Medical Students' General Beliefs and Specific Perceptions about Patient Feedback Before and after Training in a Clinical Context.

Introduction: Despite its high potential, patient feedback does not always result in learning. For feedback to be effective students must engage with it, which partly depends on their perceptions of feedback. To better understand student engagement with patient feedback in a clinical context, this study explored the following research questions: 1) What are medical students' general beliefs about patient feedback and what are their specific perceptions of feedback messages? 2) What is the difference between these general beliefs and feedback message perceptions before and after patient feedback training? Methods: The study context was a 12-week clerkship combining Pediatrics and Gynecology, which included feedback training for students and asking for patient feedback. Ninety 4th-year medical students completed pre- and post-clerkship questionnaires. The questionnaires (Beliefs about Patient Feedback Questionnaire, Feedback Perception Questionnaire) were adapted from validated peer-feedback questionnaires. Questionnaires were quantitatively analyzed. Results: Both pre- and post-clerkship, students had positive general beliefs about patient feedback and positive perceptions of the feedback messages they received. However, paired t-tests showed that students' general beliefs and feedback message perceptions became less positive after feedback training and experience. Discussion: Patient feedback is not an easy means to learn and students do not become feedback literate in terms of patient feedback overnight. We suggest that future researchers further explore reasons for the decline in positive perceptions of patient feedback. We suggest implementing longitudinal feedback training in medical curricula, where students are guided and supported in the complex task of learning from patients through feedback.

Preparing Medical and Nursing Students for Interprofessional Feedback Dialogues.

Background: In healthcare education, preparing students for interprofessional feedback dialogues is vital. However, guidance regarding developing interprofessional feedback training programs is sparse. In response to this gap, the Westerveld framework, which offers principles for interprofessional feedback dialogue, was developed. Approach: Using the Westerveld framework, we developed and implemented an interprofessional feedback intervention for 4th-year nursing and 5th-year medical students. It encompasses two half-day workshops comprising small group sessions, interactive lectures, and a goal-setting assignment for the rotations. This paper describes the intervention and reflects on students' self-reported goals, as learning outcomes, to inform future interprofessional feedback dialogue education. Outcomes: To understand student's learning outcomes, we coded the content and specificity of 288 responses to the goal-setting assignment. Students indicated they mainly aimed to improve their feedback actionability, but contrastingly set - largely unspecific - goals, addressing the initiation of feedback dialogues. To better understand the process of setting these goals, we held three focus groups (N = 11): aside from the Westerveld framework, students used previous experience in rotations, outcome expectations, and personal characteristics as sources in their goal-setting process. Reflection: The contrast between students' aims to improve their actionability and their goals to initiate dialogues, suggests that overcoming practice barriers to initiating dialogues are conditional to developing other feedback dialogue aspects. These and other goal conflicts in the workplace may hinder them setting specific feedback dialogue goals. We recommend explicit discussion of these challenges and conflicts in interprofessional feedback dialogue education.

'A role model is like a mosaic': reimagining URiM students' role models in medical school.

BACKGROUND: Role modelling is a widely acknowledged element of medical education and it is associated with a range of beneficial outcomes for medical students, such as contributing to professional identity development and a sense of belonging. However, for students who are racially and ethnically underrepresented in medicine (URiM), identification with clinical role models may not be self-evident, as they have no shared ethnic background as a basis for social comparison. This study aims to learn more about the role models of URiM students during medical school and about the added value of representative role models. METHODS: In this qualitative study we used a concept-guided approach to explore URiM alumni's experiences with role models during medical school. We conducted semi-structured interviews with ten URiM alumni about their perception of role models, who their own role models were during medical school and why they considered these figures as role models. Sensitizing concepts guided the topic list, interview questions and finally served as deductive codes in the first round of coding. RESULTS: The participants needed time to think about what a role model is and who their own role models are. Having role models was not self-evident as they had never thought about it before, and participants appeared hesitant and uncomfortable discussing representative role models. Eventually, all participants identified not one, but multiple people as their role model. These role models served different functions: role models from outside medical school, such as parents, motivated them to work hard. Clinical role models were fewer and functioned primarily as examples of professional behaviour. The participants experienced a lack of representation rather than a lack of role models. CONCLUSIONS: This study presents us with three ways to reimagine role models in medical education. First, as culturally embedded: having a role model is not as self-evident as it appears in existing role model literature, which is largely based on research conducted in the U.S. Second, as cognitive constructs: the participants engaged in selective imitation, where they did not have one archetypical clinical role model, but rather approach role models as a mosaic of elements from different people. Third, role models carry not only a behavioural but also a symbolical value, the latter of which is particularly important for URiM students because it relies heavier on social comparison.

Students generate items for an online formative assessment: Is it motivating?

