Feedback, assessments and more…

What is feedback in clinical education? van de Ridder JM, Stokking KM, McGaghie WC, ten CateOTJ.  Medical Education 2008; 42:189-97

The purpose of the research is to establish an operational definition of “feedback” for purposes of research and improved communication.  The authors reviewed the general, social science and medical education literature for conceptual formulations of and approaches to feedback.   Three concepts dominating definitions of feedback in the literature are:  feedback as information, feedback as a reaction, and feedback as a cycle.

The authors construct a definition of feedback in clinical education as “Specific information about the comparison between a trainee’s observed performance and a standard, given with the intent to improve the trainee’s performance.

Looking at the elements of this definition allows one to categorize feedback as week or strong (this is different from effective or ineffective).  Strong feedback, for example, includes specific information gleaned from observations of tasks or elements for which there is an explicit standard.  It derives from personal observation by experts with the aim of performance improvement.

This paper was published 7 years ago.  During that time the feedback attributes defined as “strong” have become the foundation of how we think about performance feedback in simulation.

So that’s STRONG feedback.  And effective feedback has to be strong, but strong feedback is not necessarily effective.  What’s the difference?

Linking Simulation Based Educational Assessments and Patient Related Outcomes: A systematic review and meta-analysis. Brydges R, et al. Acad Med 2015:90:246-256

First review of its kind trying to evaluate the evidence linking educational surrogates with corresponding assessments in the workplace — looking to examine the relationship between simulation based and patient related assessments — and furthermore if there is validity evidence for these outcomes, and what is the quality of methods and reporting in this body of research.

Almost 12 thousand articles screened, only 33 included in the review; these articles in total included 1203 participants. Patient related outcomes defined as provider behaviors and patient outcomes.

This is a long article.. If I think about what the message is – there seems to be suggestion that provider behaviors and time behaviors and patient outcomes each to varying degrees (higher to lower respectively) correlate with simulation outcomes. However – there are multiple instruments used to define/rate simulation outcomes and not all of these are validated.

Concerns from the writers about publication bias for the results – but no real way to exclude this…

Future ideas – contain recommendations to work these educational trials like we would drug trials, about consistency in ratings/assessment, sample sizes, etc.