Abstract
Feedback in medical education is complicated by the multiple contexts within which learning occurs. However, feedback research in medical education has typically focused on information provided by tutors to students with limited exploration of the influence of context. This research seeks to address this gap by exploring the influence of multiple contexts upon feedback processes. Employing video-ethnography methodology we explored feedback in two common contexts for medical student learning: the simulated clinical environment and the medical workplace. Learning and teaching sessions were filmed in each of these contexts, capturing diverse feedback processes. Data were analysed for key themes using a Framework Analysis approach and similarities and differences between the two contexts identified. In total 239 distinct feedback episodes across 28 different teaching and learning sessions were captured, with feedback processes relating to the patient, practice, educational and institutional contexts observed. In this paper, we concentrate on key similarities and differences in feedback processes between the two contexts with respect to six themes: feedback interlocutors, interlocutor positioning, feedback types, feedback foci, feedback styles and feedback milieu. We argue that feedback is inextricably linked to the multiple contexts in which feedback is enacted. It is only by exploring these contextual influences that feedback can be understood more fully. With such understanding we should be better placed to develop interventions capable of improving the long elusive experience of successful feedback.
Similar content being viewed by others
Notes
This is by no means an exhaustive list as the literature on feedback is vast but seeks to provide a few examples of differing perspectives in feedback.
References
Ajjawi, R. (2012). Going beyond ‘received and understood’ as a way of conceptualising feedback. Medical Education, 46, 1018–1019.
Ajjawi, R., Molloy, E., Bearman, M., & Rees, C. E. (2017). Contextual influences on feedback practices: An ecological perspective. In D. Carless, S. M. Bridges, C. K. Y. Chan, & R. Glofcheski (Eds.), Scaling up assessment for learning in higher education (pp. 129–143). Singapore: Springer.
Ajjawi, R., & Rees, C. E. (2012). Theories of Communication. In J. Higgs, R. Ajjawi, L. McAllister, F. Trede, & S. Loftus (Eds.), Communicating in the Health Sciences (3rd ed.). Melbourne: Oxford University Press.
Argyle, M., & Dean, J. (1965). Eye-contact, distance and affiliation. Sociometry, 28(3), 289–302.
Askew, S., & Lodge, C. (2000). Gifts, ping-pong and loops-linking feedback and learning. In S. Askew (Ed.), Feedback for learning. London: Routledge Falmer.
Bates, J., & Ellaway, R. H. (2016). Mapping the dark matter of context: a conceptual scoping review. Medical Education, 50, 807–816.
Becker, H. S., Greer, B., Hughes, E., & Strauss, A. (1961). Boys in White. Chicago: University of Chicago Press.
Blatt, B., Confessore, S., Kallenberg, G., & Greenberg, L. (2008). Verbal interaction analysis: Viewing feedback through a different lens. Teaching and Learning in Medicine, 20, 329–333.
Bloom, B. S. (1956). Taxonomy of educational objectives: The classification of education goals by a committee of college and university examiners. Cambridge: David McKay.
Boud, D., & Molloy, E. (2012). Rethinking models of feedback for learning: the challenge of design. Assessment and Evaluation in Higher Education, 38, 698–712.
Brockner, J., & Chen, Y.-R. (1996). The moderating roles of self-esteem and self-construal in reaction to a threat to the self: Evidence from the People’s Republic of China and the United States. Journal of Personality and Social Psychology, 71, 603–615.
Bulte, C., Betts, A., Gamer, K., & Durning, S. (2007). Student teaching: views of student near-peer teachers and learners. Medical Teacher, 29(6), 583–590.
Burns, E., Fenwick, J., Schmied, V., & Sheehan, A. (2012). Reflexivity in midwifery research: The insider/outsider debate. Midwifery, 28, 52–60.
Cantillon, P., & Sargeant, J. (2008). Giving feedback in clinical settings. British Medical Journal, 337, 1961.
Carless, D., Salter, D., Yang, M., & Lam, J. (2011). Developing sustainable feedback practices. Studies in Higher Education, 36, 395–407.
Cleland, J. A., Knight, L. V., Rees, C. E., Tracey, S., & Bond, C. M. (2008). Is it me or is it them? Factors that influence the passing of underperforming students. Medical Education, 42, 800–809.
Crisp, B. R. (2007). Is it worth the effort? How feedback influences students’ subsequent submission of assessable work. Assessment and Evaluation in Higher Education, 32, 571–581.
Crotty, M. (1998). The foundations of social research: meaning and perspective in the research process. London: Sage Publications.
Dohrenwend, A. (2002). Serving up the feedback sandwich. Family Practice Management, 9, 43.
Dwyer, S. C., & Buckle, J. L. (2009). The space between: On being an insider–outsider in qualitative research. International Journal of Qualitative Methods, 8(1), 54–63.
