A research project on students’ perceptions of feedback in clinical situations

Instructor:  Anna Kameen (BSc Dental Hygiene Therapy clinical teacher)
Assessment type:  Patient Care and Clinical Simulation

Feedback research: Research into students’ perceptions of receiving feedback in a clinical performance situation and implications for how clinical tutors should be developed to give more effective feedback

Why did you introduce this approach to feedback?

This is a research study that I conducted for my MSc in Clinical Education.

As a clinical tutor, we are expected to deliver constructive and timely feedback after a student has performed a procedure with a patient. This has to be done immediately or very soon afterwards. We also put written feedback on the faculty e-platform, Kaizen, however, the feedback I was more concerned with was the verbal feedback that students receive from their clinical teacher who observed the procedure.

There is little or no training for clinical teachers on how to give feedback effectively and sensitively. We are expected to learn on the job, but the stakes are high as the students are dealing with real patients in these situations.  My own role is to supervise students with their clinical practice so this was a really important topic for me. I wanted to find out how effective feedback practices were and what aspects of feedback dental students find valuable and why.

There is also very little in the research literature on clinical feedback practices within dentistry to specifically. There is a lot in relation to medical education but not so much on how students perceive their feedback and what they find useful.

Entwistle (2009) identified factors affecting the quality of learning for students more generally and I was keen to find out what aspects were pertinent or specific to a dental context:

 

Factors affecting quality of learning (Entwistle, 2009)

How did you approach the research project?

I conducted a systematic literature review, with inclusion and exclusion criteria and then performed a narrative systematic review of 11 articles from around the world. I was only looking at the perspective of students. The conclusion was that UG dental students did find feedback very valuable but there were a number of key factors affecting their emotions around it and their ability to use it and take it on board.

 

What were your main conclusions?

• Availability and training of tutors – often students felt their tutors were not able to observe all aspects of their practice. The perception that feedback was only valuable when coming from an experienced knowledgeable tutor.
• Relationships and rapport were very important. Students needed to feel that they were in a safe environment in order to be able to discuss the feedback. This was especially the case in a clinical situation if they had made errors and if they did not feel comfortable, they were more likely to feel defensive and shut down. This makes it harder for them to receive or want to use the feedback. Feedback was also accepted more willingly from a tutor with whom student had a positive/friendly relationship.
• Inconsistency – if there were no clear criteria or reasons given for the feedback, or if different people were giving very different styles of feedback.
• The most valuable was when it was constructive and could provide opportunities for reflection, delivered verbally rather than written and non-judgmental.
• Several factors affected the way students received feedback based on their own characteristics and factors-previous school, emotional resilience etc.

 

The conclusions are summarised below in a concept map:

 

 

What implications does this have for clinical practice in FoDOCS?

• Clinical teachers need more training in order to be able to give more consistent and effective feedback based on some of the research literature which shows how feedback is received by students if delivered in a certain manner. For example, a short workshop breaking down key principles of approaches to feedback or providing a framework that they can follow.
• Newer clinical teachers would benefit a lot from this. Watching a video of a teacher giving good feedback, for example, could have a positive impact on all colleagues if students feedback on the types of feedback that they find useful.

What might be some challenges in the FoDOCS context?

• Everyone has their own style, and it would be hard to impose a framework for feedback on all members of clinical staff to follow, especially the more experienced colleagues. Tutors who have learned on the job, might have acculturated some ‘bad habits’ and may also be in a vulnerable position themselves hence these colleagues may be more resistant to this type of training. We need to find a way to help them unpack their practice in a sensitive and evidence- based
• In clinical situations time is a real constraint – students and clinical teachers really value the oral ‘fireside chats’ but with busy clinics and lists of patients, this is often not done well. Students are required to fill in a post reflection form after this chat, but students may perform a few procedures in one day and they choose who to send their written reflection to. They may chose someone who they liked or who they think will give them ‘better’ feedback!

What are your next steps?

• I would like to do focus groups with my students and potentially with the tutors too. I applied for ethical approval from UCL, where I conducted the study, but sadly the pandemic hit, and I was unable to go ahead with this. This is because the context changed a lot and there were very few live clinical practices.
• I would like to research more into what students DO with their feedback – perform an action plan etc.
• Most of the articles did not control for aspects such as ethnicity, gender etc, that may have an impact on the types of or approaches to feedback that students prefer. This is a possible area of research as well.