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An autoethnographic exploration of the use of goal oriented feedback to enhance brief clinical teaching encounters


Supervision in the outpatient context is increasingly in the form of single day interactions between students and preceptors. This creates difficulties for effective feedback, which often depends on a strong relationship of trust between preceptor and student. Building on feedback theories focusing on the relational and dialogic aspects of feedback, this study explored the use of goal-oriented feedback in brief encounters with learners. This study used autoethnography to explore one preceptor’s feedback interactions over an eight-month period both in the ambulatory setting and on the wards. Data included written narrative reflections on feedback interactions with twenty-three learners informed by discussions with colleagues and repeated reading of feedback literature. Thematic and narrative analyses of data were performed iteratively. Data analysis emphasized four recurrent themes. (1) Goal discussions were most effective when initiated early and integrated throughout the learning experience. (2) Both learner and preceptor goals were multiple and varied, and feedback needed to reflect this complexity. (3) Negotiation or co-construction of goals was important when considering the focus of feedback discussions in order to create safer, more effective interactions. (4) Goal oriented interactions offer potential benefits to the learner and preceptor. Goal oriented feedback promotes dialogue as it requires both preceptor and learner to acknowledge and negotiate learning goals throughout their interaction. In doing so, feedback becomes an explicit component of the preceptor–learner relationship. This enhances feedback interactions even in relatively brief encounters, and may begin an early educational alliance that can be elaborated with longer interactions.

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  • Anderson, L. (2006). Analytic autoethnography. Journal of Contemporary Ethnography, 35(4), 373–395.

    Article  Google Scholar 

  • Askew, S., & Lodge, C. (2000). Gifts, ping-pongs and loops: Linking feedback and learning. In S. Askew (Ed.), Feedback for learning (pp. 1–17). London: Routledge.

    Google Scholar 

  • Bates, J., Konkin, J., Suddards, C., Dobson, S., & Pratt, D. (2013). Student perceptions of assessment and feedback in longitudinal integrated clerkships. Medical Education, 47(4), 362–374.

    Article  Google Scholar 

  • Bing-you, R., & Trowbridge, R. (2009). Why medical educators may be failing at feedback. Journal of the American Medical Association, 302, 1330–1331.

    Article  Google Scholar 

  • Boud, D., & Molloy, E. (2013). Rethinking models of feedback for learning: The challenge of design. Assessment and Evaluation in Higher Education, 38(6), 698–712.

    Article  Google Scholar 

  • Braune, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research Psychology, 3(2), 77–101.

    Article  Google Scholar 

  • Chang, H. (2008). Autoethnography as method. Walnut Creek, CA: Left Coast Press Inc.

    Google Scholar 

  • Ellis, C. (2004). The ethnographic I. Walnut Creek, CA: AltaMira Press.

    Google Scholar 

  • Ende, J. (1983). Feedback in clinical medical education. Journal of the American Medical Association, 250(6), 777–781.

    Article  Google Scholar 

  • Ende, J., Pomerantz, A., & Erickson, F. (1995). Preceptors’ strategies for correcting residents in an ambulatory care medicine setting: A qualitative analysis. Academic Medicine, 70(3), 224–229.

    Article  Google Scholar 

  • Eva, K., Armson, H., Holmboe, E., Lockyer, J., Loney, E., Mann, K., & Sargeant, J. (2012). Factors influencing responsiveness to feedback: On the interplay between fear, confidence, and reasoning processes. Advances in Health Sciences Education, 17(1), 15–26.

    Article  Google Scholar 

  • Eva, K., & Regehr, G. (2013). Effective feedback for maintenance of competence: From data delivery to trusting dialogues. Canadian Medical Association Journal, 185(6), 463–464.

    Article  Google Scholar 

  • Farrell, L., Bourgeois-Law, G., Regehr, G., & Ajjawi, R. (2015). Autoethnography: Introducing “I” into medical education research. Medical Education, 49(10), 974–982.

    Article  Google Scholar 

  • Goldman, S. (2009). The educational kanban: Promoting effective self-directed adult learning in medical education. Academic Medicine, 84(7), 927–934.

    Article  Google Scholar 

  • Hattie, J., & Timperley, H. (2007). The power of feedback. Review of Educational Research, 77(1), 81–112.

