Clinical learning in the context of uncertainty: a multi-center survey of emergency department residents’ and attending physicians’ perceptions of clinical feedback

Abstract

Background Feedback is an essential part of clinical teaching and learning, yet it is often perceived as unsatisfactory in busy clinical settings. Clinical teachers need to balance the competing demands of clinical duty and feedback provision. The influence of the clinical environment and the mutual relationship between feedback giving and seeking has been inadequately investigated. This study therefore aimed to quantify the adequacy, perceptions, and influential factors of feedback provision during resident training in emergency departments (EDs). Methods A multicenter online questionnaire study was undertaken. The respondents comprised ED residents and clinical teachers from four teaching hospitals in Taiwan. The questionnaire was developed via an expert panel, and a pilot study ensured validity. Ninety clinical teachers and 54 residents participated. Results The respondents reported that the majority of feedback, which usually lasted 1–5 min, was initiated by the clinical teachers. Feedback satisfaction was significantly lower for the clinical teachers than for the residents (clinical teachers M = 13.8, SD = 1.83; residents M = 15.3, SD = 2.14; p < 0.0001), and positive feedback was provided infrequently in clinical settings (31.1%). Both groups of participants admitted hesitating between providing/seeking feedback and completing clinical work. Being busy, the teachers’ clinical abilities, the learners’ attitudes, and the relationship between both parties were reported as the most influential factors in feedback provision. Conclusion ED clinical feedback provision is often short, circumstantial, and initiated by clinical teachers. Providing or seeking feedback appears to be an important part of clinical learning in the context of uncertainty. The importance of the relationship between the feedback seeker and the provider highlights the interactive, reciprocal nature of clinical feedback provision. Electronic supplementary material The online version of this article (10.1186/s12909-019-1597-8) contains supplementary material, which is available to authorized users.

Junior doctor perceptions of education and feedback on ward rounds

“…Enabling these behaviours and facilitating feedback is challenging in a busy clinical context, such as ward rounds, where there is tension between service and delivery of effective education. In emergency departments in Taiwan more than half of both staff and trainees reported struggling with the work‐learning tension, and almost three quarters of staff forgot to give feedback due to clinical demands 16 . Both cohorts reported relatively infrequent and brief feedback, that was mostly focused on critique, rather than on positive reinforcement of performance, similar to the lived experience of our trainees.…”

“…In emergency departments in Taiwan more than half of both staff and trainees reported struggling with the work-learning tension, and almost three quarters of staff forgot to give feedback due to clinical demands. 16 Both cohorts reported relatively infrequent and brief feedback, that was mostly focused on critique, rather than on positive reinforcement of performance, similar to the lived experience of our trainees. This leads to feedback avoidance.…”

“…Both cohorts reported relatively infrequent and brief feedback, that was mostly focused on critique, rather than on positive reinforcement of performance, similar to the lived experience of our trainees. This leads to feedback avoidance 16,17 . Feedback and teaching skills can be improved through educational intervention 18,19 .…”

“…This leads to feedback avoidance. 16,17 Feedback and teaching skills can be improved through educational intervention. 18,19 A randomised control trial of anaesthetic faculty using an educational intervention based on the advocacy-inquiry method demonstrated improved feedback quality, higher psychological safety and increased frequency of addressing difficult issues (professionalism) in a simulated scenario.…”

Evolution of Reactions to Uncertainty Among Residents During a Clinical Rotation

“…28 However, it is encouraging that first-year residents felt more able to disclose mistakes to physicians at the end of the clinical rotation, as disclosure allows feedback which is an important part of clinical learning in the context of uncertainty. 29…”