Author: Dr Christopher Elsey, Chantelle Rizan, Thomas Lemon, Dr Andrew Grant and Dr Lynn Monrouxe, Cardiff University

Day Two – Wednesday 26th June

Strand – Health & Well Being

Session Six: 2.45pm – 4.15pm

Feedback is conventionally considered synonymous with ‘reflection-on-action’ which occurs following the bedside teaching encounter (BTE), thus providing performance evaluation out of context. At its extreme, feedback is reduced to a written appraisal of a submitted assessment. In our study we identify feedback-in-action: investigating how feedback (as correction) delivered during clinical encounters provides students’ with opportunities to improve their performance with patients present.

Our video ethnographic study expands on previous research by uniquely incorporating video recordings capturing the verbal and embodied conduct that comprise BTEs. Our aim is to explore how clinicians ‘correct’ students’ verbal or embodied actions: a vital part of student training and development. 43 BTEs across various healthcare settings totalling 937 minutes of footage were recorded. We systematically analysed feedback and correction within 12 encounters recorded in 4 GP surgeries (involving 4 GPs and 4 students), totalling 236 minutes of footage averaging 19 minutes per BTE (range 4:45-26:42).

Building on previous studies of correction in educational and healthcare settings, we develop the basic Initiation-Response-Evaluation (I-R-E) model. (I) a question proffered by the teacher/clinician; (R) an answer given by the student; (E) tutors’ confirmation or evaluation of the student’s reply. Within our data we demonstrate GP evaluations (E) which either initiate student self-correction of their own answers or lead GPs to correct student’s answers directly. The learning impacts entailed in these methods are examined.

Clinical teachers must be aware of their communicative conduct for optimum student learning and development particularly in the presence of an audience, the patient.

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