BACKGROUND: A reported problem with e-learning is sustaining students' motivation. We propose a framework explaining to what extent an e-learning task is motivating. This framework includes students' perceived Value of the task, Competence in executing the task, Autonomy over how to carry out the task, and Relatedness. METHODS: To test this framework, students generated items in an online environment and answered questions developed by their fellow students. Motivation was measured by analyzing engagement with the task, with an open-ended questionnaire about engagement, and with the motivated strategies for learning questionnaire (MSLQ). RESULTS: Students developed 59 questions and answered 1776 times on the questions. Differences between students who did or did not engage in the task are explained by the degree of self-regulation, time management, and effort regulation students report. There was a significant relationship between student engagement and achievement after controlling for previous academic achievement. CONCLUSIONS: This study proposes a way of explaining the motivational value of an e-learning task by looking at students' perceived competence, autonomy, value of the task, and relatedness. Student-generated items are considered of high task value, and help to perceive relatedness between students. With the right instruction, students feel competent to engage in the task.

Peer-instructed seminar attendance is associated with improved preparation, deeper learning and higher exam scores: a survey study.

BACKGROUND: Active engagement in education improves learning outcomes. To enhance active participation in seminars, a student-centered course design was implemented and evaluated in terms of self-reported preparation, student motivation and exam scores. We hypothesized that small group learning with intensive peer interaction, using buzz-groups followed by plenary discussion, would motivate students to prepare seminar assignments at home and to actively engage in the seminars. Active engagement involved discussion of the preparatory assignments until consensus was reached. METHODS: In total seven seminars were scheduled in a 10-week physiology course of an undergraduate Biomedical Sciences program. After each seminar, students were asked to fill out their perceptions of preparation and quality of the seminar (deepening of knowledge and confidence in answers) on a five-point scale using electronic questionnaires. Student motives were first collected using open questions. In the final questionnaire students were asked to indicate on a five-point scale how each motive was perceived. Students overall explanations why they had learned from seminars were collected via open questions in the final questionnaire. One hundred and twenty-four students of the cohort from November 2012 to February 2013 (82.6 %) voluntarily participated. Students' motives to prepare and attend seminars were analyzed by inspection of descriptive statistics. Linear regression analysis was conducted to relate student preparation to the quality of seminars, seminar attendance to exam scores, and exam scores to the quality of seminars. Answers to open questions were deductively clustered. RESULTS: Studying the material, training for exams and comparing answers with peers motivated students to prepare the seminars. Students were motivated to participate actively because they wanted to keep track of correct answers themselves, to better understand the content and to be able to present their findings in plenary discussions. Perceived preparation of peers was positively associated with the perceived quality of seminars. Also, seminar attendance was positively associated with exam scores. Students' overall explanations suggest that discussing with peers and applying knowledge in pathophysiology cases underlies this association. CONCLUSION: Discussion with well-prepared peers during seminars improves student perceptions of deeper learning and peer-instructed seminar attendance was associated with higher exam scores.

Students' motives for using online formative assessments when preparing for summative assessments.

BACKGROUND: Formative assessments intend to provide feedback on student performance in order to improve and accelerate learning. Several studies have indicated that students using online formative assessments (OFAs), have better results on their exams. AIMS: The present study aims to provide insight in student reasons for using or not using available OFAs. METHOD: Three OFAs with feedback were available in a second year undergraduate course in physiology for biomedical sciences students (N = 147). First, students received an open questionnaire about why they did (not) complete the first two OFAs. Based on this data, a closed questionnaire was developed and distributed among students. Exploratory factor analysis (EFA) was applied. RESULTS: The results indicate reasons why students do (not) use the OFAs. The EFA for using the OFAs indicated three factors, that were interpreted as collecting (1) feed up, (2) feed forward, and (3) feed back information. The main reasons for not using the OFAs were lack of time and having completed the questions before. CONCLUSIONS: Students' reasons for using OFAs can be described in terms of collecting feed up, forward and back information and students' reasons for not using OFAs can be student-, teacher-, or mode-related.

Online formative tests linked to microlectures improving academic achievement.

BACKGROUND: Online formative tests (OFTs) are powerful tools to direct student learning behavior, especially when enriched with specific feedback. AIM: In the present study, we have investigated the effect of OFTs enriched with hyperlinks to microlectures on examination scores. METHODS: OFTs, available one week preceding each midterm and the final exams, could be used voluntarily. The use of OFTs was related to scores on midterm and final exams using ANOVA, with prior academic achievement as a covariate. RESULTS: On average, 74% of all students used the online formative tests (OFT+) while preparing for the summative midterm exam. OFT+ students obtained significantly higher grades compared to OFT-students, both without and with correction for previous academic achievement. Two out of three final exam scores did not significantly improve. CONCLUSION: Students using online formative tests linked to microlectures receive higher grades especially in highly aligned summative tests.