Kwang Cham¹
Elizabeth Molloy¹, Anu Polster², David Steed1 and Anna Ryan¹
1 The University of Melbourne
2 La Trobe University

Feedback on procedural/clinical skills is essential for healthcare student skill development. Historically, the culture of assessment environments privileges assessors as providing judgement of student performance, and student self-assessment or reflection on performance during or immediately after a task is neither supported nor encouraged.(1) Yet self-assessment is recognised as being an important component of ongoing improvement in professional practice. Clearly traditional assessor-driven feedback approaches are not supporting our students to develop the kind of workplace-based behaviours expected of them in the future. 

We situated student self-reflection and dialogue with assessors in the ‘here and now’ and within constraints of current assessment conditions. Students across three health professions performed two formative simulated clinical assessment tasks, engaged in purposeful feedback conversation with assessors (including prompting for their own self-assessment), and then developed a learning plan for future learning. We aimed to understand if this approach was feasible, as well as impact on students’ learning experience. 

A total of 46 students and 12 assessors from Medicine, Dentistry and Optometry participated in the study. 41 learning plans were submitted. Focus groups were conducted with students and assessors to capture the experience of the intervention. 

Discussion: 

This study explores the feasibility of this assessment approach and whether students found value in ‘real time’ feedback dialogues that directed students to exercise their evaluative judgement. Initial observations suggest that students found the experience useful but may not have the resilience to digest negative feedback between tasks and recover to perform the next task. Assessors were cautious about the practicality of such an approach, and also pondered if the dialogue might negatively impact learning and performance at the next task station. 

The balance between authentic assessment, meaningful student learning and the demand and feasibility of such an assessment approach may be challenging. 

1. Chong L, Taylor S, Haywood M, Adelstein BA, Shulruf B. The sights and insights of examiners in objective structured clinical examinations. J Educ Eval Health Prof. 2017;27;14:34. 

Muirne Spooner¹
Teresa Pawlikowska¹
1 Royal College of Surgeons in Ireland University of Medicine and Health Sciences 

Research differs on how feedback-seeking behaviours (FSB) develop during training. Medical student migration and programme internationalisation. have implications for how Western- derived educational practices affect diverse learner populations (2). Exploring undergraduate activity using a validated model of FSB(1) may give insight into how FSB evolves and the influence of situational factors such as nationality and site of study. Our findings seek to inform medical school processes that support feedback literacy. 

Using a mixed methods approach, we collected questionnaire and interview data from final- yearmedicalstudentsinIreland,BahrainandMalaysia. Avalidatedquestionnaireinvestigated relationships with FSB and goal orientation, leadership style preference, and perceived costs and benefits. Interviews with the same student population explored their FSB experiences in clinical practice, qualitatively, enriching this data. Data were integrated using the “following the thread” technique 

Of 514 students, 325 completed questionnaires, 57 participated in interviews. Learning goal orientation (LGO), instrumental leadership and supportive leadership related positively to perceived feedback benefits. (0.23, 0.2 and 0.31, respectively, P<0.05). Perceived feedback benefits related positively to Feedback Monitoring and Inquiry (0.13 and 0.38, respectively, P<0.05). While unsupported in quantitative data, personal costs were a strong theme in interviews, as were feedback avoidance, peer feedback and unsupportive learning environment. There were no differences in sub-groups based on gender, study site or student nationality. Integrated analysis uncovered 3 themes: avoiding “unsafe” feedback (first, do no harm), overcoming barriers (beat the system) and goal-centred curation (shop around) in FSB. 

Diverse students at culturally distinct sites share FSBs. They carefully navigate feedback- seeking, as a valued but risky business, that is highly contextualised. 

Conclusion

Promoting constructive FSB is complex. Overcoming outdated theory and practices on the wards remains a challenge to psychologically safe, learner-centred feedback. Postgraduate models to support feedback need adapting for undergraduate contexts. 

