What problems were addressed?  Critical reflection, a skill necessary for lifelong learning, requires the practice of self-assessment informed by external feedback to develop a plan for improvement. We hypothesised that students who performed self-assessments and received faculty staff feedback on targeted communication skills would improve in this area.

Medical schools conduct Clinical Skills Assessments (CSAs) in which students can practise clinical skills, including communication skills. However, schools face the ongoing challenge of providing students with timely and meaningful feedback following each CSA experience in order to help them improve their communication skills over time. Our intervention incorporated a structured reflection process that allowed students to self-assess their CSA performance and receive faculty staff feedback. We assumed that this process would stimulate students to identify their strengths and weaknesses, recognise inconsistencies between the feedback and their self-perceptions, and make plans for improving their skills.

What was tried?  This study sought to determine the impact of structured feedback associated with the communication skills CSA. Prior to the implementation of this study, Year 1 students (MS1) completed a doctor–patient communication skills course. A new CSA was introduced to the MS1 class (control group = 143), and a small subset of 47 students identified for this study viewed recordings of their patient encounters, completed a self-assessment and received faculty staff and standardised patient (SP) feedback. Online delivery expedited the faculty staff feedback process.

The study’s feedback process closely mirrored the four-step model of formative feedback.1 Each participant viewed a video-recording of his or her encounter and completed an online self-assessment (step 1: assessment of performance). Next, faculty volunteers concurrently reviewed the recordings and provided specific feedback on four targeted communication skills: starting the interview; gaining the patient’s perspective; demonstrating empathy, and completing the visit.

Within 1 week, students retrieved the online faculty feedback (step 2: provision of assessment feedback). Students reflected on their self-assessment and the faculty staff comments (step 3: reflection and decision making). Three months later, MS1s completed a post-intervention CSA that gave them the opportunity to demonstrate improvement (step 4: use of feedback for learning and change).

The resources needed for this institutional review board-approved study included faculty time, an online evaluation tool, and a simulation centre with videotaping capabilities.

What lessons were learned?  Baseline performance was similar between the intervention and control groups in overall SP mean scores (p = 0.71). Post-intervention scores were similar (p = 0.66). In a post hoc analysis, we found students were more critical of their own performances compared with evaluations provided by SPs or faculty staff, specifically with regard to starting and ending the interview. Qualitative analysis of comments supported this finding.

We infer that students did not improve for two main reasons. Firstly, students had limited opportunities to practise their skills (i.e. 3 months between CSAs). More importantly, students received no instruction for critical reflection. Our study incorporated the first steps of the feedback model, but later steps, defining and implementing an improvement plan based on feedback, did not occur. This is an essential part of the feedback process that, as educators, we cannot assume occurs without explicit guidance.


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