Identifying educator behaviours for high quality verbal feedback in health professions education: literature review and expert refinement

Abstract

BackgroundHealth professions education is characterised by work-based learning and relies on effective verbal feedback. However the literature reports problems in feedback practice, including lack of both learner engagement and explicit strategies for improving performance. It is not clear what constitutes high quality, learner-centred feedback or how educators can promote it. We hoped to enhance feedback in clinical practice by distinguishing the elements of an educator’s role in feedback considered to influence learner outcomes, then develop descriptions of observable educator behaviours that exemplify them.MethodsAn extensive literature review was conducted to identify i) information substantiating specific components of an educator’s role in feedback asserted to have an important influence on learner outcomes and ii) verbal feedback instruments in health professions education, that may describe important educator activities in effective feedback. This information was used to construct a list of elements thought to be important in effective feedback. Based on these elements, descriptions of observable educator behaviours that represent effective feedback were developed and refined during three rounds of a Delphi process and a face-to-face meeting with experts across the health professions and education.ResultsThe review identified more than 170 relevant articles (involving health professions, education, psychology and business literature) and ten verbal feedback instruments in health professions education (plus modified versions). Eighteen distinct elements of an educator’s role in effective feedback were delineated. Twenty five descriptions of educator behaviours that align with the elements were ratified by the expert panel.ConclusionsThis research clarifies the distinct elements of an educator’s role in feedback considered to enhance learner outcomes. The corresponding set of observable educator behaviours aim to describe how an educator could engage, motivate and enable a learner to improve. This creates the foundation for developing a method to systematically evaluate the impact of verbal feedback on learner performance.

Avaliação Formativa Sob a Ótica Do Tutor

“…Johnson et al 13 , ao revisarem a literatura, também identificaram desconforto durante o processo avaliativo, quando professores referiram medo de afetar a autoestima do aluno e desencadear uma resposta defensiva, prejudicando a relação. Isto os leva, muitas vezes, a considerarem-se malvados.…”

“…Considerando-se as estratégias utilizadas pelo tutor outro ponto fundamental, Johnson et al 13 buscaram identificar alguns comportamentos que podem diminuir o potencial da avaliação. Destacam a realização de observações não específicas, com comentários do tipo "você foi muito bem" ou "você precisa melhorar um pouco", sem apontar o que foi feito corretamente e o que precisa ser melhorado; a não elaboração de plano de melhoria; a não estimulação da participação ativa do aluno, ao fazer observações e recomendações através de monólogos, dando pouco espaço para falas e perguntas do aluno, não valorizando a autoavaliação e não colaborando para que participem ativamente das decisões.…”

“…É fundamental usar um tom respeitoso, de suporte, além de buscar compreender as possíveis razões para estas dificuldades 13,23 . É importante que se procure conhecer o aluno, sua personalidade e seu temperamento 16 e que se esteja atento às reações emocionais despertadas pelo feedback.…”

“…Já para alunos menos desenvolvidos, é provável que seja necessário fornecer orientações específicas 12 . As medidas definidas pelo aluno serão reforçadas ou modificadas pelo professor, de acordo com a necessidade, até que, juntos, possam elaborar um plano de ação para atingir os resultados desejados 13 . A maioria dos tutores refere avaliar o aluno de forma contínua e progressiva, pontuando a sua evolução (94,29%).…”

Co-constructing Simulations with Learners: Roles, Responsibilities, and Impact

“…Given the level of the learners and the potential to not be aware of what they need to know for entry-level practice (Eva, Cunnington, Reiter, Keane, & Norman, 2004), the role of the instructor was to ensure content and skill expectations were practice ready. In addition, the instructor was prepared to engage, motivate, and support the learner during feedback interactions (Johnson et al, 2016).…”