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Advances in Health Sciences Education

, Volume 14, Issue 3, pp 399–410 | Cite as

Reflection: a link between receiving and using assessment feedback

  • Joan M. Sargeant
  • Karen V. Mann
  • Cees P. van der Vleuten
  • Job F. Metsemakers
Original Paper

Abstract

Problem statement and background Feedback is essential to learning and practice improvement, yet challenging both to provide and receive. The purpose of this paper was to explore reflective processes which physicians described as they considered their assessment feedback and the perceived utility of that reflective process. Methods This is a qualitative study using principles of grounded theory. We conducted interviews with 28 family physicians participating in a multi-source feedback program and receiving scores across the spectrum from high to low. Results Feedback, especially negative feedback, evoked reflective responses. Reflection seemed to be the process through which feedback was or was not assimilated and appeared integral to decisions to accept and use the feedback. Facilitated reflection upon feedback was viewed as a positive influence for assimilation and acceptance. Conclusions Receiving feedback inconsistent with self-perceptions stimulated physicians’ reflective processes. The process of reflection appeared instrumental to feedback acceptance and use, suggesting that reflection may be an important educational focus in the formative assessment and feedback process.

Keywords

Reflection Feedback Performance assessment Physicians Multi-source feedback Facilitation 

Notes

Acknowledgements

We acknowledge the support of the Nova Scotia Health Research Foundation, the Medical Council of Canada and the College of Physicians and Surgeons of Nova Scotia for this research, and the assistance of our research associate, Tanya Hill, in preparing the final draft of this paper.

