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      Feedback on students' clinical reasoning skills during fieldwork education

      research-article
      , PhD, Reg OT 1 , , PhD, Reg OT 2
      Australian Occupational Therapy Journal
      John Wiley & Sons, Ltd
      feedback, fieldwork education, mixed methodology research, physical dysfunction

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          Abstract

          Background/aim

          Feedback on clinical reasoning skills during fieldwork education is regarded as vital in occupational therapy students' professional development. The nature of supervisors' feedback however, could be confirmative and/or corrective and corrective feedback could be with or without suggestions on how to improve. The aim of the study was to evaluate the impact of supervisors' feedback on final-year occupational therapy students' clinical reasoning skills through comparing the nature of feedback with the students' subsequent clinical reasoning ability.

          Method

          A mixed-method approach with a convergent parallel design was used combining the collection and analysis of qualitative and quantitative data. From focus groups and interviews with students, data were collected and analysed qualitatively to determine how the students experienced the feedback they received from their supervisors. By quantitatively comparing the final practical exam grades with the nature of the feedback, their fieldwork End-of-Term grades and average academic performance it became possible to merge the results for comparison and interpretation.

          Results

          Students' clinical reasoning skills seem to be improved through corrective feedback if accompanied by suggestions on how to improve, irrespective of their average academic performance. Supervisors were inclined to underrate high performing students and overrate lower performing students.

          Conclusions

          Students who obtained higher grades in the final practical examinations received more corrective feedback with suggestions on how to improve from their supervisors. Confirmative feedback alone may not be sufficient for improving the clinical reasoning skills of students.

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          Most cited references28

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          Research Design - qualitative, quantitative and mixed methods approaches

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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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              Unwritten rules of talking to doctors about depression: integrating qualitative and quantitative methods.

              We wanted to understand concordance and discordance between physicians and patients about depression status by assessing older patient's views of interactions with their physicians. We used an integrated mixed methods design that is both hypothesis testing and hypothesis generating. Patients aged 65 years and older, who identified themselves as being depressed, were recruited from the offices of primary care physicians and interviewed in their homes using a semistructured interview format. We compared patients whose physicians rated them as depressed with those whose physicians who did not according to personal characteristics (hypothesis testing). Themes regarding patient perceptions of their encounters with physicians were then used to generate further hypotheses. Patients whose physician rated them as depressed were younger than those whose physician did not. Standard measures, such as depressive symptoms and functional status, did not differentiate between patients. Four themes emerged in interviews with patients regarding how they interacted with their physicians; namely, "My doctor just picked it up," "I'm a good patient," "They just check out your heart and things," and "They'll just send you to a psychiatrist." All patients who thought the physician would "just pick up" depression and those who thought bringing up emotional content would result in a referral to a psychiatrist were rated as depressed by the physician. Few of the patients who discussed being a "good patient" were rated as depressed by the physician. Physicians may signal to patients, wittingly or unwittingly, how emotional problems will be addressed, influencing how patients perceive their interactions with physicians regarding emotional problems.
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                Author and article information

                Contributors
                Role: Head
                Role: Senior Lecturer
                Journal
                Aust Occup Ther J
                Aust Occup Ther J
                aot
                Australian Occupational Therapy Journal
                John Wiley & Sons, Ltd (Chichester, UK )
                0045-0766
                1440-1630
                August 2015
                09 August 2015
                : 62
                : 4
                : 255-264
                Affiliations
                [1 ]Department of Occupational Therapy, Faculty of Health Sciences, School of Health Care Sciences, University of Pretoria Pretoria, South Africa
                [2 ]Institute of Neuroscience and Physiology/Occupational Therapy, Sahlgrenska Academy, Göteborg University Göteborg, Sweden
                Author notes
                Marianne de Beer, Department of Occupational Therapy, Faculty of Health Sciences, University of Pretoria, Private Bag X 323, Pretoria 0001, South Africa. Email: Marianne.debeer@ 123456up.ac.za , and, Lena Mårtensson, Sahlgrenska Academy, Institute of Neuroscience and Physiology/Occupational Therapy, PO Box 455, SE 40530 Gothenburg, Sweden. Email: lena.martensson@ 123456neuro.gu.se
                Article
                10.1111/1440-1630.12208
                4584508
                26256854
                6573fd15-cd0c-4d14-b1ae-735d4b02baf5
                © 2015 The Authors. Australian Occupational Therapy Journal published by Wiley Publishing Asia Pty Ltd on behalf of Occupational Therapy Australia

                This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 04 May 2015
                Categories
                Research Articles

                feedback,fieldwork education,mixed methodology research,physical dysfunction

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