.

    Article  Google Scholar 

  • Becker, H. S., Greer, B., Hughes, E., & Strauss, A. (1961). Boys in White. Chicago: University of Chicago Press.

    Google Scholar 

  • Blatt, B., Confessore, S., Kallenberg, G., & Greenberg, L. (2008). Verbal interaction analysis: Viewing feedback through a different lens. Teaching and Learning in Medicine, 20, 329–333.

    Article  Google Scholar 

  • Bloom, B. S. (1956). Taxonomy of educational objectives: The classification of education goals by a committee of college and university examiners. Cambridge: David McKay.

    Google Scholar 

  • Boud, D., & Molloy, E. (2012). Rethinking models of feedback for learning: the challenge of design. Assessment and Evaluation in Higher Education, 38, 698–712.

    Article  Google Scholar 

  • Brockner, J., & Chen, Y.-R. (1996). The moderating roles of self-esteem and self-construal in reaction to a threat to the self: Evidence from the People’s Republic of China and the United States. Journal of Personality and Social Psychology, 71, 603–615.

    Article  Google Scholar 

  • Bulte, C., Betts, A., Gamer, K., & Durning, S. (2007). Student teaching: views of student near-peer teachers and learners. Medical Teacher, 29(6), 583–590.

    Article  Google Scholar 

  • Burns, E., Fenwick, J., Schmied, V., & Sheehan, A. (2012). Reflexivity in midwifery research: The insider/outsider debate. Midwifery, 28, 52–60.

    Article  Google Scholar 

  • Cantillon, P., & Sargeant, J. (2008). Giving feedback in clinical settings. British Medical Journal, 337, 1961.

    Article  Google Scholar 

  • Carless, D., Salter, D., Yang, M., & Lam, J. (2011). Developing sustainable feedback practices. Studies in Higher Education, 36, 395–407.

    Article  Google Scholar 

  • Cleland, J. A., Knight, L. V., Rees, C. E., Tracey, S., & Bond, C. M. (2008). Is it me or is it them? Factors that influence the passing of underperforming students. Medical Education, 42, 800–809.

    Article  Google Scholar 

  • Crisp, B. R. (2007). Is it worth the effort? How feedback influences students’ subsequent submission of assessable work. Assessment and Evaluation in Higher Education, 32, 571–581.

    Article  Google Scholar 

  • Crotty, M. (1998). The foundations of social research: meaning and perspective in the research process. London: Sage Publications.

    Google Scholar 

  • Dohrenwend, A. (2002). Serving up the feedback sandwich. Family Practice Management, 9, 43.

    Google Scholar 

  • Dwyer, S. C., & Buckle, J. L. (2009). The space between: On being an insider–outsider in qualitative research. International Journal of Qualitative Methods, 8(1), 54–63.

    Article  Google Scholar 

  • Ende, J. (1983). Feedback in clinical medical education. JAMA, the Journal of the American Medical Association, 250, 777–781.

    Article  Google Scholar 

  • Eva, K. W., Armson, H., Holmboe, E., Lockyer, J., Loney, E., Mann, K., et al. (2012). Factors influencing responsiveness to feedback: On the interplay between fear, confidence, and reasoning processes. Advances in Health Sciences Education Theory and Practice, 17, 15–26.

    Article  Google Scholar 

  • Fanning, R. M., & Gaba, D. M. (2007). The role of debriefing in simulation based learning. Society for Simulation in Healthcare, 2, 115–125.

    Article  Google Scholar 

  • Gelfand, M J., Erez, M., & Aycan, Z. (2007). Cross cultural organizational behaviour. Annual Review of Psychology, 58, 479–514.

    Article  Google Scholar 

  • GMC. (2015). GMC: National Training Survey for Doctors [Online]. Available: https://unistats.direct.gov.uk/search/SubjectCode/001/Medicine. Accessed 25 July 2016.

  • Hafferty, F. W. (1998). Beyond curriculum reform: Confronting medicine’s hidden curriculum. Academic Medicine, 73, 403–407.

    Article  Google Scholar 

  • Hammersley, M., & Atkinson, P. (2007). Ethnography: Principles in practice. Abingdon: Routledge.

    Book  Google Scholar 

  • Hattie, J., & Timperley, H. (2007). The power of feedback. Review of Educational Research, 77, 81–112.

    Article  Google Scholar 

  • Heath, C., & Hindmarsh, J. (2002). Analysing interaction: Video, ethnography and situated conduct. In T. May (Ed.), Qualitative research in action. London: SAGE.

    Google Scholar 

  • Hewson, M. G., & Little, M. L. (1998). Giving feedback in medical education: Verification of recommended techniques. Journal of General Internal Medicine, 13, 111–116.