References

  1. Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, N.J.: Prentice Hall.Google Scholar
  2. Blank, L. L., & Cohen, J. J. (2007). Feedback improves performance: Validating a first principle. Archives of Pediatrics & Adolescent Medicine, 161, 103–104. doi: 10.1001/archpedi.161.1.103.CrossRefGoogle Scholar
  3. Boehler, M. L., Rogers, D. A., Schwind, C. J., Mayforth, R., Quin, J., Williams, R. G., et al. (2006). An investigation of medical student reactions to feedback: A randomised controlled trial. Medical Education, 40, 746–749. doi: 10.1111/j.1365-2929.2006.02503.x.CrossRefGoogle Scholar
  4. Boud, D., Keough, R., & Walker, D. (1985). Reflection: Turning experience into learning. London: Kogan Page.Google Scholar
  5. Boud, D., & Walker, D. (2002). Promoting reflection in professional courses: The challenge of context. In R. Harrison, F. Reeve, A. Hanson, & J. Clark (Eds.), Support lifelong learning (Vol. I, pp. 91–110). New York: RoutledgeFalmer.Google Scholar
  6. Branch, W. T., & Paranjape, A. (2002). Feedback and reflection: Teaching methods for clinical settings. Academic Medicine, 77(12), 1185–1188. doi: 10.1097/00001888-200212000-00005.CrossRefGoogle Scholar
  7. Carr, S. (2006). The Foundation Programme assessment tools: An opportunity to enhance feedback to trainees? Postgraduate Medical Journal, 82, 576–579. doi: 10.1136/pgmj.2005.042366.CrossRefGoogle Scholar
  8. Crabtree, B., & Miller, W. (Eds.). (1999). Making sense of qualitative research. London: Sage.Google Scholar
  9. DeNisi, A. S., & Kluger, A. N. (2000). Feedback effectiveness: Can 360-degree appraisals be improved? Academy of Management Executive, 14, 129–139.Google Scholar
  10. Epstein, R. M., & Hundert, E. M. (2002). Defining and assessing professional competence. Journal of the American Medical Association, 287(2), 226–235. doi: 10.1001/jama.287.2.226.CrossRefGoogle Scholar
  11. Eva, K. W., & Regher, G. (2005). Self-assessment in the health professions: A reformulation and research agenda. Academic Medicine, 80(10), S46–S54. doi: 10.1097/00001888-200510001-00015.CrossRefGoogle Scholar
  12. Evans, R., Elwyn, G., & Edwards, A. (2004). Review of instruments for peer assessment of physicians. Journal of the American Medical Association, 328, 1240.Google Scholar
  13. Gielen, S., Dochy, F., & Dierick, S. (2003). Evaluating the consequential validity of new modes of assessment the influence of assessment on learning, including pre-, post-, and true assessment effects. In M. Sigers (Ed.), Optimising new modes of assessment: In search of qualities and standards (pp. 37–54). Dordrecht, The Netherlands: Kluwer Academic Publishers.CrossRefGoogle Scholar
  14. Goodstone, M. S., & Diamante, T. (1998). Organizational use of therapeutic change: Strengthening multisource feedback systems through interdisciplinary coaching. Consulting Psychology Journal: Practice and Research, 50(3), 152–163. doi: 10.1037/1061-4087.50.3.152.CrossRefGoogle Scholar
  15. Hattie, J., & Timperley, H. (2007). The power of feedback. Review of Educational Research, 77, 81–112. doi: 10.3102/003465430298487.CrossRefGoogle Scholar
  16. Hatton, N., & Smith, D. (1995). Reflection in teacher education: Towards definition and implementation. Teaching and Teacher Education, 11(1), 33–49. doi: 10.1016/0742-051X(94) 00012-U.CrossRefGoogle Scholar
  17. Kjaer, N. K., Maagaard, R., & Wied, S. (2006). Using an online portfolio in postgraduate training. Medical Teacher, 28(8), 708–712. doi: 10.1080/01421590601047672.CrossRefGoogle Scholar
  18. Kluger, A. N., & DeNisi, A. (1996). The effects of feedback interventions on performance: A historical review, a meta-analysis, and a preliminary feedback intervention theory. Psychological Bulletin, 119, 254–284. doi: 10.1037/0033-2909.119.2.254.CrossRefGoogle Scholar
  19. Kolb, D. (1984). Experiential learning. Englewood Cliffs, N.J.: Prentice-Hall.Google Scholar
  20. Mamede, S., & Schmidt, H. (2004). The structure of reflective practice in medicine. Medical Education, 38, 1302–1306. doi: 10.1111/j.1365-2929.2004.01917.x.CrossRefGoogle Scholar
  21. Mann, K. V., Gordon, J., & MacLeod, A. (2007). Reflective practice in health professions education: A review of the literature. Advances in Health Science Education. doi: 10.1007/s10459-007-9090-2.
  22. Menachery, E. P., Knight, A. M., Kolodner, K., & Wright, S. M. (2006). Physician characteristics associated with proficiency in feedback skills. Journal of General Internal Medicine, 21, 440–446. doi: 10.1111/j.1525-1497.2006.00424.x.CrossRefGoogle Scholar