References (maximum three) 

1. Teunissen, Pim W, Stapel, Diederik A, van der Vleuten, Cees, Scherpbier, Albert, Boor, Klarke, & Scheele, Fedde. (2009). Who wants feedback? An investigation of the variables influencing residents’ feedback-seeking behavior in relation to night shifts. Academic Medicine, 84(7), 910-917 

2. Brouwer, Emmaline, Driessen, Erik, Mamat, Norul Hidayah, Nadarajah, Vishna Devi, Somodi, Klara, & Frambach, Janneke. (2020). Educating universal professionals or global physicians? A multi-centre study of international medical programmes design. Medical Teacher, 42(2), 221-227. 

Muirne Spooner¹
Teresa Pawlikowska¹
1 Royal College of Surgeons in Ireland University of Medicine and Health Sciences 

Feedback is well recognised as influencing academic achievement (1). Factors which influence learner responses to feedback are well described(2,3). The processes by which feedback affects learners’ subsequent internal processing is less well researched. This review maps what is known of how learners interact with feedback through the lens of self-regulatory learning theory, to better understand how feedback affects learning strategies, and explore enhancing and inhibiting factors. 

Pilot searching indicated heterogeneous study designs, prompting choice of scoping methodology. Inclusion criteria comprised: i) learners (undergraduate, postgraduate, continuing education) who regularly receive feedback, and ii) studies which associated feedback with subsequent learner reaction. Screening was performed independently in duplicate. Data extraction and synthesis occurred via an iterative consensus approach. Self- regulatory learning theory (SRL) was used as the conceptual framework. 

Of 4253 abstracts reviewed, 232 were included in final synthesis. Few papers defined feedback and interpretations varied widely. Learners cognitively using feedback to aid understanding, identify strengths and weaknesses, and reflect on learning. Emotional reactions are common and often negative. Changes to practice and seeking more feedback were the most frequent behavioural responses. Many studies reported contextual factors mediating learner acceptance of feedback. 

Heterogeneity in definitions and practice are barriers to interactions that support learning. Feedback has the potential to interact with all areas of self-regulation with context often impacting if this is positive or negative. 

Educational programmes should explicitly define feedback, describe feedback goals and apply research-informed practice models. To support SRL, feedback should focus on learner needs, facilitate bi-directional dialogue, acknowledge and support emotions, provide transparent standards and foster constructive learner-supervisor relationships 

References (maximum three) 

1. Hattie J. 2008. Visible learning: a synthesis of over 800 meta-analyses relating to achievement. London 

2. Sargeant J, Mann K, Sinclair D, Van der Vleuten C, Metsemakers J. 2008. Understanding the influence of emotions and reflection upon multi-source feedback acceptance and use. Adv Health Sci Educ Theory Pract. 13(3):275–288. 

3. Winstone NE, Nash RA, Rowntree J, Parker M. 2017b. Supporting learners' agentic engagement with feedback: a systematic review and a taxonomy of recipience processes. Educ Psychol. 52(1):17–37. 

Carolyn Cracknell¹
Elizabeth Molloy¹, Robyn Woodward-Kron¹, Christy Noble² and Anna Ryan¹
1 University of Melbourne
2 University of Queensland

Background
The University of Melbourne’s medical course has a strong focus on developing students’ feedback literacy: this study involved student engagement in immersive tasks to practise feedback conversations with multiple stakeholders. 

Summary
A simulation-based program, ‘Productive Feedback Conversations in Healthcare’ was developed for first year medical students. Students work in teams through authentic feedback scenarios and conversations. Video recordings of student engagement in the tasks were collected for thematic analysis (Clarke and Braun, 2017). Our research aimed to investigate the educational potential of the program and learner feedback literacy in practice, including aspects challenging for novice students. 

Preliminary analysis of video data revealed three main themes: 

Discussion-These preliminary findings suggest that students struggled to articulate benefits of self-evaluation and tended to confine feedback exchanges to learner-teacher, overlooking inputs from peers and patients. The simulation-based prompts facilitated better comprehension of multi-source feedback and self-evaluation, while 'feedback in private' was highlighted as a significant marker of respecting learners' needs. 

Conclusions-The simulation-based activity builds off the published work in how to explicitly teach learners to seek, utilise and provide feedback in authentic learning contexts (Molloy et al, 2020; Nobel et al, 2019). 

References (maximum three)