1. Can specialised feedback enhance future learning strategies?
Mr Billy Bryan1
, Prof. Deborah Murdoch-Eaton1
, Dr Denise Bee1
, and Prof. John Sandars1
1
Academic unit of Medical Education, The University of Sheffield, UK
Contact: bjbryan1@sheffield.ac.uk, d.murdoch-eaton@sheffield.ac.uk, d.bee@sheffield.ac.uk, j.e.sandars@sheffield.ac.uk
Introduction and Background
How learners recognise, understand, and implement feedback is a hot topic in medical education.
Very little is known about what kind of feedback improves learning strategies. Expert reviewers1
recommend that feedback should aim to improve Self Regulated Learning (SRL). SRL in medical
education is the cyclical control of academic and clinical performance using targeted strategies to
achieve a desired goal2
(fig 1). Medical practitioners who are proficient self-regulators are able to
effectively critique and adjust their own clinical performance in real time3
.
However, another large review found that clini-
cal skills instructors typically do not support
the development of student’s SRL during su-
pervised practice4
.
New evidence from multiple fields suggest that
feedback informed by SRL concepts may have a
more positive impact compared to traditional
models of feedback. Giving feedback using
methods such as microanalysis can help to im-
prove clinical performance5
, potentially leading
to increased patient safety and long-term
learning strategies.
This study will be the first to explicitly use SRL informed feedback to attempt to improve students’
SRL behaviours and skills performance in authentic medical teaching settings.
Results
Surveys
Statistical analysis of the SRL survey re-
sponses before/after revealed that stu-
dents in the SRL feedback group im-
proved their scores significantly,
whereas scores in the BPF group signifi-
cantly decreased.
Methods
A mixed methods cohort comparison study was conducted in which undergraduate medical stu-
dents (n=171) completed two SRL surveys (SSRQ and GSE) before and after random allocation to
either an SRL feedback group (n=107) or a best practice feedback group (n=64) in a clinical skills
programme (venepuncture and catheterisation).
Two Feedback Methods
All clinical educators (n=14) attended best-practice feedback (BPF) training. Half (n=7) of these
clinical educators were then randomly allocated to SRL feedback group where tutors were
trained to use a questioning technique called microanalysis. This identifies and rectifies weak
SRL behaviours with specialised feedback (fig 2.). The other half (n=7) formed the BPF group.
Tutor Interviews
Thirteen out of fourteen clinical skills tutors agreed to be interviewed. These interviews were
semi-structured in nature and followed a topic guide which aimed to qualitatively evaluate the
educator’s experiences.
Video recording
All sessions were videoed using pre-existing class video technology. This enabled the researcher
to be a ‘fly on the wall’ and observe how each educator used the techniques and how students
reacted to them. A sample of recordings were analysed in-depth by the researcher to ensure fi-
delity. This way we know that students got feedback and also how they got feedback.
Future Work and Study Implications
We will soon be collecting more data from students while they are on their first placement to see
whether the feedback has made a lasting impact in a real-world medical context. The results of
this study may identify short and long-term benefits of combining feedback and SRL and lead to
creating models of enhanced feedback impact in other areas of medical education.
The findings from this study will also inform future research in the SRL and feedback fields, and
will also serve to inform future SRL interventions using feedback.
Acknowledgements
I would like to thank the staff and students who took part in this study and others who supported in the data col-
lection within the medical education department. I would also like to thank my supervisors for their support and
guidance.
References
1. HATTIE, John and TIMPERLEY, Helen (2007). The power of feedback. Review of educational research, 77 (1), 81-112.
2. SANDARS, John and PATEL, Rakesh (2015). Self-regulated learning: the challenge of learning in clinical settings. Medical education, 49 (6), 554-555.
3. CLEARY, Timothy J., et al. (2014). Examining shifts in medical students’ microanalytic motivation beliefs and regulatory processes during a diagnostic reasoning task. Ad-
vances in health sciences education, 1-16.
4. BRYDGES, Ryan, et al. (2015). Self-regulated learning in simulation-based training: a systematic review and meta-analysis. Medical education, 49 (4), 368-378.
5. CLEARY, Timothy J., et al. (2016) Microanalytic Assessment of Self-Regulated Learning During Clinical Reasoning Tasks: Recent Developments and Next Steps. Academic
Medicine. (volume, issue, pages not named).
Conclusions
These findings indicate that the SRL feedback model is effective in improving SRL for students and
is perceived to be efficacious for the tutors using it. It is also clear that the conceptions of feed-
back and background of tutors are major influencers in how tutors deliver these feedback models
in authentic settings.
Hypothesis/aims
The purpose of this PhD project is to explore the impact of an SRL model to improve feedback im-
pact and learning strategies for medical undergraduates in clinical skills training. It is hypothesised
that students improve their learning strategies and feedback recognition by receiving an SRL
feedback intervention compared to usual “best practice” feedback.
Figure 1. The three phase cyclical model of self-regulatory learning, adapted
from Cleary et al. (2014).
Figure 2. The SRL microanalysis feedback model.
Condition
GSE
1st round
GSE
2nd round
SSRQ
1st round
SSRQ
2nd round
BPF
Mean 30.94 23.19 117.47 84.86
Std. D
3.207 7.536 12.071 31.616
SRL
Mean 30.73 33.96 115.83 130.40
Std.
3.164 4.489 12.025 20.020
Tutor Interviews - Thematic Analysis
Initial themes Initial categories Refined categories Final themes Core concepts
Personal perceptions of feed-
back and teaching practice
Previous feedback experiences
Teaching background
Previous feedback training
Previous knowledge of SRL and/or BPF
Sporting experiences
Ward teaching experiences
The type of feedback
Feedback seeking
Feedback training
Perfect feedback situation
Personal philosophy on feedback
Feedback giving practices
Previous experiences affecting
practice
What feedback is like in clinical
skills education
Pressures on giving feedback
Enablers for feedback
Factors affecting perceptions and beliefs
about feedback in clinical teaching and
learning
Factors affecting feedback giving
(affordances - help and hinder)
Satisfaction of use - technique
Educator's reflections and plans for fu-
ture practice
Contradictions and differences in experi-
ence, background, and role impacting
upon practice
Conceptions of feedback
which inform/influence
practice
Educator response to the feed-
back techniques
Level of comfort using feedback
Challenges in using the techniques
Contextual relevance
Learner reactions
Peer support in teaching
Modifications, adherence and use over
time
Training and data collection
Perceived ease of use
Acceptability
Usefulness
Effects of the study process
Perceived learner response
Impact of the feedback
techniques on current and
future practice
Making sense of the techniques
The
Medical
School
Before
Before
After
After
Figure 3. A thematic chart of the qualitative interview data collected from the clinical skills tutors