Identity matters - perceptions of inter-professional feedback in the context of workplace-based assessment in Diabetology training: a qualitative study

Abstract

Background: Inter-professional collaboration is acknowledged as essential for quality patient-care. However, little is known about receptiveness to inter-professional feedback in the postgraduate training. This study explores, in light of social identity theory, the perceptions of residents, supervising physicians and allied health care professionals regarding inter-professional feedback in the context of workplace-based assessment. Methods: For 6 months, residents in Diabetology at the University Hospital of Bern performed formative workplace-based assessments under direct observation of a supervising physician and an allied health care professional. Feedback from both observers was given to the resident after every assessment. Subsequently, focus group discussions were conducted to collect the participants' perceptions of inter-and intra-professional feedback. Transcripts were analyzed qualitatively using a thematic analysis approach. Results: We identified four main themes: (1) Identity and hierarchy; (2) Interdependence of feedback source and feedback content; (3) Impact on collaboration and patient-care; (4) Logistical and organizational requirements. While different social identities are the source of inter-professional hierarchies, they did not impede the receptiveness to feedback. Perceived trustworthiness of the feedback was attributed with more importance than professional affiliations, whereas intra-professional hierarchies between physicians led to the perception of a more summative nature of the feedback and rather impeded receptiveness. According to the participants, inter-professional feedback raised awareness of the working reality of other team members and had a positive impact on communication between the different professional groups. Moreover, participants reported positive response from patients regarding the inter-professional collaboration they experienced. Considerable organizational effort is required to enable the parallel observation of a resident's consultation by a supervising physician and an allied health care professional. Conclusions: Feedback from allied health care professionals can be a valuable learning resource for residents, given its role outside the sometimes conflicting area of intra-professional hierarchies. Inter-professional feedback in the context of workplace-based assessment carries the potential to strengthen collaboration between the different professional groups.

How workplace‐based assessments guide learning in postgraduate education: A scoping review

“…As this stands, it is critical that both supervisors and trainees using WBAs share an understanding of the workflow and purpose of these tools. Given that WBAs have begun to serve a dual purpose (formative or for‐learning versus summative or of‐learning ), 11 there remains an understandable lack of clarity of purpose from the perspective of both trainees and supervisors 7–9,49,50,56,57 . The diversity of understanding regarding the purpose of WBAs has been shown to go beyond the perception of the dual ‘summative versus formative’ purpose.…”

Understanding Feedback for Learners in Interprofessional Settings: A Scoping Review

“…In another study, residents were found to actively contemplate the feedback they received based on their judgments of the feedback provider’s clinical credibility and their relationship with that feedback provider [ 24 ]. Similarly, another article found that identity and hierarchy is a significant theme in the feedback process, with social identities being the source of these interprofessional hierarchies [ 25 ]. In that article, residents valued interprofessional feedback and had a positive attitude toward it.…”

“… The sampling strategy, a limited number of participants and a focus on psychiatry residents may have affected the validity of the results. Feller and Berendonk [ 25 ] 2020 Switzerland The objective was to explore the perspectives of interprofessional feedback in the context of workplace-based assessment. 7 residents, 7 supervising physicians, and 9 allied healthcare professionals (4 diabetes nurses, 3 nutritionists and 2 psychologists) The study used a qualitative approach based on grounded theory.…”

The personal dimension of allied health professional identity: A scoping review in health sciences literature / Die persönliche Dimension der beruflichen Identität von Gesundheitsfachkräften: ein Scoping-Review in der gesundheitswissenschaftlichen Literatur

“…In spite of widespread research into professional identity (Burford et al, 2014;Feller & Berendonk, 2020;Fitzgerald, 2020;Goldie, 2012;Kwakman & Schilder, 2005;Monrouxe & Rees, 2017;Rees & Monrouxe, 2018;Ruijters, 2015), the multilayered and multidiscoursal nature of the subject makes it difficult to define professional identity in a straightforward way. According to Beijaard et al (2004), Trede et al (2012), andFitzgerald (2020), a clear definition of professional identity is missing because of the multi-discoursal nature of the subject.…”