Melbourne Medical School Collected Works - Theses
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ItemGuiding educators in learner-centred feedback: designing, testing and refining the Feedback Quality Instrument( 2020)Feedback is important but problematic in the health workplace. The aim of this research is to promote quality feedback discussions that enhance learner outcomes. This thesis reports the process of developing, testing and refining an instrument to guide and systematically evaluate an educator’s role in quality face-to-face feedback in clinical practice. It is underpinned by social constructivism, and uses a multiphase mixed methods design to achieve the research objective. The research was conducted in three phases. Phase 1 comprised a systematic review and meta-analysis to summarise the empirical evidence available concerning the impact of face-to-face feedback on workplace task performance involving health professionals. Phase 2 focused on the development of a provisional feedback instrument. An extensive narrative literature review identified the distinct elements of an educator’s role with the potential to influence learner outcomes. These elements were then operationalised into corresponding observable educator behaviours and refined in collaboration with an expert panel using a Delphi process. This resulted in consensus on a set of twenty-five descriptions of educator behaviours that manifest quality feedback, which constituted a provisional instrument. Phase 3 involved refining the provisional instrument to create the Feedback Quality Instrument using quantitative and qualitative analyses. Thirty-six videos of authentic clinical feedback discussions were collected. Six raters independently administered the provisional instrument to evaluate educator behaviours seen in the videos, compared with recommended behaviours in the provisional instrument, using a Likert scale: 0 = not seen, 1 = done somewhat, 2 = done consistently. This enabled usability testing and generated 174 sets of ratings data. Quantitative analysis of these ratings data were used to describe a) how commonly each recommended behaviour was demonstrated by the group of educators and b) variation across educators’ practice, which was achieved by describing how many of the recommended behaviours each individual educator demonstrated. This afforded rare observational insights into contemporary feedback interactions, confirmed a gap between recommended and workplace practice, and indicated priorities for professional development initiatives. These ratings data were also used for psychometric analysis of the provisional instrument using multifaceted Rasch model analysis and exploratory factor analysis. In addition, using thematic analysis, qualitative analysis of the video data was performed to explore two key emergent phenomena 1) the potential for promoting learners’ own evaluative judgement and 2) ways in which educators could help to cultivate psychological safety with learners within feedback conversations. The qualitative analyses further clarified desirable educator approaches to feedback, enabling refinement of the instrument and addressing gaps identified during psychometric testing. Finally, the provisional instrument was refined, informed by the usability testing, psychometric testing, qualitative analysis, and foundational literature and theory. This resulted in the Feedback Quality Instrument (FQI), ready-for-use in clinical practice. The FQI includes 25 items, grouped into five domains: set the scene, analyse performance, plan improvements, foster learner agency, and foster psychological safety. These domains characterise five core concepts underpinning quality feedback identified by exploratory factor analysis. The items offer practical guidance for clinicians in fostering learner-centred feedback in collaboration with learners by describing behaviours that engage, motivate and enable a learner to improve. The instrument also provides a platform for future research investigating the impact of specific components of feedback on learner outcomes in the clinical workplace. This PhD program of research leading to the FQI includes four published articles, one article under submission and one published book chapter.