Culture and understanding the role of feedback for health professions students: realist synthesis protocol.

INTRODUCTION: 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.The (scientific) realist approach of Pawson and Tilley provides a means to examine complex interventions in social situations, and thus is an appropriate lens to use for this study. This is a protocol for a realist synthesis which asks how, why and in what circumstances do Asian Cultures influence health professional trainees to seek, respond to and use feedback given in the clinical environment, if at all. METHODS AND ANALYSIS: An initial search was performed to help define the scope of the review question and develop our initial programme 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 programme theory. ETHICS AND DISSEMINATION: As this study is a literature review, ethics approval is not required.The findings will be documented in line with the RAMESES (Realist And MEta-narrative Evidence Syntheses: Evolving Standards) publications standards for Realist syntheses, and we plan to disseminate the findings by means of a peer-reviewed journal article and conference presentation(s).

Simulated patient scenario development: A methodological review of validity and reliability reporting.

INTRODUCTION: Some healthcare scholars (educators and researchers) develop their own simulated patient scenarios to address specific learning objectives. Clear processes of validity and reliability are needed in the development of simulated scenarios for the purpose of replication and the transfer of findings to other contexts. METHODS: This paper reports a methodological review of CINAHL to determine how valid and reliable simulated patient scenarios are developed. We reviewed 375 abstracts based on specific inclusion and exclusion criteria to yield 17 qualifying records. Data about the discipline, population, type of simulation, and validity and reliability processes were extracted. RESULTS: Selected records were from nursing, medicine, and paramedicine. While some studies used high-fidelity simulations, some used low-fidelity or a combination of high- and low-fidelity simulations. Scholars validated scenarios by using personal experience, consulting experts, or requesting participant feedback. They also examined different types of validity (face, content, construct). Most studies did not address how reliability of scenarios was determined. To ensure consistency in scenario delivery, some studies piloted scenarios with participants, or examined performance through video-tapes or virtual patients. CONCLUSIONS: This review shows that scholars use inconsistent processes to develop valid and reliable simulated patient scenarios, often overlooking evidence-based approaches to determining validity and reliability. Future practices pertaining to scenario development should use systematic processes in determining validity and reliability so simulation exercises can be replicated in other contexts.

Identifying educator behaviours for high quality verbal feedback in health professions education: literature review and expert refinement.

BACKGROUND: Health professions education is characterised by work-based learning and relies on effective verbal feedback. However the literature reports problems in feedback practice, including lack of both learner engagement and explicit strategies for improving performance. It is not clear what constitutes high quality, learner-centred feedback or how educators can promote it. We hoped to enhance feedback in clinical practice by distinguishing the elements of an educator's role in feedback considered to influence learner outcomes, then develop descriptions of observable educator behaviours that exemplify them. METHODS: An extensive literature review was conducted to identify i) information substantiating specific components of an educator's role in feedback asserted to have an important influence on learner outcomes and ii) verbal feedback instruments in health professions education, that may describe important educator activities in effective feedback. This information was used to construct a list of elements thought to be important in effective feedback. Based on these elements, descriptions of observable educator behaviours that represent effective feedback were developed and refined during three rounds of a Delphi process and a face-to-face meeting with experts across the health professions and education. RESULTS: The review identified more than 170 relevant articles (involving health professions, education, psychology and business literature) and ten verbal feedback instruments in health professions education (plus modified versions). Eighteen distinct elements of an educator's role in effective feedback were delineated. Twenty five descriptions of educator behaviours that align with the elements were ratified by the expert panel. CONCLUSIONS: This research clarifies the distinct elements of an educator's role in feedback considered to enhance learner outcomes. The corresponding set of observable educator behaviours aim to describe how an educator could engage, motivate and enable a learner to improve. This creates the foundation for developing a method to systematically evaluate the impact of verbal feedback on learner performance.

Subject recruitment for cancer control studies in an adverse environment.

Subject recruitment in an adverse environment prompted researchers to identify a novel method to gain a different perspective on the problem. Lewin's Model of Change was used in a post hoc examination of recruitment strategies from 5 cancer control studies of breast or prostate cancer. Based on this evaluation, driving and restraining forces in recruitment were identified. Lessons learned and recommendations are discussed based on this evaluation. Five categories of restrainers were identified from this evaluation and include sociocultural, institutional, individuals, budget, and study design. Conversely, only 3 categories of drivers were elucidated by the examination: sociocultural, institutional, and individuals. Lessons and recommendations ranged from addressing institutional barriers to capitalizing on public relations. Researchers entering a new environment for recruitment would benefit from using Lewin's force field analysis before writing a proposal or implementing a project. This approach better directs energy and resources and enhances the ability of the investigator to maintain a broad, less biased perspective.

Context effects in recognition memory: the role of familiarity and recollection.

A variant of the process dissociation procedure was coupled with a manipulation of response signal lag to assess whether manipulations of context affect one or both of the familiarity and search processes described by the dual process model of recognition. Participants studied a list of word pairs (context+target) followed by a recognition test with target words presented in the same or different context, and in the same or different form as study (singular/plural). Participants were asked to recognize any target word regardless of changes to form (inclusion), or to only recognise words that were presented in the same form (exclusion). The standard context reinstatement effect was evident even at the short response lags. Analyses of the estimates of the contributions of familiarity and search processes suggest that the context effect demonstrated here can be attributed in part to the influence of familiarity on recognition, whereas the effect on recollection was less clear.