Ajjawi Rola, Bearman Margaret, Molloy Elizabeth, Noble Christy
Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, VIC, Australia.
Department of Medical Education, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
Front Med (Lausanne). 2023 Apr 25;10:1121602. doi: 10.3389/fmed.2023.1121602. eCollection 2023.
Underperformance in clinical environments can be costly and emotional for all stakeholders. Feedback is an important pedagogical strategy for working with underperformance - both formal and informal strategies can make a difference. Feedback is a typical feature of remediation programs, and yet there is little consensus on how feedback should unfold in the context of underperformance.
This narrative review synthesises literature at the intersections of feedback and underperformance in clinical environments where service, learning and safety need to be considered. We do so with a critical eye towards generating insights for working with underperformance in the clinical environment.
There are compounding and multi-level factors that contribute to underperformance and subsequent failure. This complexity overwrites simplistic notions of 'earned' failure through individual traits and deficit. Working with such complexity requires feedback that goes beyond educator input or 'telling'. When we shift beyond feedback as input to process, we recognise that these processes are fundamentally relational, where trust and safety are necessary for trainees to share their weaknesses and doubts. Emotions are always present and they signal action. Feedback literacy might help us consider how to engage trainees with feedback so that they take an active (autonomous) role in developing their evaluative judgements. Finally, feedback cultures can be influential and take effort to shift if at all. A key mechanism running through all these considerations of feedback is enabling internal motivation, and creating conditions for trainees to feel relatedness, competence and autonomy. Broadening our perceptions of feedback, beyond telling, might help create environments for learning to flourish.
在临床环境中表现不佳对所有利益相关者来说可能代价高昂且令人情绪低落。反馈是应对表现不佳的一项重要教学策略——正式和非正式策略都能发挥作用。反馈是补救计划的一个典型特征，然而对于在表现不佳的情况下应如何进行反馈，几乎没有达成共识。
本叙述性综述综合了临床环境中反馈与表现不佳交叉领域的文献，在这些环境中需要考虑服务、学习和安全。我们以批判性的眼光进行综述，旨在为应对临床环境中的表现不佳生成见解。
导致表现不佳及随后失败的因素是复杂且多层次的。这种复杂性推翻了通过个体特质和缺陷来解释“应得”失败的简单观念。应对这种复杂性需要超越教育者的输入或“告知”的反馈。当我们从将反馈视为输入转向视为过程时，我们认识到这些过程从根本上说是关系性的，信任和安全感是学员分享其弱点和疑虑所必需的。情绪始终存在，并且它们预示着行动。反馈素养或许能帮助我们思考如何让学员参与反馈，以便他们在形成评价性判断时发挥积极（自主）作用。最后，反馈文化可能具有影响力，而且若要转变则需要付出努力。贯穿所有这些反馈考量的一个关键机制是激发内在动力，并为学员创造能感受到关联性、能力和自主性的条件。拓宽我们对反馈的认知，超越“告知”，可能有助于营造促进学习蓬勃发展的环境。
