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      A Systematic Approach to Working With Medical Learners in Difficulty: A Faculty Development Workshop

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          Abstract

          Introduction

          For medical educators, applying a systematic approach to working with struggling learners (learners in difficulty) can improve faculty success and satisfaction with the remediation process. Use of the familiar SOAP diagnostic framework can ensure that faculty develop a thorough differential diagnosis and target their interventions to address underlying issues affecting learner success.

          Methods

          We developed a workshop to teach medical education faculty essential skills for supporting learners in difficulty. Teaching methods included didactic presentation, large-group discussion, and small-group work with role-plays. Over three 2-hour sessions, participants learned to assess a learner in difficulty, develop an initial remediation plan, and evaluate their learning system with the goal of improving support to learners in difficulty. Evaluation included pre- and postsession assessment of learner self-perceived confidence and skill with working with struggling learners, as well as brief postsession evaluation.

          Results

          Ninety-nine faculty participated in the Learners in Difficulty workshop over 7 years. Participants’ overall rating of the workshop was 4.9 (1 = poor, 5 = outstanding). Pre- and postworkshop evaluation showed a statistically significant increase in perceived self-confidence to “Meet the needs of a struggling learner,” from an average of 4.4 to 7.6 on a 10-point scale (mean Δ = 3.2; 95% confidence interval, 2.6–3.8; p < .001).

          Discussion

          This workshop provides a stepwise approach to working with learners in difficulty and assessing participants’ educational systems to identify strengths and weaknesses. Evaluations indicated participants felt more confident in their ability to engage in this topic following completion of the workshop.

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          Most cited references16

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          State of the science in health professional education: effective feedback.

          Effective feedback may be defined as feedback in which information about previous performance is used to promote positive and desirable development. This can be challenging as educators must acknowledge the psychosocial needs of the recipient while ensuring that feedback is both honest and accurate. Current feedback models remain reductionist in their approach. They are embedded in the hierarchical, diagnostic endeavours of the health professions. Even when it acknowledges the importance of two-way interactions, feedback often remains an educator-driven, one-way process. An understanding of the various types of feedback and an ability to actively seek an appropriate approach may support feedback effectiveness. Facilitative rather than directive feedback enhances learning for high achievers. High-achieving recipients undertaking complex tasks may benefit from delayed feedback. It is hypothesised that such learners are supported by reducing interruptions during the task. If we accept that medical students and doctors are high achievers, we can draw on some guiding principles from a complex and rarely conclusive literature. Feedback should focus on the task rather than the individual and should be specific. It should be directly linked to personal goals. Self-assessment as a means to identify personal learning requirements has no theoretical basis. Motivated recipients benefit from challenging facilitated feedback from external sources. To achieve truly effective feedback, the health professions must nurture recipient reflection-in-action. This builds on self-monitoring informed by external feedback. An integrated approach must be developed to support a feedback culture. Early training and experience such as peer feedback may over time support the required cultural change. Opportunities to provide feedback must not be missed, including those to impart potentially powerful feedback from high-stakes assessments. Feedback must be conceptualised as a supported sequential process rather than a series of unrelated events. Only this sustained approach will maximise any effect.
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            Giving feedback in clinical settings

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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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                Author and article information

                Journal
                MedEdPORTAL
                MedEdPORTAL
                MEP
                MedEdPORTAL : the Journal of Teaching and Learning Resources
                Association of American Medical Colleges
                2374-8265
                2020
                31 January 2020
                : 16
                : 10872
                Affiliations
                [1 ]Associate Professor, Department of Family and Community Medicine, University of California, San Francisco, School of Medicine
                [2 ]Lead, Family Medicine Faculty Development Fellowship, University of California, San Francisco, School of Medicine
                [3 ]Program Director, Contra Costa Family Medicine Residency Program
                [4 ]Director, Family Medicine Faculty Development Fellowship, University of California, San Francisco, School of Medicine
                [5 ]Vice Chair of Research, Department of Family and Community Medicine, University of California, San Francisco, School of Medicine
                Author notes
                Article
                10.15766/mep_2374-8265.10872
                7062539
                de88233e-92aa-4594-a40c-206ab81ac035
                Copyright © 2019 Stafford et al.

                This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial license.

                History
                : 25 February 2019
                : 07 September 2019
                Page count
                Tables: 1, References: 17, Pages: 6
                Categories
                Original Publication

                faculty development,learners in difficulty,remediation,case-based learning

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