    Article  Google Scholar 

  • Hounsell, D. (2007). Towards more sustainable feedback to students. In D. Boud & N. Falchikov (Eds.), Rethinking assessment in higher education. Abingdon: Routledge.

    Google Scholar 

  • Iedema, R. A., Jorm, C., Long, D., Braithwaite, J., Travaglia, J., & Westbrook, M. (2006a). Turning the medical gaze in upon itself: Root cause analysis and the investigation of clinical error. Social Science and Medicine, 62, 1605–1615.

    Article  Google Scholar 

  • Iedema, R., Long, D., & Forsyth, R. (2006b). Visibilising clinical work: Video ethnography in the contemporary hospital. Health Sociology Review, 15, 156–168.

    Article  Google Scholar 

  • Iedema, R., Mesman, J., & Carroll, K. (2013). Visualising Healthcare practice improvement innovation from within. London: Radcliffe Publishing Ltd.

    Google Scholar 

  • Kapoor, S., Arora, P., Kapoor, V., Jayachandran, M., & Tiwari, M. (2014). Haptics—touch feedback technology widening the Horizon of medicine. Journal of Clinical and Diagnostic Research JCDR, 8, 294–299.

    Google Scholar 

  • Kluger, A., & DeNisi, A. (1996). The effects of feedback interventions on performance: A historical review, a meta-analysis and a preliminary feedback intervention theory. Psychological Bulletin, 119, 254–284.

    Article  Google Scholar 

  • Kluger, A. N., & Van Dijk, D. (2010). Feedback, the various tasks of the doctor, and the feedforward alternative. Medical Education, 44, 1166–1174.

    Article  Google Scholar 

  • Knapp, M. L., & Hall, J. A. (2010). The effects of the environment on human communication non verbal communication in human interaction. Boston: Wadsworth.

    Google Scholar 

  • Krause, K.-L., Hartley, R., James, R., & McInnis, C. (2005). The first year experience in Australian universities: Findings from a decade of national studies. Melbourne: Centre for the Study of Higher Education, University of Melbourne.

    Google Scholar 

  • Lockspeir, T. M., O’Sullivan, P., Teharani, A., & Muller, J. (2008). Understanding the experience of being taught by peers: The value of social and cognitive congruence. Advances in Health Sciences Education Theory and Practice, 13, 361–372.

    Article  Google Scholar 

  • Mann, K. V. (2011). Theoretical perspectives in medical education: past experience and future possibilities. Medical Education, 45, 60–68.

    Article  Google Scholar 

  • Maxwell, J. A. (2010). Using numbers in qualitative research. Qualitative Inquiry, 16, 475–482.

    Article  Google Scholar 

  • Molloy, E. (2009). Time to pause: Giving and receiving feedback in clinical education. In C. Delany & E. Molloy (Eds.), Clinical Education in the Health Professions. Chatswood: Churchill Livingstone.

    Google Scholar 

  • Panait, L., Akkary, E., Bell, R. L., Roberts, K. E., Dudrick, S. J., & Duffy, A. J. (2009). The role of haptic feedback in laparoscopic simulation training. The Journal of Surgical Research, 156, 312–316.

    Article  Google Scholar 

  • Pendleton, D. (1984). The consultation approach to learning and teaching. Oxford: Oxford University Press.

    Google Scholar 

  • Pink, S. (2001). Doing Visual Ethnography: images, media and representation in research. London: Sage publications.

    Google Scholar 

  • Price, M., Handley, K., Millar, J., & O’Donovan, B. (2010). Feedback: All that effort but what is the effect? Assessment and Evaluation in Higher Education, 35, 277–289.

    Article  Google Scholar 

  • Reeves, S., Kuper, A., & Hodges, B. D. (2008). Qualitative research methodologies: Ethnography. British Medical Journal, 337, 512–514.

    Google Scholar 

  • Ritchie, J., & Spencer, L. (1994). Qualitative analysis for applied policy research. In A. Bryman, & R G. Burgess (Eds.), Analysing qualitative data. London: Routledge.

    Google Scholar 

  • Rizan, C., Elsey, C., Lemon, T., Grant, A., & Monrouxe, L. V. (2014). Feedback in action within bedside teaching encounters: A video ethnographic study. Medical Education, 48, 902–920.

    Article  Google Scholar 

  • Sargeant, J., Eva, K W., Armson, H., Chesluk, B., Dornan, T., Holmeboe, E., et al. (2011). Features of assessment learners use to make informed self-assessments of clinical performance. Medical Education, 45, 636–647.

    Article  Google Scholar 

  • Sargeant, J., Mann, K., Sinclair, D., Van Der Vleuten, C., & Metsemakers, J. (2008). Understanding the influence of emotions and reflection upon multi-source feedback acceptance and use. Advances in Health Sciences Education Theory and Practice, 13, 275–288.

