Identifying educator behaviours for high quality verbal feedback in health professions education: literature review and expert refinement

doi:10.1186/s12909-016-0613-5

Review

. 2016 Mar 22:16:96.

doi: 10.1186/s12909-016-0613-5.

Identifying educator behaviours for high quality verbal feedback in health professions education: literature review and expert refinement

Christina E Johnson^{1

2}, Jennifer L Keating³, David J Boud^{4

5

6}, Megan Dalton⁷, Debra Kiegaldie⁸, Margaret Hay⁹, Barry McGrath⁹, Wendy A McKenzie¹⁰, Kichu Balakrishnan R Nair¹¹, Debra Nestel¹², Claire Palermo¹³, Elizabeth K Molloy¹²

Affiliations

¹ Health Professions Education and Educational Research (HealthPEER), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia. christina.johnson@monashhealth.org.
² Monash Doctors Education, Monash Health, Monash Medical Centre, Clayton, Melbourne, Australia. christina.johnson@monashhealth.org.
³ Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
⁴ Centre for Research on Assessment and Digital Learning, Deakin University, Geelong, Australia.
⁵ Faculty of Arts and Social Sciences, University of Technology Sydney, Ultimo, Australia.
⁶ Institute of Work-Based Learning, Middlesex University, London, UK.
⁷ School of Human, Health and Social Science, Central Queensland University, Rockhampton, Australia.
⁸ Faculty of Health Science, Youth and Community Studies, Holmesglen Institute and Healthscope Hospitals, Holmesglen, Melbourne, Australia.
⁹ Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
¹⁰ Faculty of Education, Monash University, Melbourne, Australia.
¹¹ School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.
¹² Health Professions Education and Educational Research (HealthPEER), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
¹³ Department of Nutrition and Dietetics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.

PMID: 27000623
PMCID: PMC4802720
DOI: 10.1186/s12909-016-0613-5

Review

Identifying educator behaviours for high quality verbal feedback in health professions education: literature review and expert refinement

Christina E Johnson et al. BMC Med Educ. 2016.

. 2016 Mar 22:16:96.

doi: 10.1186/s12909-016-0613-5.

Authors

Affiliations

¹ Health Professions Education and Educational Research (HealthPEER), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia. christina.johnson@monashhealth.org.
² Monash Doctors Education, Monash Health, Monash Medical Centre, Clayton, Melbourne, Australia. christina.johnson@monashhealth.org.
³ Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
⁴ Centre for Research on Assessment and Digital Learning, Deakin University, Geelong, Australia.
⁵ Faculty of Arts and Social Sciences, University of Technology Sydney, Ultimo, Australia.
⁶ Institute of Work-Based Learning, Middlesex University, London, UK.
⁷ School of Human, Health and Social Science, Central Queensland University, Rockhampton, Australia.
⁸ Faculty of Health Science, Youth and Community Studies, Holmesglen Institute and Healthscope Hospitals, Holmesglen, Melbourne, Australia.
⁹ Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
¹⁰ Faculty of Education, Monash University, Melbourne, Australia.
¹¹ School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.
¹² Health Professions Education and Educational Research (HealthPEER), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
¹³ Department of Nutrition and Dietetics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.

PMID: 27000623
PMCID: PMC4802720
DOI: 10.1186/s12909-016-0613-5

Abstract

Background: Health professions education is characterised by work-based learning and relies on effective verbal feedback. However the literature reports problems in feedback practice, including lack of both learner engagement and explicit strategies for improving performance. It is not clear what constitutes high quality, learner-centred feedback or how educators can promote it. We hoped to enhance feedback in clinical practice by distinguishing the elements of an educator's role in feedback considered to influence learner outcomes, then develop descriptions of observable educator behaviours that exemplify them.

Methods: An extensive literature review was conducted to identify i) information substantiating specific components of an educator's role in feedback asserted to have an important influence on learner outcomes and ii) verbal feedback instruments in health professions education, that may describe important educator activities in effective feedback. This information was used to construct a list of elements thought to be important in effective feedback. Based on these elements, descriptions of observable educator behaviours that represent effective feedback were developed and refined during three rounds of a Delphi process and a face-to-face meeting with experts across the health professions and education.

