From the Field: Reconceptualizing the Feedback Dilemma in Clinical Education

This guest post comes to us from Jack R. Scott, EdD, MPH; Winthrop University Hospital – Stony Brook School of Medicine. Dr. Scott leads faculty development in teaching and educational research and scholarship, so you can rest assured that your next 2 minutes will be well spent in reading his thoughts. Now, put your feet up and dig in!

The "educational alliance" as a framework for reconceptualizing feedback in medical education. Telio S, Aijawi R, Regehr G. Acad Med. 2014.

Available online from the Baystate Health Sciences Library or from PubMed at your institution.

The Educational Alliance offers keen insights for our long-standing, historic assessment of students’ clinical performance, namely formative feedback. Most will agree that our assessment methods have been ineffective, infrequent and even haphazard when measuring observed clinical performance. While students often report that receiving feedback is among the most defining moments in their clinical rotations they are quick to recognize its inefficiencies that we seem to stubbornly ignore. Perhaps this is due to our own lack of standardized approaches, infrequent observation opportunities, subjectivity, fear of giving negative comments, complex procedural logbook ‘sign-offs’ or even intimidating learning environments. Yet much like in apprenticeships, we believe that our judgments and advice are important no matter how flawed.  Whatever the extant disconnect in authentic formative assessment, we need a method that approaches consistent reliability. The solution may be in an adaptation of the therapeutic alliance in psychotherapy, namely the ‘educational alliance’.

These authors purport an innovative process by a clinical-educator sufficiently trained in giving constructive feedback in appropriate clinical/surgical education settings. This educational alliance offers a mentoring role-model that is best applied at multiple assessment points. Incorporating technology may likewise add authentic assessment opportunities (there must be a feedback algorithm app for this).

We are all guilty of grade inflation when we eschew standardized rubric measures or behavioral anchors that award a grade for students that is not truly deserved.  Extrapolating our brief encounters into a grade is limiting. So that is why multi-source feedback is ever more in vogue. Clerkship Directors should assign an experienced faculty member who aspires to excellence in accurately assessing students’ clinical performance.  Such a consistent approach ensures that ‘we act according to what we believe’ (Latin: agree sequitar credere). Let’s recognize, optimize and reward exemplary learner-centered assessments that are coherent with the credible relationship-based therapeutic alliance model. 

Bottom Line:
Being a great teacher means giving great feedback (in all its forms) to students. They are inextricably linked. This article offers one way that an alliance can start the process. Carpe diem.