Ende, J. (1983). Feedback in clinical medical education. JAMA, the Journal of the American Medical Association, 250, 777–781.
Eva, K. W., Armson, H., Holmboe, E., Lockyer, J., Loney, E., Mann, K., et al. (2012). Factors influencing responsiveness to feedback: On the interplay between fear, confidence, and reasoning processes. Advances in Health Sciences Education Theory and Practice, 17, 15–26.
Fanning, R. M., & Gaba, D. M. (2007). The role of debriefing in simulation based learning. Society for Simulation in Healthcare, 2, 115–125.
Gelfand, M J., Erez, M., & Aycan, Z. (2007). Cross cultural organizational behaviour. Annual Review of Psychology, 58, 479–514.
GMC. (2015). GMC: National Training Survey for Doctors [Online]. Available: https://unistats.direct.gov.uk/search/SubjectCode/001/Medicine. Accessed 25 July 2016.
Hafferty, F. W. (1998). Beyond curriculum reform: Confronting medicine’s hidden curriculum. Academic Medicine, 73, 403–407.
Hammersley, M., & Atkinson, P. (2007). Ethnography: Principles in practice. Abingdon: Routledge.
Hattie, J., & Timperley, H. (2007). The power of feedback. Review of Educational Research, 77, 81–112.
Heath, C., & Hindmarsh, J. (2002). Analysing interaction: Video, ethnography and situated conduct. In T. May (Ed.), Qualitative research in action. London: SAGE.
Hewson, M. G., & Little, M. L. (1998). Giving feedback in medical education: Verification of recommended techniques. Journal of General Internal Medicine, 13, 111–116.
Hounsell, D. (2007). Towards more sustainable feedback to students. In D. Boud & N. Falchikov (Eds.), Rethinking assessment in higher education. Abingdon: Routledge.
Iedema, R. A., Jorm, C., Long, D., Braithwaite, J., Travaglia, J., & Westbrook, M. (2006a). Turning the medical gaze in upon itself: Root cause analysis and the investigation of clinical error. Social Science and Medicine, 62, 1605–1615.
Iedema, R., Long, D., & Forsyth, R. (2006b). Visibilising clinical work: Video ethnography in the contemporary hospital. Health Sociology Review, 15, 156–168.
Iedema, R., Mesman, J., & Carroll, K. (2013). Visualising Healthcare practice improvement innovation from within. London: Radcliffe Publishing Ltd.
Kapoor, S., Arora, P., Kapoor, V., Jayachandran, M., & Tiwari, M. (2014). Haptics—touch feedback technology widening the Horizon of medicine. Journal of Clinical and Diagnostic Research JCDR, 8, 294–299.
Kluger, A., & 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.
Kluger, A. N., & Van Dijk, D. (2010). Feedback, the various tasks of the doctor, and the feedforward alternative. Medical Education, 44, 1166–1174.
Knapp, M. L., & Hall, J. A. (2010). The effects of the environment on human communication non verbal communication in human interaction. Boston: Wadsworth.
Krause, K.-L., Hartley, R., James, R., & McInnis, C. (2005). The first year experience in Australian universities: Findings from a decade of national studies. Melbourne: Centre for the Study of Higher Education, University of Melbourne.
Lockspeir, T. M., O’Sullivan, P., Teharani, A., & Muller, J. (2008). Understanding the experience of being taught by peers: The value of social and cognitive congruence. Advances in Health Sciences Education Theory and Practice, 13, 361–372.
Mann, K. V. (2011). Theoretical perspectives in medical education: past experience and future possibilities. Medical Education, 45, 60–68.
Maxwell, J. A. (2010). Using numbers in qualitative research. Qualitative Inquiry, 16, 475–482.
Molloy, E. (2009). Time to pause: Giving and receiving feedback in clinical education. In C. Delany & E. Molloy (Eds.), Clinical Education in the Health Professions. Chatswood: Churchill Livingstone.
Panait, L., Akkary, E., Bell, R. L., Roberts, K. E., Dudrick, S. J., & Duffy, A. J. (2009). The role of haptic feedback in laparoscopic simulation training. The Journal of Surgical Research, 156, 312–316.
Pendleton, D. (1984). The consultation approach to learning and teaching. Oxford: Oxford University Press.
Pink, S. (2001). Doing Visual Ethnography: images, media and representation in research. London: Sage publications.
Price, M., Handley, K., Millar, J., & O’Donovan, B. (2010). Feedback: All that effort but what is the effect? Assessment and Evaluation in Higher Education, 35, 277–289.
Reeves, S., Kuper, A., & Hodges, B. D. (2008). Qualitative research methodologies: Ethnography. British Medical Journal, 337, 512–514.
Ritchie, J., & Spencer, L. (1994). Qualitative analysis for applied policy research. In A. Bryman, & R G. Burgess (Eds.), Analysing qualitative data. London: Routledge.
