McDonald Jenny, Tobin Stephen, Parsons Carl, Joyce Caroline
School of Medicine, Western Sydney University, Penrith, New South Wales, Australia.
New Medical Education Pty Ltd, Hamilton, Queensland, Australia.
Clin Teach. 2025 Feb;22(1):e13837. doi: 10.1111/tct.13837. Epub 2024 Nov 6.
Entrustable professional activities (EPAs) are used to support clinical skills training by providing a scaffold for practice and feedback. The aim of this study was to evaluate how written feedback provided for EPAs supports medical students' learning.
The written feedback for two EPAs (admit or consult patient and discharge summary) was analysed using a mixed methods approach. Content analysis determined the types of feedback received. Qualitative analysis identified themes related to the feedback quality. Hattie and Timperley's feedback model that provides a framework for effective feedback was used as an interpretive lens for our analysis and integrated findings.
Written feedback was provided for 89.5% of 997 EPAs. The proportions of feedback types to support learning were as follows: feedback related to what was done well (75.6%), areas for improvement (27.7%) and next steps (17.4%). Only 10% of EPAs received all three types of feedback. EPAs completed independently were more likely to receive any feedback. Feedback for supervised EPAs was more likely to include areas for improvement or next steps. Qualitative analysis identified two themes: effective feedback for present and future performance with detailed description of performance or targeted advice, and lack of specific guidance for improvement with affirmative statements or non-specific directions.
EPAs most often elicited feedback about what is done well without areas or strategies for improvement. Descriptive feedback and tailored advice are ideal, but uncommon. Students and supervisors need guidance on how to optimise feedback through instruction and EPA form design.
可托付专业活动（EPA）通过提供实践和反馈的框架来支持临床技能培训。本研究的目的是评估为EPA提供的书面反馈如何支持医学生的学习。
采用混合方法分析了两个EPA（收治或会诊患者以及出院小结）的书面反馈。内容分析确定了收到的反馈类型。定性分析确定了与反馈质量相关的主题。哈蒂和廷珀利的反馈模型为有效反馈提供了一个框架，被用作我们分析和整合研究结果的解释视角。
997项EPA中有89.5%收到了书面反馈。支持学习的反馈类型比例如下：与做得好的方面相关的反馈（75.6%）、改进领域（27.7%）和下一步措施（17.4%）。只有10%的EPA收到了所有三种类型的反馈。独立完成的EPA更有可能收到任何反馈。对有监督的EPA的反馈更有可能包括改进领域或下一步措施。定性分析确定了两个主题：对当前和未来表现的有效反馈，包括对表现的详细描述或针对性建议，以及缺乏具体的改进指导，只有肯定性陈述或非特定方向。
EPA最常引发的反馈是关于做得好的方面，而没有改进的领域或策略。描述性反馈和量身定制的建议是理想的，但并不常见。学生和导师需要通过指导和EPA表格设计来了解如何优化反馈。
