April 2020

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Feedback from students

Faculty Perceptions of Formative Feedback from Medical Students.

Robins L, Smith S, Kost A, Combs H, Kritek PA, Klein EJ. Teach Learn Med. 2020 Apr-May;32(2):168-175. https://dx.doi.org/10.1080/10401334.2019.1657869



Reviewed by Linlei Ye and Angela Punnett

What was the study question?  What are faculty perspectives on formative feedback about their teaching from undergraduate medical students and how might they respond?

How was the study done? Semi-structured interviews were conducted with 24 faculty at a large US medical school. Participants were asked to reflect on receiving a teaching evaluation that had surprised them. Follow-up questions explored enabling factors and barriers to inviting and receiving formative feedback from students. Rigorous qualitative content analysis was used to develop and refine a coding framework from the interview transcripts.

What were the results? Faculty described nonspecific feedback from mid-rotation reviews and elaborated on barriers to receiving constructive feedback such as preserving student-teacher relationships and the inherent student-teacher power differential. Participants expressed a desire for bidirectional feedback to help refine teaching skills.

Factors that positively influence faculty to be more receptive of student feedback include feedback from students perceived to be interested, hardworking and doing well, is specific and actionable, is communicated positively and respectfully, and is motivated by good intentions to improve the student’s own learning and that of peers.

What are the implications of these findings?  Identifying the factors that influence faculty’s attitudes and receptiveness of feedback is an essential step towards creating an open dialogue. This study’s findings suggest there is a need for promoting more positive faculty attitudes regarding feedback from students while helping to encourage students to provide honest feedback in an effective manner. These are components to foster a healthy feedback and workplace culture.

Editor’s note:  Honest, constructive, and considerate bi-directional feedback is essential to ongoing improvement of educational efforts and outcomes. This study helps to show the way to achieve that goal. (RR)

 It’s hard for clerkship directors to affect shelf exam scores

Which Internal Medicine Clerkship Characteristics Are Associated With Students’ Performance on the NBME Medicine Subject Exam? A Multi-Institutional Analysis.

Fitz MM,  Adams W,  Haist SA et al.  Academic Medicine, online publication ahead of print..   https://dx.doi.org/10.1097/ACM.0000000000003322

Reviewed by Amit Pahwa

What was the study question? What characteristics of internal medicine clerkships are correlated with better performance on the internal medicine NBME subject exam?

How was the study done? The study included 24,452 students from 62 schools and included NBME data from 2011-2014. The authors conducted telephone interviews to assess the characteristics of the clerkships of each school from 2014-2015. Characteristics included longitudinal status, clerkship length, start month of clinical clerkships, when a student enrolled in the clerkship, ambulatory experience, presence of a study day, combining with another clerkship, preclinical curriculum type, how many NBME subject exams a student took, number of didactic hours, and Step 1 performance.  All this data was sent to NBME who matched the clerkship characteristics with the students’ scores. The NBME then gave de-identified data to the first author. Statistical analysis involved a mixed effects model for the characteristics the authors were interested in assessing.

What were the results? Many of the characteristics after adjusting had no significant association with NBME scores. In elements that the school can control, later start date of clerkships (January versus after July) and having a criterion score for passing the subject exam are significantly associated with an increase. Students who took the exam in the 2nd, 3rd, or 4th quarter of the year performed significantly better than students in the first quarter. Students who performed better on USMLE Step 1 were more likely to perform better on the NBME.

What are the implications? The study demonstrates that despite various structures to the internal medicine clerkship there was very little association with a change in NBME score. It also alludes to a possible parallel curriculum that exists with standardized test.  Often it is said in medical education there is a curriculum the students complete in the schools and another studying for their various standardized tests. This study further supports that we as educators should use our time in the clerkship to create great physicians rather than worry about their knowledge. It was also interesting that the presence of a study day had no effect, and this is something students always desire.

Editor’s Note: On the one hand, this study reassures us that innovative curricular changes (e.g. longitudinal clerkships, integrated curricula) have no apparent negative effect on student’s NBME scores.  On the other hand, these changes don’t seem to improve scores either.  How we think about this study may depend on whether we think the NBME subject exams measure something important about a student’s ability to be a physician.  (JG)

The impact of gender on medical education

‘Man up’: Medical students’ perceptions of gender and learning in clinical practice: A qualitative study.

Samuriwo R, Patel Y, Webb K, Bullock A. Medical Education. 2020; 54:150161. https://doi.org/10.1111/medu.13959

Reviewed by: Kimberly Young and Angela Punnett

What was the study question? How do medical students perceive the impact of their gender on their clinical learning?    How was the study done? Thirty-one third, fourth, and fifth year UK medical students were asked how they felt gender impacted their medical training using semi-structured interviews and/or case reports with open-ended prompts. All students had experience in clinical placements and had teaching about gender differences during their first year of medical school.    A thematic analysis of pooled data was conducted based on a theoretical framework developed by the study investigators. Researchers kept reflexive journals during data analysis to capture how their personal views coloured their interpretations. Central themes were identified from the data and agreed upon by four reviewers.    What were the results?  Qualitative analysis identified two main themes: 1) predominant gendered culture and career prospects and 2) gendered support and mentorship. The former encompasses how traits were attributed to a specific gender and qualified those trainees to pursue certain specialties. Females were considered well-suited for generalist medicine owing to their interpersonal skills, but their perceived emotional lability precluded them from surgical specialties. Males were considered more intellectually and physically strong yet emotionally blunted, thus suitable for careers in surgery.

With regards to mentorship, participants reported that staff preferred medical students of the same gender due to shared lived experiences. They also noted that physicians made assumptions about patient preferences for medical student involvement when their genders were discordant, limiting learning opportunities with patients of the opposite gender.   What are the implications?  A medical student’s gender impacts their clinical learning, largely by influencing how physicians and nurses interact with them. Trainees stand to benefit from mentorship from both male and female senior physicians to gain exposure to various perspectives and insights. Clinical educators should reflect upon how their own biases influence their interactions with students in order to support their students’ individual learning and career goals.

Editor’s Comments: The authors of this study propose a “Gendered apprenticeship theory” that explains how the gendered experience of students impacts their learning, confidence, motivation and career opportunities, and how ultimately the gender bias becomes internalized, normalized and perpetuated. In order to change the culture of gender and other unconscious biases in the clinical learning environment, we must first acknowledge they exist (KFo).