Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Med Educ. 2012 Feb;46(2):201-15. doi: 10.1111/j.1365-2923.2011.04137.x.
Performance-based workplace assessments are increasingly important in clinical training. Given the inaccuracy of self-assessment, the provision of external feedback to residents about their clinical skills is necessary for the development of expertise. However, little is known about the processes used by faculty members in giving feedback to residents after observing them with patients. This study explores the factors that underpin faculty members' decisions regarding the feedback they give to residents after directly observing them with patients and the factors that influence how feedback is delivered.
In 2009, 44 general internal medicine faculty staff responsible for out-patient resident teaching from 16 internal medicine residency programmes watched four videotaped scenarios and two live scenarios of standardised residents (SRs) with standardised patients and rated the SRs using the mini-clinical evaluation exercise (mini-CEX) format. Faculty staff also provided feedback to the SRs after the live encounters. After each encounter, faculty staff were individually interviewed using a semi-structured interview. Interviews were videotaped, transcribed and analysed using grounded theory methods.
Two broad themes were identified in faculty members' descriptions of the feedback process: variability in feedback techniques, and the factors that influence how faculty staff think and feel about delivering feedback. Multiple approaches to feedback delivery were observed. Faculty members' tensions in balancing positive and negative feedback, their own perceived self-efficacy, their perceptions of the resident's insight, receptivity, skill and potential, the faculty member-resident relationship and contextual factors impacted the feedback process.
The provision of feedback by faculty staff to residents after observing resident-patient interactions is a complex and dynamic process and is influenced by many factors. Understanding these cognitive and affective factors may provide insight into potential new approaches to faculty development to improve faculty staff's feedback skills and the effectiveness of their feedback.
基于表现的工作场所评估在临床培训中变得越来越重要。鉴于自我评估的不准确性，为了专业知识的发展，有必要向住院医师提供有关其临床技能的外部反馈。但是，对于在观察住院医师与患者互动后，教职员工提供反馈的过程知之甚少。这项研究探讨了教职员工在直接观察住院医师与患者互动后，决定提供哪些反馈的依据因素以及影响反馈方式的因素。
2009 年，来自 16 个内科住院医师培训计划的 44 名负责门诊住院医师教学的普通内科教职员工观看了四个录像情景和两个标准住院医师（SR）与标准化患者的现场情景，并使用迷你临床评估练习（mini-CEX）格式对 SR 进行了评分。教职员工还在现场互动后向 SR 提供了反馈。每次互动后，教职员工都使用半结构化访谈进行了单独访谈。使用扎根理论方法对访谈进行了录像、转录和分析。
教职员工在描述反馈过程时确定了两个广泛的主题：反馈技术的多样性，以及影响教职员工思考和提供反馈方式的因素。观察到了多种反馈方式。教职员工在平衡积极和消极反馈方面的紧张情绪，他们自己的自我效能感，他们对住院医师的洞察力，接受度，技能和潜力的看法，教职员工与住院医师的关系以及背景因素都影响了反馈过程。
教职员工在观察住院医师与患者互动后向住院医师提供反馈是一个复杂而动态的过程，受到许多因素的影响。了解这些认知和情感因素可能会为提高教职员工反馈技能和反馈效果的教职员工发展提供新的方法。
