Wednesday, 12 March 2014

The challenge of feedback and the burden of accountability in clinical medical education

Have you received good feedback in a clinical setting as a doctor or medical student?

Some of the best feedback I received was during my GP reg training year when my trainer reviewed most of my consultations with me every day for the first 4 or 5 months. I knew it would be a chance to ask what he thought about a patient, and also that I would have to justify some of the decisions I had made or hadn't made. It was above and beyond any feedback I have ever had before or since on my clinical work.

We know what makes good feedback. Here is a great paper about this from 31 years ago. There was no talk about eportfolios or skills logs or apps at that time. 16 years later when I was during my GP trainee year we didn't have the burden of documenting our feedback either.

So do current moves to use technology, including smart phones, to try and document feedback in clinical settings enhance the quality of feedback given? Do they make it more likely to happen? If they don't why do we do them?

Is there a risk that in an effort to be accountable, we are making it harder for learners to achieve good feedback because of the burden of documentation? If you want to read more about this I strongly recommend Onora O'Neill on 'Intelligent Accountability in Education'.


  1. On-going feedback is the most useful as it accustoms the recipient to receiving feedback and allows real time reflection and timely changes to practice to make it a developmental process. Feedback becomes less daunting than if it is delivered in a less frequent staged way. Face to face feedback is also more beneficial as it allows discussion and explanation which ensures optimal communication and understanding. This does not always happen with written feedback. It also encourages the individual to describe the rationale for their decisions which is a useful skill and overcomes defensive response to challenge.

  2. Thanks Cathy. The systems I am alluding to are those which aim to document that face to face feedback has occurred. The documentation can start seeming more important than the feedback itself... getting 'signed off' becomes ever more important. Do you see that as a risk where you work? Maybe I need to describe my concerns more in the post.

  3. I agree with the suggestion that the documentation becomes more important than the activity and the outcomes. This can be observed with clinicians attending learning events where they need a certificate of attendance. This means nothing, it's the reflective assessment of impact on knowledge and practice that's important. The best documentation would be for the individual to document a reflective report of the feedback, learning points and how this will impact on future practice.

  4. Actually I think we are pretty good at this in general practice. At appraisal I get credit for showing how I put learning from an event into action... not just attending.

  5. great information it will helps many needed .This setting is where they are most often. clinical medical education who work in hospitals are often required to make medical reports of cases, Medical for more detail visit our site. kaplan usmle latest edition

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