September 2020

Experiencing and engaging in feedback through a longitudinal lens

Fostering a Feedback Mindset: A Qualitative Exploration of Medical Students’ Feedback Experiences with Longitudinal Coaches. Bakke BM, Sheu L, Hauer KE. Academic Medicine (2020) 95:7. DOI: 10.1097/ACM.0000000000003012

Reviewed by: Zafira Bhaloo

What was the study question? For students involved in a longitudinal relationship with a physician coach, what were their experiences with feedback, and how did they interpret, apply and seek feedback in this context. What did they do? One-on-one semi-structured interviews were conducted with seventeen second-year medical students at the University of California, San Francisco School of Medicine. These students were in a coaching program which involved structured, weekly sessions with a coach who provided frequent observation and feedback but not summative assessments. Interviews explored students’ experiences of feedback with their coach, what made feedback useful, how they applied the feedback and how their longitudinal experience affected their engagement in feedback discussions. Qualitative analysis was undertaken using a constructivist grounded theory approach. What were the results? Three major themes were identified from the interviews. Firstly, medical students developed a feedback mindset where their emotional reaction to feedback changed to being “less scared” and finding “it really useful.” They grew to expect and value feedback for continued learning which helped create a feedback dialogue. Secondly, students identified factors important in setting the stage for effective feedback. Valuable structural components included an individual longitudinal relationship, frequent and regular interactions, direct observation and a nonevaluative coaching role. Students also identified trust in their coach as competent, empathetic and invested individuals important to set the stage for credible feedback. Thirdly, students were able to interpret and implement feedback received through iterative feedback discussions which led to growth in their skill set. What are the implications? Longitudinal coaching relationships create feedback literacy amongst medical students. This facilitates engagement in iterative feedback discussions. Ultimately, a culture of seeking, appreciating and providing feedback is fostered which results in a mindset that appreciates feedback as essential for learning and growth in medical training. Editor’s comments: One of the things that struck me as I read the exemplar quotes was the students’ repeated use of the word “coach” to name the faculty role, rather than the word “preceptor.” I suspect that one of the most important aspects of the relationship between the students and faculty was fact that the faculty had a non-evaluative role and truly be seen as a coach. The challenge, however, is how faculty can foster this coaching mindset in the clinical setting, where they are expected to take on dual roles of both coaching and evaluating (KFo). Wikipedia for Students Teaching Evidence-Based Medicine to Medical Students Using Wikipedia as a Platform. Murray H, Walker M, Dawson J, Simper N, Maggio LA. Acad Med. 2020;95(3):382-386. https://dx.doi.org/10.1097/ACM.0000000000003085 Reviewed by Sanaz Devlin and Elizabeth Cappello What was the study question? Can Wikipedia be used as an interactive platform to teach Evidence-Based Medicine skills to first year medical students? How was the study done? First year medical students at Queen’s University School of Medicine participated in a project to evaluate Wikipedia as a platform to search for and share appropriate biomedical information; to enhance Wikipedia medical content using EBM skills; and analyze a Wikipedia article on complementary and alternative medicine. Students worked in small groups on articles identified by WikiProject Medicine as needing improvement. Feedback was then gathered from the students to evaluate both strengths and limitations of the project. What were the results? 101 students made more than 1000 edits to 16 online articles, adding over 10,000 words. Students enjoyed applying critical appraisal skills being learned, the opportunity to be involved in the improvement of a Wikipedia article, and the experience of positive collaboration within a team. Difficulties included learning Wikipedia coding and engaging with the Wikipedia community as well as a perceived lack of “payoff” for the time dedicated to the assignment. What are the implications? This project allowed students to evaluate and conduct a literature review appraising a medical topic on a highly accessed public resource. It demonstrated that platforms such as Wikipedia could be a source of interactive assignments for students to build skills in Evidence-Based Medicine. This study demonstrates a way to improve assessment of EBM skills in platforms used by patients and families, helping students to move beyond acquisition of knowledge to the higher order outcomes of critical thinking and problem solving. Editor’s note: This study represents an effort to simultaneously enhance students’ EBM skills and provide the opportunity to participate in the improvement of a public forum where medical information is accessed by the medical and lay public. It is a good example of where learning and productivity can happen together. Some of the problems cited by students (Wiki coding difficulties and frustrations interacting with Wikipedia staff) could be overcome with similar future endeavors. (RR) Hand it over… Does Educational Handover Influence Subsequent Assessment? Dory V, Danoff, D, Plotnick, L, Cummings, B, Gomez-Garibello, C, Pal, N, Gumuchian, ST, Young M. , Academic Medicine: June 2, 2020 - Volume Publish Ahead of Print. https://dx.doi.org/10.1097/ACM.0000000000003528 Review recorded by Amit Pahwa and Jon Gold https://www.youtube.com/watch?v=_7JA34IRRBo