  23. Moon, J. (1999). A handbook of reflective and experiential learning: Theory and practice. London, UK: Routledge Falmer.Google Scholar
  24. Moon, J. (2004). Using reflective learning to improve the impact of short courses and workshops. The Journal of Continuing Education in the Health Professions, 24(1), 4–11. doi: 10.1002/chp. 1340240103.CrossRefGoogle Scholar
  25. NSPAR. (2006). Nova Scotia Physician Achievement Review: Sample questionnaires. Website: http://www.nspar.ca/about.htm (Accessed April 18, 2008)
  26. Prins, F. J., Sluijsmans, D. M., & Kirschner, P. A. (2006). Feedback for general practitioners in training: Quality, styles, and preferences. Advances in Health Sciences Education, 11(3), 289–303. doi: 10.1007/s10459-005-3250-z.CrossRefGoogle Scholar
  27. Rice, P. L., & Ezzy, D. (2000). Qualitative research methods. Victoria, Australia: Oxford University Press.Google Scholar
  28. Richardson, B. K. (2004). Feedback. Academic Emergency Medicine, 11, 1283–12835. doi: 10.1111/j.1553-2712.2004.tb01913.x.CrossRefGoogle Scholar
  29. Sargeant, J. (2006). Multi-source feedback for physician learning and change. Halifax, Canada: Halcraft Printers Inc. (Doctoral dissertation, Maastricht University, NL).Google Scholar
  30. Sargeant, J., Mann, K., & Ferrier, S. (2005). Exploring family physicians’ reaction to MSF performance assessment: Perceptions of credibility and usefulness. Medical Education, 39, 497–504. doi: 10.1111/j.1365-2929.2005.02124.x.CrossRefGoogle Scholar
  31. Sargeant, J., Mann, K., Ferrier, S., Langille, D., Muirhead, P., & Sinclair, D. (2003). Responses of rural family physicians and their colleague and coworker raters to multi-source feedback: A pilot study. Academic Medicine, 78(10), S42–S44. doi: 10.1097/00001888-200310001-00014.CrossRefGoogle Scholar
  32. Sargeant, J., Mann, K., Sinclair, D., Ferrier, S., Muirhead, P., van der Vleuten, C., et al. (2006a). Learning in practice: Experiences and perceptions of high-scoring physicians. Academic Medicine, 81(7), 655–660. doi: 10.1097/01.ACM.0000232422.81299.b7.CrossRefGoogle Scholar
  33. Sargeant, J., Mann, K., Sinclair, D., van der Vleuten, C., & Metsemakers, J. (2006b). Understanding the influence of emotions and reflection upon multi-source feedback acceptance and use. Advances in Health Science Education. doi: 10.1007/s104569-006-9039-x
  34. Sargeant, J., Mann, K., Sinclair, D., van der Vleuten, C., & Metsemakers, J. (2007). Challenges in multi-source feedback: Intended and unintended outcomes. Medical Education, 41, 583–591. doi: 10.1111/j.1365-2923.2007.02769.x.CrossRefGoogle Scholar
  35. Sargeant, J., Mann, K., van der Vleuten, C., & Metsemakers, J. (2008). Directed” self-assessment: practice and feedback within a social context. The Journal of Continuing Education in the Health Professions, 28(1), 64–73.Google Scholar
  36. Schon, D. (1983). The reflective practitioner: How professionals think in action. New York: Basic Books.Google Scholar
  37. Smither, J., London, M., & Reilly, R. R. (2005). Does performance improve following multisource feedback? A theoretical model, meta- analysis, and review of empirical findings. Personnel Psychology, 58, 33–66. doi: 10.1111/j.1744-6570.2005.514_1.x.CrossRefGoogle Scholar
  38. Strauss, A. C., & Corbin, J. M. (1998). Basics of qualitative research: Second edition: Techniques and procedures for developing grounded theory. Thousand Oaks: Sage Publications.Google Scholar
  39. van den Boss, K., Vermunt, R., & Wilke, A. M. (1997). Procedural and distributive justice: What is fair depends more on what comes first than on what comes next. Journal of Personality and Social Psychology, 72(1), 95–104. doi: 10.1037/0022-3514.72.1.95.CrossRefGoogle Scholar
  40. van der Vleuten, C., & Schuwirth, L. W. T. (2005). Assessing professional competence: From methods to programmes. Medical Education, 39, 309–317. doi: 10.1111/j.1365-2929.2005.02094.x.CrossRefGoogle Scholar
  41. Westberg, J., & Jason, H. (2001). Fostering reflection and providing feedback: Helping others learn from experience. New York: Springer Publications.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Joan M. Sargeant
    • 1
  • Karen V. Mann
    • 2
  • Cees P. van der Vleuten
    • 3
  • Job F. Metsemakers
    • 4
  1. 1.Continuing Medical Education, Faculty of MedicineDalhousie UniversityHalifaxCanada
  2. 2.Division of Medical Education, Faculty of MedicineDalhousie UniversityHalifaxCanada
  3. 3.Department of Educational Development and ResearchMaastricht UniversityMaastrichtThe Netherlands
  4. 4.Department of General PracticeMaastricht UniversityMaastrichtThe Netherlands

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