Developing Feedback Literacy for Better Patient Outcomes
Feedback is a dance between students and teachers; and to make it work, both parties need to know the steps, yet for decades efforts have exclusively focused on only teaching the teachers the moves.
Elizabeth Molloy, Professor of Work Integrated Learning, Department of Medical Education, Melbourne Medical School, is passionate about developing medical graduates who know how to learn and know how to teach.
“There are strong parallels between delivering patient-centred care as a clinician, and being learner-centred as a teacher,” Professor Molloy said.
“Our aim is to engage students early in these agendas, of patient-centredness and learner-centredness, so they understand they have a key role to play in empowering others to reach their goals,” she said.
“Research has shown patients experience better outcomes when engaged in the process, with an emphasis on shared decision making and goal setting, and this is no different to the student learning process in clinical education.”
“If we ‘tell’ learners what to do, we should not be surprised when they fail to take up the suggestions in practice.”
“If learners are invested in shaping goals for their practice, they are more likely to translate these into action.”
Professor Molloy has been designing and researching education methods for more than 15 years.
To prepare medical students for their entry into the healthcare system, Professor Molloy works on curriculum design and engages in research to encourage learners to become better at seeking out workplace experiences.
“To create feedback literate students, both in the classroom and when they are on placement, they need to understand what feedback is, have the confidence to solicit feedback, and know what to do with it,” Professor Molloy said.
“Students traditionally have held the belief that feedback is something done to them by educators and their role is to simply be an obedient learner,” she said.
“We want to disrupt this pattern, and instil the idea that feedback is a gift to help migration of learning and performance, and ensure students are confident and savvy in feedback processes.”
Workplace learning is quite different to classroom-based learning as it often requires the student to sensitively request feedback, at an appropriate time, from a variety of sources, without disrupting patient care.
Through a commitment to feedback literacy throughout the Doctor of Medicine (MD) program, students build an understanding of how different people and sources can provide them with performance relevant information.
“It is not about obtaining three different opinions and triangulating the information to find the one truth,” Professor Molloy said.
“Feedback literacy is about soliciting information from different sources which serve different purposes,” she said.
“The information given is like pixels which can be pieced together to form a picture of your own performance.”
“If you want to know if a procedure is comfortable for the patient, for example, the only person who can really provide this feedback is the patient.”
“The supervisor may be able to give some sort of performance relevant information, but it will be from a different perspective, that is, inferred, and certainly not first hand.”
Professor Molloy indicated they are also educating students that there is no such thing as an expert who stops learning.
“We want our students to be open and to be co-constructing knowledge, and constantly seeking feedback and adjusting and refining their performance, throughout their career trajectory,” Professor Molloy said.
Feedback and assessment are both inherently social processes and Professor Molloy acknowledges there must be suitable motivation provided to encourage changes in student and educator approaches to these activities.
To address this need, she has been working with clinical supervisors to ensure they are well equipped to guide and shape a productive learning experience when working with students on placement.
“When a clinical supervisor engages in a feedback discussion, they need to work with the student to clearly identify a gap and provide strategies to bridge the gap,” Professor Molloy said.
“Storytelling is an effective framework to provide the rationale of why it is important to change behaviour, including the consequences of not changing behaviour,” she said.
Developing a culture for productive learning and feedback exchanges provides benefits for patient care.
If a clinician has a good rapport with a patient, then the patient will be more likely to share information which may be very important to informing a diagnosis and shared management plan, Professor Molloy said.
Patient feedback and experiential learning has formed part of the strategy for elevating the learning experience.
Rather than developing a case study with a person with a disability on paper, for example, the team provides an experience for learners to hear from the person who has a disability to learn about goal setting and management from the patient’s perspective.
“It can be cathartic for individuals and provide the necessary gravitas for students to make it a more visceral learning experience,” Professor Molloy said.
Professor Molloy also works on interprofessional education and practice development for health professional students across the Faculty of Medicine, Dentistry and Health Sciences (MDHS) at the University of Melbourne.
“Delivering healthcare is a team-based sport and it is important to develop the necessary skills to appropriately refer and interact with professionals from other disciplines,” Professor Molloy said.
“I hope one of the signature features of our medical program, is that graduates will know how to work very well within a team,” she said.
“This ultimately will lead to better patient outcomes as most of the errors seen in healthcare are due to errors in communication and teamwork.”
“We absolutely have a mandate to ensure we develop better interprofessional collaboration, and it’s exciting that the Faculty is investing in development in this area.”
Hospitals are similarly working on systems to improve learning cultures, including communication and respect in the workforce.
Some have implemented anonymous reporting for inappropriate behaviour such as bullying, as well as reporting on exemplary practice.
“The ideal would be for clinicians and students to have such high levels of feedback literacy, where they are both confident in the process, to essentially make anonymous reporting systems redundant,” Professor Molloy said.
“Unfortunately, we are not at that stage yet,” she said.
“If we educate differently, and use research to track outcomes, we will obtain greater accountability which should translate to benefits for patients.”
“Education is a science; and when we make changes to clinical practice it needs to be evidence-based and pedagogy is no different.”