    Article  Google Scholar 

  • Schofield, S., Nathwani, D., & Anderson, F. (2009). Consultants in Scotland: Survey of educational qualifications, experience and needs of Scottish consultants. Scottish Medical Journal, 54, 25–29.

    Article  Google Scholar 

  • Sheriff, B. (2001). the ambiguity of boundaries in the fieldwork experience: Establishing rapport and negotiating insider/outsider status. Qualitative Inquiry, 7(4), 436–447.

    Article  Google Scholar 

  • Shute, V. J. (2008). Focus on formative feedback. Review of Educational Research, 78, 153–189.

    Article  Google Scholar 

  • Sully De Luque, M. F., & Sommer, S. M. (2000). The impact of culture on feedback-seeking behaviour: An integrated model and propositions. Academy of Management Review, 25, 829–849.

    Article  Google Scholar 

  • Thurlings, M., Vermeulen, M., Bastiaens, T., & Stijnen, S. (2012). Understanding feedback: A learning theory perspective. Educational Research Review, 9, 1–15.

    Article  Google Scholar 

  • UNISTATS. (2016). National Student Survey [Online]. Available: https://unistats.direct.gov.uk/search/SubjectCode/001/Medicine. Accessed 25 July 2016.

  • Urquhart, L. (2015). Exploring the feedback process with medical students and their educators: Listening, watching, understanding. Doctor of Philosophy, University of Dundee.

  • Urquhart, L. M., Rees, C. E., & Ker, J. S. (2014). Making sense of feedback experiences: A multi-school study of medical students’ narratives. Medical Education, 48, 189–203.

    Article  Google Scholar 

  • Van De Vliertt, E., Shi, K., Sanders, K., Wang, Y., & Huang, X. (2004). Chinese and Dutch interpretations of supervisory feedback. Journal of Cross Cultural Psychology, 35, 417–435.

    Article  Google Scholar 

  • Van Dijk, D., & Kluger, A. N. (2004). Feedback sign effect on motivation: Is it moderated by regulatory focus? Applied Psychology An International Review, 53, 113–135.

    Article  Google Scholar 

  • Veloski, J., Boex, J. R., Grasberger, M. J., Evans, A., & Wolfson, D. B. (2006). Systematic review of the literature on assessment, feedback and physicians’ clinical performance. BEME Guide No. 7. Medical Teacher, 28, 117–128.

    Article  Google Scholar 

  • Watling, C., Driessen, E., Van Der Vleuten, C. P., & Lingard, L. (2012a). Learning from clinical work: The roles of learning cues and credibility judgements. Medical Education, 46, 192–200.

    Article  Google Scholar 

  • Watling, C., Driessen, E., Van Der Vleuten, C. P., Vanstone, M., & Lingard, L. (2012b). Understanding responses to feedback: the potential and limitations of regulatory focus theory. Medical Education, 46, 593–603.

    Article  Google Scholar 

  • Watling, C., Driessen, E., Vleuten, C. P., Vanstone, M., & Lingard, L. (2013). Beyond individualism: Professional culture and its influence on feedback. Medical Education, 47, 585–594.

    Article  Google Scholar 

  • Zhou, M., Tse, S., Derevianko, A., Jones, D. B., Schwaitzberg, S. D., & Cao, C. G. L. (2012). Effect of haptic feedback in laparoscopic surgery skill acquisition. Surgical Endoscopy, 26, 1128–1134.

    Article  Google Scholar 

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Acknowledgements

We thank the leaders of both sites for allowing us to conduct the study in the simulated and workplace settings. We thank all study participants—tutors, students and patients—for allowing us to observe and video the 28 teaching and learning sessions, and for allowing us to share their visual and textual data relating to excerpts.

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Authors and Affiliations

  1. Ninewells Hospital, Dundee, Scotland, UK

    L. M. Urquhart

  2. NHS Education for Scotland, East Deanery, Ninewells Hospital, Dundee, Scotland, UK

    J. S. Ker

  3. Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia

    C. E. Rees

Authors
  1. L. M. Urquhart
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  2. J. S. Ker
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  3. C. E. Rees
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Contributions

All authors contributed to the design, securing ethics approval, analysis and interpretation of data and writing and/or editing the manuscript. LMU collected all data and coded it using Atlas Ti. LMU conducted this study as part of her PhD in Medical Education from the University of Dundee Scotland (completed 2015), and CER was her principal supervisor and JSK the co-supervisor.

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Correspondence to L. M. Urquhart.

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We received ethics approval from the University and NHS Human Research Ethics Committees (these are not named here to protect the anonymity of the study sites and participants).

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Urquhart, L.M., Ker, J.S. & Rees, C.E. Exploring the influence of context on feedback at medical school: a video-ethnography study. Adv in Health Sci Educ 23, 159–186 (2018). https://doi.org/10.1007/s10459-017-9781-2

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