Results: The review identified more than 170 relevant articles (involving health professions, education, psychology and business literature) and ten verbal feedback instruments in health professions education (plus modified versions). Eighteen distinct elements of an educator's role in effective feedback were delineated. Twenty five descriptions of educator behaviours that align with the elements were ratified by the expert panel.

Conclusions: This research clarifies the distinct elements of an educator's role in feedback considered to enhance learner outcomes. The corresponding set of observable educator behaviours aim to describe how an educator could engage, motivate and enable a learner to improve. This creates the foundation for developing a method to systematically evaluate the impact of verbal feedback on learner performance.

Keywords: Clinical practice; Delphi process; Educator behaviour; Feedback; Health professions education.

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Figures

**Fig. 1**
PRISMA flow diagram for the literature review

**Fig. 2**
Desirable criteria and example of two questions from Delphi Round 3 survey

**Fig. 3**
Key elements of an educator’s role in effective feedback, extracted and substantiated from the literature

**Fig. 4**
List of educator behaviours that demonstrate high quality verbal feedback in clinical practice

See this image and copyright information in PMC

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References

1. Morris C, Blaney D. Work-based learning. In: Swanwick T, editor. Understanding medical education: evidence, theory and practice. Oxford: Assocation for the Study of Medical Education; 2010. pp. 69–82.
1. Higgs J. Ways of knowing for clinical practice. In: Delany C, Molloy E, editors. Clinical education in the health professions. Sydney: Elsevier; 2009. p. 26.
1. Boud D, Molloy E, Boud D, Molloy E. Feedback in higher and professional education. London: Routledge; 2013. What is the problem with feedback? p. 6.
1. Hattie J, Timperley H. The power of feedback. Rev Educ Res. 2007;77(1):81–112. doi: 10.3102/003465430298487. - DOI
1. Sadler DR. Formative assessment and the design of instructional systems. Instr Sci. 1989;18(2):119–144. doi: 10.1007/BF00117714. - DOI

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[1] Morris C, Blaney D. Work-based learning. In: Swanwick T, editor. Understanding medical education: evidence, theory and practice. Oxford: Assocation for the Study of Medical Education; 2010. pp. 69–82.

[2] Morris C, Blaney D. Work-based learning. In: Swanwick T, editor. Understanding medical education: evidence, theory and practice. Oxford: Assocation for the Study of Medical Education; 2010. pp. 69–82.

[3] Higgs J. Ways of knowing for clinical practice. In: Delany C, Molloy E, editors. Clinical education in the health professions. Sydney: Elsevier; 2009. p. 26.

[4] Higgs J. Ways of knowing for clinical practice. In: Delany C, Molloy E, editors. Clinical education in the health professions. Sydney: Elsevier; 2009. p. 26.

[5] Boud D, Molloy E, Boud D, Molloy E. Feedback in higher and professional education. London: Routledge; 2013. What is the problem with feedback? p. 6.

[6] Boud D, Molloy E, Boud D, Molloy E. Feedback in higher and professional education. London: Routledge; 2013. What is the problem with feedback? p. 6.

[7] Hattie J, Timperley H. The power of feedback. Rev Educ Res. 2007;77(1):81–112. doi: 10.3102/003465430298487. - DOI

[8] Hattie J, Timperley H. The power of feedback. Rev Educ Res. 2007;77(1):81–112. doi: 10.3102/003465430298487. - DOI

[9] Sadler DR. Formative assessment and the design of instructional systems. Instr Sci. 1989;18(2):119–144. doi: 10.1007/BF00117714. - DOI

[10] Sadler DR. Formative assessment and the design of instructional systems. Instr Sci. 1989;18(2):119–144. doi: 10.1007/BF00117714. - DOI

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Identifying educator behaviours for high quality verbal feedback in health professions education: literature review and expert refinement

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Identifying educator behaviours for high quality verbal feedback in health professions education: literature review and expert refinement

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