Health Systems and Public Health

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    A descriptive study of clinicians’ experiences of giving feedback to final year medical students
    (Stellenbosch : Stellenbosch University, 2024-03) Mouton, Jannie; Blitz, Julia; Schmutz, A. M. S.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
    ENGLISH SUMMARY: The translation of the science of learning to improve models of training should form part of the delivery of clinical services and the process of transforming health systems. Though good clinical teaching is at the centre of medical education, there are concerns about maintaining this in current pressured healthcare environments. Research revealed that feedback on student performance plays a crucial part of learning in the workplace and thus also as part of educational programs in health professions education. The importance of an educator’s role in feedback and how that role can improve achievement of learning outcomes via quality feedback have been reported. We are also reminded that experience-based learning of medical students plays an important role in competency-based medical curricula, and its value depends greatly on how clinicians and students use the exposure to achieve learning. Furthermore, it identified inadequate training in the giving of feedback as one of the key shortcomings of experience-based learning. Despite the importance of educators’, or in this case, clinicians’ roles in feedback and learning outcomes, my experience is that many of the clinicians, in our and in neighbouring training hospitals, have not been properly orientated or trained with regard to their responsibilities and simply had to assume this role of a clinician teacher as part of their duties. This experience is corroborated by research, who informs us that clinicians are sometimes unclear on how their teaching fits into the curriculum and that they feel unprepared for the tasks of giving feedback and of teaching and highlighted the need for faculty development of this area. The aim of this study, therefore, was to gain a better understanding of the perceptions of clinicians on giving feedback by exploring their experiences of doing this with final-year year medical students at rural teaching sites of Stellenbosch University, and in doing so, finding ways to improve the giving of feedback. This was an interpretivist study, generating qualitative data and using thematic analysis to analyse the data. This study was conducted at two rural district hospitals in the Western Cape (WC) Province of South Africa, namely that of Hermanus and Ceres, which form part of the LIC model of training of the Ukwanda Rural Clinical School of Stellenbosch University. Data was generated by conducting interviews with the clinicians, who are involved in teaching at these hospitals. Individual perspectives and experiences were explored by using a semi-structured interview schedule for the asking of the questions. Five overarching themes were developed from the findings of the study, and these highlight the important roles and responsibilities that both the clinical teacher and the student have in the feedback process, as well as the different aspects involved in the process of the giving of feedback itself. The overarching themes are the importance of relationship building between medical officer and student, the environment in which the feedback occurs, clinicians’ general experiences of feedback, more personal experiences of giving feedback and fifthly, considerations with regard to students, as the other party in the feedback process. Probably the most significant point that emerged was the importance of establishing a relationship between the medical officer and the student, and that connection between the two parties needed to take place before a relationship could be built. This was also crucial for the establishment of mutual trust and for feedback to translate into learning for the student. It was also revealed that this relationship or connection should entail a two-way discussion and was not a one-way monologue where the teacher or clinician just commented on what the student did wrong, as was very much a practice in the past. What was interesting was the various ways in which the process of feedback was described. According to some responses, the feedback process was something that should be specific and focused, but also should be carefully and skillfully done and therefore required thinking, preparation and more efficient orientation of the clinical teacher. It is well summarised in this quote: “Feedback should be a learning opportunity and not a scoring episode”. The need for training and capacity building for clinicians to improve the quality of the feedback they gave was another aspect that emerged almost unanimously from the data. The most prominent challenges identified in giving feedback that translated to learning were sufficient time and appropriate space to deliver the feedback. The envisaged contribution of the study is that gaining a better understanding of how clinicians experience giving feedback, could contribute towards planning and implementing appropriate training to improve the capacity of clinicians to provide feedback and therefore potentially improve quality of teaching and learning on this platform.