Rizan, C., Elsey, C., Lemon, T., Grant, A., & Monrouxe, L. V. (2014). Feedback in action within bedside teaching encounters: A video ethnographic study. Medical Education, 48, 902–920.
Sargeant, J., Eva, K W., Armson, H., Chesluk, B., Dornan, T., Holmeboe, E., et al. (2011). Features of assessment learners use to make informed self-assessments of clinical performance. Medical Education, 45, 636–647.
Sargeant, J., Mann, K., Sinclair, D., Van Der Vleuten, C., & Metsemakers, J. (2008). Understanding the influence of emotions and reflection upon multi-source feedback acceptance and use. Advances in Health Sciences Education Theory and Practice, 13, 275–288.
Schofield, S., Nathwani, D., & Anderson, F. (2009). Consultants in Scotland: Survey of educational qualifications, experience and needs of Scottish consultants. Scottish Medical Journal, 54, 25–29.
Sheriff, B. (2001). the ambiguity of boundaries in the fieldwork experience: Establishing rapport and negotiating insider/outsider status. Qualitative Inquiry, 7(4), 436–447.
Shute, V. J. (2008). Focus on formative feedback. Review of Educational Research, 78, 153–189.
Sully De Luque, M. F., & Sommer, S. M. (2000). The impact of culture on feedback-seeking behaviour: An integrated model and propositions. Academy of Management Review, 25, 829–849.
Thurlings, M., Vermeulen, M., Bastiaens, T., & Stijnen, S. (2012). Understanding feedback: A learning theory perspective. Educational Research Review, 9, 1–15.
UNISTATS. (2016). National Student Survey [Online]. Available: https://unistats.direct.gov.uk/search/SubjectCode/001/Medicine. Accessed 25 July 2016.
Urquhart, L. (2015). Exploring the feedback process with medical students and their educators: Listening, watching, understanding. Doctor of Philosophy, University of Dundee.
Urquhart, L. M., Rees, C. E., & Ker, J. S. (2014). Making sense of feedback experiences: A multi-school study of medical students’ narratives. Medical Education, 48, 189–203.
Van De Vliertt, E., Shi, K., Sanders, K., Wang, Y., & Huang, X. (2004). Chinese and Dutch interpretations of supervisory feedback. Journal of Cross Cultural Psychology, 35, 417–435.
Van Dijk, D., & Kluger, A. N. (2004). Feedback sign effect on motivation: Is it moderated by regulatory focus? Applied Psychology An International Review, 53, 113–135.
Veloski, J., Boex, J. R., Grasberger, M. J., Evans, A., & Wolfson, D. B. (2006). Systematic review of the literature on assessment, feedback and physicians’ clinical performance. BEME Guide No. 7. Medical Teacher, 28, 117–128.
Watling, C., Driessen, E., Van Der Vleuten, C. P., & Lingard, L. (2012a). Learning from clinical work: The roles of learning cues and credibility judgements. Medical Education, 46, 192–200.
Watling, C., Driessen, E., Van Der Vleuten, C. P., Vanstone, M., & Lingard, L. (2012b). Understanding responses to feedback: the potential and limitations of regulatory focus theory. Medical Education, 46, 593–603.
Watling, C., Driessen, E., Vleuten, C. P., Vanstone, M., & Lingard, L. (2013). Beyond individualism: Professional culture and its influence on feedback. Medical Education, 47, 585–594.
Zhou, M., Tse, S., Derevianko, A., Jones, D. B., Schwaitzberg, S. D., & Cao, C. G. L. (2012). Effect of haptic feedback in laparoscopic surgery skill acquisition. Surgical Endoscopy, 26, 1128–1134.
Acknowledgements
We thank the leaders of both sites for allowing us to conduct the study in the simulated and workplace settings. We thank all study participants—tutors, students and patients—for allowing us to observe and video the 28 teaching and learning sessions, and for allowing us to share their visual and textual data relating to excerpts.
Author information
Authors and Affiliations
Contributions
All authors contributed to the design, securing ethics approval, analysis and interpretation of data and writing and/or editing the manuscript. LMU collected all data and coded it using Atlas Ti. LMU conducted this study as part of her PhD in Medical Education from the University of Dundee Scotland (completed 2015), and CER was her principal supervisor and JSK the co-supervisor.
Corresponding author
Ethics declarations
Conflicts of interest
None.
Ethical approval
We received ethics approval from the University and NHS Human Research Ethics Committees (these are not named here to protect the anonymity of the study sites and participants).
Rights and permissions
About this article
Cite this article
Urquhart, L.M., Ker, J.S. & Rees, C.E. Exploring the influence of context on feedback at medical school: a video-ethnography study. Adv in Health Sci Educ 23, 159–186 (2018). https://doi.org/10.1007/s10459-017-9781-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10459-017-9781-2