    Article  Google Scholar 

  • Hewson, M. G., & Little, M. L. (1998). Giving feedback in medical education. Journal of General Internal Medicine, 13(2), 111–116.

    Article  Google Scholar 

  • Jackson, J. L., O’Malley, P., Salerno, S., & Kroenke, K. (2002). The teacher and learner interactive assessment system (TeLIAS): A new tool to assess teaching behaviors in the ambulatory setting. Teaching and Learning in Medicine, 14(4), 249–256.

    Article  Google Scholar 

  • Locke, E., & Latham, G. (2002). Building a practically useful theory of goal setting and task motivation: A 35-year odyssey. American Psychologist, 57(9), 705–717.

    Article  Google Scholar 

  • Mann, K., van der Vleuten, C., Eva, K., Armson, H., Chesluk, B., Dornan, T., et al. (2011). Tensions in informed self-assessment: How the desire for feedback and reticence to collect and use it can conflict. Academic Medicine, 86(9), 1120–1127.

    Article  Google Scholar 

  • Molloy, E. K. (2009). Time to Pause: Feedback in Clinical Education. In C. Delaney & E. Molloy (Eds.), Clinical education in the health professions (chap 9). Sydney: Elsevier.

    Google Scholar 

  • Nicol, D., & MacFarlane-Dick, D. (2006). Formative assessment and self-regulated learning: A model and seven principles of good feedback practice. Studies in Higher Education, 31(2), 199–218.

    Article  Google Scholar 

  • Rudolph, J. W., Simon, R., Dufresne, R., & Raemer, D. (2006). There’s no such thing as non-judgmental debriefing: A theory and method for debriefing with good judgment. Simulation in Healthcare, 1(1), 49–55.

    Article  Google Scholar 

  • Sargeant, J., Lockyer, J., Mann, K., Holmboe, E., Silver, I., Armson, H., et al. (2015). Facilitated reflective performance feedback: Developing an evidence- and theory-based model that builds relationship, explores reactions and content, and coaches for performance change (R2C2). Academic Medicine, 90(12), 1698–1706.

    Article  Google Scholar 

  • Silverman, J., Kurtz, S., & Draper, J. (1996). The Calgary-Cambridge approach to communication skills teaching 1: Agenda-led, outcome-based analysis of the consultation. Education for General Practice, 7, 288–299.

    Google Scholar 

  • Telio, S., Ajjawi, R., & Regehr, G. (2015). The ‘educational alliance’ as a framework for reconceptualizing feedback in medical education. Academic Medicine, 90(5), 609–614.

    Article  Google Scholar 

  • Telio, S., Regehr, G., & Ajjawi, R. (in press) Feedback and the educational alliance: Examining credibility judgements and their consequences. Medical Education.

  • Teunisson, P., Stapel, D., Diederik, A., van der Vleuten, C., Scherbier, A., Boor, K., & Scheele, F. (2009). Who wants feedback? An investigation of the variables influencing residents’ feedback-seeking behaviour in relation to night shifts. Academic Medicine, 84(7), 910–917.

    Article  Google Scholar 

  • Voyer, S., & Pratt, D. (2011). Feedback: Much more than a tool. Medical Education, 45(9), 862–864.

    Article  Google Scholar 

  • Watling, C., Driessen, E., van der Vleuten, C., & Lingard, L. (2012). Learning from clinical work: The roles of learning cues and credibility judgements. Medical Education, 46(2), 192–200.

    Article  Google Scholar 

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Correspondence to Laura Farrell.

Appendix: Reflection template

Appendix: Reflection template

Date of encounter:

Date of reflection:

Learner level:

Encounter number:

Where was feedback given:

Description of experience:

What happened?

What contributed to the experience?

What background factors influenced the experience?

What are the key issues for reflection in this experience?


What was I trying to achieve?

Why did I intervene the way I did?

What were the consequences of the action for myself? For the learner?

How did I feel about the experience as it was happening?

How did the learner feel?

How did I know what the learner felt?

Influencing factors:

What internal factors influenced my decision making?

What external factors influenced my decision making?


Action plan:

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Farrell, L., Bourgeois-Law, G., Ajjawi, R. et al. An autoethnographic exploration of the use of goal oriented feedback to enhance brief clinical teaching encounters. Adv in Health Sci Educ 22, 91–104 (2017).

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