Quality of written narrative feedback and reflection in a modified mini-clinical evaluation exercise: an observational study.

BACKGROUND: Research has shown that narrative feedback, (self) reflections and a plan to undertake and evaluate improvements are key factors for effective feedback on clinical performance. We investigated the quantity of narrative comments comprising feedback (by trainers), self-reflections (by trainees) and action plans (by trainer and trainee) entered on a mini-CEX form that was modified for use in general practice training and to encourage trainers and trainees to provide narrative comments. In view of the importance of specificity as an indicator of feedback quality, we additionally examined the specificity of the comments. METHOD: We collected and analysed modified mini-CEX forms completed by GP trainers and trainees. Since each trainee has the same trainer for the duration of one year, we used trainer-trainee pairs as the unit of analysis. We determined for all forms the frequency of the different types of narrative comments and rated their specificity on a three-point scale: specific, moderately specific, not specific. Specificity was compared between trainee-trainer pairs. RESULTS: We collected 485 completed modified mini-CEX forms from 54 trainees (mean of 8.8 forms per trainee; range 1-23; SD 5.6). Trainer feedback was more frequently provided than trainee self-reflections, and action plans were very rare. The comments were generally specific, but showed large differences between trainee-trainer pairs. CONCLUSION: The frequency of self-reflection and action plans varied, all comments were generally specific and there were substantial and consistent differences between trainee-trainer pairs in the specificity of comments. We therefore conclude that feedback is not so much determined by the instrument as by the users. Interventions to improve the educational effects of the feedback procedure should therefore focus more on the users than on the instruments.

The process of feedback in workplace-based assessment: organisation, delivery, continuity.

OBJECTIVES: Feedback in workplace-based clinical settings often relies on expert trainers' judgements of directly observed trainee performance. There is ample literature on effective feedback, but in practice trainees in workplace-based training are not regularly observed. We aimed to examine external conditions that impact feedback in observational workplace-based assessment (WBA). METHODS: Interviews were conducted and the resulting data analysed using a qualitative, phenomenological approach. Between October 2009 and January 2010, we interviewed 22 postgraduate general practice trainees at two institutions in the Netherlands. Three researchers analysed the transcripts of the interviews. RESULTS: A three-step scheme emerged from the data. Feedback as part of WBA is of greater benefit to trainees if: (i) observation and feedback are planned by the trainee and trainer; (ii) the content and delivery of the feedback are adequate, and (iii) the trainee uses the feedback to guide his or her learning by linking it to learning goals. Negative emotions reported by almost all trainees in relation to observation and feedback led to different responses. Some trainees avoided observation, whereas others overcame their apprehension and actively sought observation and feedback. Active trainers were able to help trainees overcome their fears. Four types of trainer-trainee pairs were distinguished according to their engagement in observation and feedback. External requirements set by training institutions may stimulate inactive trainers and trainees. CONCLUSIONS: In line with the literature, our results emphasise the importance of the content of feedback and the way it is provided, as well as the importance of its incorporation in trainees' learning. Moreover, we highlight the step before the actual feedback itself. The way arrangements for feedback are made appears to be important to feedback in formative WBA. Finally, we outline several factors that influence the success or failure of feedback but precede the process of observation and feedback.