Noble Christy, Young Jessica, Brazil Victoria, Krogh Kristian, Molloy Elizabeth
Academy for Medical Education, Medical School The University of Queensland Herston Queensland Australia.
Emergency Department Gold Coast Hospital and Health Service Gold Coast Queensland Australia.
AEM Educ Train. 2023 Jul 30;7(4):e10897. doi: 10.1002/aet2.10897. eCollection 2023 Aug.
Residents in emergency medicine have reported dissatisfaction with feedback. One strategy to improve feedback is to enhance learners' feedback literacy-i.e., capabilities as seekers, processors, and users of performance information. To do this, however, the context in which feedback occurs needs to be understood. We investigated how residents typically engage with feedback in an emergency department, along with the potential opportunities to improve feedback engagement in this context. We used this information to develop a program to improve learners' feedback literacy in context and traced the reported translation to practice.
We conducted a year-long design-based research study informed by agentic feedback principles. Over five cycles in 2019, we interviewed residents and iteratively developed a feedback literacy program. Sixty-six residents participated and data collected included qualitative evaluation surveys ( = 55), educator-written reflections ( = 5), and semistructured interviews with residents ( = 21). Qualitative data were analyzed using framework analysis.
When adopting an agentic stance, residents reported changes to the frequency and tenor of their feedback conversations, rendering the interactions more helpful. Despite reporting overall shifts in their conceptions of feedback, they needed to adjust their feedback engagement depending on changing contextual factors such as workload. These microsocial adjustments suggest their feedback literacy develops through an interdependent process of individual intention for feedback engagement-informed by an agentic stance-and dynamic adjustment in response to the environment.
Resident feedback literacy is profoundly contextualized, so developing feedback literacy in emergency contexts is more nuanced than previously reported. While feedback literacy can be supported through targeted education, our findings raise questions for understanding how emergency medicine environments afford and constrain learner feedback engagement. Our findings also challenge the extent to which this contextual feedback know-how can be "developed" purposefully outside of the everyday work.
急诊医学住院医师表示对反馈不满意。提高反馈效果的一种策略是提升学习者的反馈素养，即作为绩效信息寻求者、处理者和使用者的能力。然而，要做到这一点，需要了解反馈发生的背景。我们调查了住院医师在急诊科通常如何参与反馈，以及在这种背景下改善反馈参与度的潜在机会。我们利用这些信息制定了一个项目，以在实际情境中提高学习者的反馈素养，并追踪所报告的转化情况以应用于实践。
我们进行了一项为期一年的基于设计的研究，以能动反馈原则为指导。在2019年的五个周期中，我们采访了住院医师，并迭代开发了一个反馈素养项目。66名住院医师参与其中，收集的数据包括定性评估调查（n = 55）、教育工作者撰写的反思（n = 5）以及对住院医师的半结构化访谈（n = 21）。定性数据采用框架分析法进行分析。
当采取能动立场时，住院医师报告称他们反馈对话的频率和基调发生了变化，使互动更有帮助。尽管他们报告了对反馈概念的总体转变，但他们需要根据工作量等不断变化的情境因素调整自己的反馈参与度。这些微观社会调整表明，他们的反馈素养是通过一个相互依存的过程发展而来的，这个过程包括由能动立场驱动的个人参与反馈的意图，以及对环境的动态调整。
住院医师的反馈素养具有深刻的情境性，因此在急诊情境中培养反馈素养比之前报道的更为微妙。虽然可以通过有针对性的教育来支持反馈素养，但我们的研究结果引发了一些问题，即如何理解急诊医学环境如何促进和限制学习者的反馈参与。我们的研究结果还对这种情境性反馈技能在日常工作之外有目的地“培养”的程度提出了挑战。
