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      Are junior doctors competent in providing effective feedback to medical students?

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      Advances in Medical Education and Practice
      Dove Medical Press

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          Abstract

          Dear editor Effective feedback is widely recognized as one of the main catalysts for learners to achieve their educational goals and fulfill their potential. Its crucial role in medical education has been well established over many years.1 However, previous studies of medical student perceptions show that they are dissatisfied with the feedback received from tutors. The key findings were the lack of feedback on medical students’ performances or inadequate feedback when provided.2,3 In the UK, provisionally registered doctors (foundation doctors in their first year of training following graduation) are expected by the General Medical Council to teach medical students. In addition, they should also “contribute to the appraisal, assessment or review of students and colleagues”.4 One of the main issues expressed by medical students is the lack of feedback as mentioned. Foundation doctors often ask for formal feedback from the medical students they teach in order to collect evidence to fulfill teaching requirements of the training program. However, in many cases, feedback to medical students is not always forthcoming and this can potentially hinder their educational development. In addition, literature on the quality of feedback provided by junior doctors is scarce. This raises an important question: are junior doctors competent in giving effective feedback? As junior doctors with an interest in medical education, we believe that there is a lack of formal training on how to provide effective feedback, within the UK undergraduate curriculum. Junior doctor-led teaching of medical students has become omnipresent at medical schools worldwide. Moreover, many formal teaching programs have recently been set up by junior doctors across the UK.5 In fact, it was noted in a recent study by Rashid et al6 that medical students highly value junior doctor-led teaching and found the latter comparable to consultant-led teaching, hence highlighting the importance of feedback provided by junior doctors. Junior doctors are the most approachable members of medical staff for medical students, as they were themselves in the position of medical students on a similar journey of learning not so long ago. As recent medical graduates, junior doctors can offer a unique perspective to medical school exam preparation or life after medical school, hence emphasizing the importance of the symbiosis between medical students and junior doctors. Several faculty development programs including workshops, have been implemented to encourage faculty members to give feedback to medical students and to improve their skills in doing so effectively.7,8 However, such interventions are very limited on an undergraduate level in the UK. This forms a basis for future studies on the quality of feedback delivered by junior doctors and efficacy of implementing future interventions. In conclusion, all the issues regarding feedback given to medical students on their clinical rotations need to be addressed by the medical education departments so that the latter can come away with a valuable learning experience. Furthermore, we believe that incorporating this aspect of medical education into the undergraduate curriculum will acquaint new medical graduates with the necessary tools to provide feedback to medical students in a way that is effective and constructive. In doing so, both safety of patient care and medical education will benefit.

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          Most cited references8

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          An investigation of medical student reactions to feedback: a randomised controlled trial.

          Medical educators have indicated that feedback is one of the main catalysts required for performance improvement. However, medical students appear to be persistently dissatisfied with the feedback that they receive. The purpose of this study was to evaluate learning outcomes and perceptions in students who received feedback compared to those who received general compliments. All subjects received identical instruction on two-handed surgical knot-tying. Group 1 received specific, constructive feedback on how to improve their knot-tying skill. Group 2 received only general compliments. Performance was videotaped before and after instruction and after feedback. Subjects completed the study by indicating their global level of satisfaction. Three faculty evaluators observed and scored blinded videotapes of each performance. Intra-observer agreement among expert ratings of performance was calculated using 2-way random effects intraclass correlation (ICC) methods. Satisfaction scores and performance scores were compared using paired samples t-tests and independent samples t-tests. Performance data from 33 subjects were analysed. Inter-rater reliability exceeded 0.8 for ratings of pre-test, pre-intervention and post-intervention performances. The average performance of students who received specific feedback improved (21.98 versus 15.87, P<0.001), whereas there was no significant change in the performance score in the group who received only compliments (17.00 versus 15.39, P=0.181) The average satisfaction rating in the group that received compliments was significantly higher than the group that received feedback (6.00 versus 5.00, P=0.005). Student satisfaction is not an accurate measure of the quality of feedback. It appears that satisfaction ratings respond to praise more than feedback, while learning is more a function of feedback.
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            Giving feedback in medical education: verification of recommended techniques.

            We investigated naturally occurring feedback incidents to substantiate literature-based recommended techniques for giving feedback effectively. A faculty development course for improving the teaching of the medical interview, with opportunities for participants to receive feedback. Seventy-four course participants (clinician-educators from a wide range of medical disciplines, and several behavioral scientists). We used qualitative and quantitative approaches. Participants provided narratives of helpful and unhelpful incidents experienced during the course and then rated their own narratives using a semantic-differential survey. We found strong agreement between the two approaches, and congruence between our data and the recommended literature. Giving feedback effectively includes: establishing an appropriate interpersonal climate; using an appropriate location; establishing mutually agreed upon goals; eliciting the learner's thoughts and feelings; reflecting on observed behaviors; being nonjudgmental; relating feedback to specific behaviors; offering the right amount of feedback; and offering suggestions for improvement. Feedback techniques experienced by respondents substantiate the literature-based recommendations, and corrective feedback is regarded as helpful when delivered appropriately. A model for providing feedback is offered.
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              A near-peer teaching program designed, developed and delivered exclusively by recent medical graduates for final year medical students sitting the final objective structured clinical examination (OSCE)

              Background The General Medical Council states that teaching doctors and students is important for the care of patients. Our aim was to deliver a structured teaching program to final year medical students, evaluate the efficacy of teaching given by junior doctors and review the pertinent literature. Methods We developed a revision package for final year medical students sitting the Objective Structured Clinical Examination (OSCE). The package was created and delivered exclusively by recent medical graduates and consisted of lectures and small group seminars covering the core areas of medicine and surgery, with a focus on specific OSCE station examples. Students were asked to complete a feedback questionnaire during and immediately after the program. Results One hundred and eighteen completed feedback questionnaires were analysed. All participants stated that the content covered was relevant to their revision. 73.2% stated that junior doctors delivered teaching that is comparable to that of consultant - led teaching. 97.9% stated the revision course had a positive influence on their learning. Conclusions Our study showed that recent medical graduates are able to create and deliver a structured, formal revision program and provide a unique perspective to exam preparation that was very well received by our student cohort. The role of junior doctors teaching medical students in a formal structured environment is very valuable and should be encouraged.
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                Author and article information

                Journal
                Adv Med Educ Pract
                Adv Med Educ Pract
                Advances in Medical Education and Practice
                Advances in Medical Education and Practice
                Dove Medical Press
                1179-7258
                2015
                20 July 2015
                : 6
                : 497-498
                Affiliations
                [1 ]Monklands Hospital, Airdrie, North Lanarkshire, UK
                [2 ]Glasgow Royal Infirmary, Glasgow, Scotland, UK
                Author notes
                Correspondence: Elliott Yann Ah-kee, Monklands Hospital, Monkscourt Avenue, Airdrie, North Lanarkshire ML6 0JS, UK, Email elliottahkee@ 123456gmail.com
                Article
                amep-6-497
                10.2147/AMEP.S90892
                4514144
                26229516
                414447fd-2665-41b9-9857-40de576f1024
                © 2015 Ah-kee and Khan. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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