The effectiveness of terminal feedback delivery to improve the clinical skills of pre-registration health professional students in simulated environments: A systematic review

Jessica Stanhope; Robyn Gill

doi:10.11157/fohpe.v16i2.73

Authors

Jessica Stanhope University of South Australia University of Tasmania
Robyn Gill University of South Australia Country Health South Australia Flinders University

DOI:

https://doi.org/10.11157/fohpe.v16i2.73

Keywords:

review, education, health, feedback, universities, clinical competence

Abstract

Aim: To determine whether terminal feedback is effective in improving the practical, clinical skills of pre-registration health professional students in simulated environments, and how it is best delivered.

Methods: Eight databases were searched systematically to identify studies addressing our aim. Eligible studies were published 2004–2014, in English language, within peer- reviewed journals. Study designs were determined and assigned to the National Health and Medical Research Council hierarchy of evidence, with the PEDro scale used to appraise ≥Level III_1 studies. Data regarding the country, participant characteristics, sample size, task critiqued, prior experience with the task, feedback delivered, follow-up time, outcome measures, methods of statistical analysis and the results were extracted and reported descriptively.

Results: Eight studies (Levels II–V) were included. Most investigated medical students performing laparoscopic and/or knot tying tasks. PEDro scale scores ranged from 18–54%. Results were mixed when comparing terminal verification feedback and no feedback (n=3), and comparing different types of feedback (n=3). Overall, it would appear that, in terms of terminal feedback, elaborative feedback is more effective in improving the practical, clinical skills of pre-registration health professional students (n=4).

Discussion: Whilst there is some indication that elaborative feedback may be more effective than no feedback, the small number of studies and poor methodological quality of the included studies precludes any strong conclusions from being drawn. There are a number of gaps in the current literature, particularly investigating non-medical professions, that should be addressed in future research. Furthermore, larger-scale, well-designed studies in the area are required to guide clinical teaching.

References

Archer, J. C. (2010). State of the science in health professional education: Effective feedback. Medical Education, 44(1), 101–108. doi:10.1111/j.1365- 2923.2009.03546.x

Black, P., & McCormick, R. (2010). Reflections and new directions. Assessment and Evaluation in Higher Education, 35(5), 493–499. doi: 10.1080/02602938.2010.493696

Boehler, M. L., Rogers, D. A., Schwind, C. J., Mayforth, R., Quin, J., Williams, R. G., & Dunnington, G. (2006). An investigation of medical students’ reactions to feedback: A randomized controlled trial. Medical Education, 40(8), 746–749. doi:10.1111/j.1365-2929.2006.02503.x

Bok, H. G., Teunissen, P. W., Spruijt, A., Fokkema, J. P., van Beukelen, P., Jaarsma, D. A., & van der Vleuten, C. P. M. (2013). Clarifying students’ feedback-seeking behaviour in clinical clerkships. Medical Education, 47(3), 282–291. doi: 10.1111/ medu.12054

Bokken, L., Linssen, T., Scherpbier, A., Van Der Vleuten, C., & Rethans, J.-J. (2009). Feedback by simulated patients in undergraduate medical education: A systematic review of the literature. Medical Education, 43(3), 202–210. doi: 10.1111/j.1365- 2923.2008.03268.x

Branch, W. T., & Paranjape, A. (2002). Feedback and reflection: Teaching methods for clinical settings. Academic Medicine, 77(12), 1185–1188.

Cramp, A. (2011). Developing first-year engagement with written feedback. Active Learning in Higher Education, 12(2), 113–124. doi: 10.1177/1469787411402484

Crowe, M., & Sheppard, L. (2011). A review of critical appraisal tools show they lack rigor: Alternative tool structure is proposed. Journal of Clinical Epidemiology, 64(1), 79–89.

de Morton, N. A. (2009). The PEDro scale is a valid measure of the methodological quality of clinical trials: A demographic study. Australian Journal of Physiotherapy, 55(2), 129–133.

Harrison, C. J., Könings, K. D., Molyneux, A., Schuwirth, L. W. T., Wass, V., & van der Vleuten, C. P. M. (2013). Web-based feedback after summative assessment: How do students engage? Medical Education, 47(7), 734–744. doi: 10.1111/ medu.12209

Hayes, K. D., & Devitt, A. A. (2008). Classroom discussions with student- led feedback: A useful activity to enhance development of critical thinking skills. Journal of Food Science Education, 7(4), 65–68. doi: 10.1111/j.1541- 4329.2008.00054.x

Jaehnig, W., & Miller, M. L. (2007). Feedback types in programmed instruction: A systematic review. The Psychological Record, 57(2) , 219–232.

Lazarski, M. P., Susarla, S. M., Bennett, N., & Seldin, E. B. (2007). How do feedback and instructions affect the performance of a simulated surgical task? Journal of Oral and Maxillofacial Surgery, 65(6), 1155–1161.

Macedo, L. G., Elkins, M. R., Maher, C. G., Moseley, A. M., Herbert, R. D., & Sherrington, C. (2010). There was evidence of convergent and construct validity of Physiotherapy Evidence Database quality scale for physiotherapy trials. Journal of Clinical Epidemiology, 63(8), 920–925.

Maher, C. G., Sherrington, C., Herbert, R. D., Moseley, A. M., & Elkins, M. (2003). Reliability of the PEDro Scale for rating quality of randomized controlled trials. Physical Therapy, 83(8), 713–721.

Manzone, J., Tremblay, L., You-Ten, K. E., Desai, D., & Brydges, R. (2014). Task- versus ego-oriented feedback delivered as numbers or comments during intubation training. Medical Education, 48(4), 430–440. doi: 10.1111/medu.12397

National Health and Medical Research Council (NHMRC). (2009). NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. Canberra, Australia: Author. Retrieved from http://www.nhmrc.gov. au/_files_nhmrc/file/guidelines/stage_2_consultation_levels_and_grades.pdf

O’Connor, A., Schwaitzberg, S. D., & Cao, C. G. L. (2008). How much feedback is necessary for learning to suture? Surgical Endoscopy and Other Interventional Techniques, 22(7), 1614–1619. doi: 10.1007/s00464-007-9645-6

Porte, M. C., Xeroulis, G., Reznick, R. K., & Dubrowski, A. (2007). Verbal feedback from an expert is more effective than self-accessed feedback about motion efficiency in learning new surgical skills. The American Journal of Surgery, 193(1), 105–110.

Shute, V. J. (2008). Focus on formative feedback. Review of Educational Research, 78(1), 153–189.

doi:10.3102/0034654307313795

Skinner, B. F. (1968). The Technology of Teaching. New York: Appleton-Century-Crofts.

Strandbygaard, J., Bjerrum, F., Maagaard, M., Winkel, P., Larsen, C. R., Ringsted, C., . . . Sorensen, J. L. (2013). Instructor feedback versus no instructor feedback on performance in a laparoscopic virtual reality simulator: A randomized trial. Annals of Surgery, 257(5), 839–844. doi: 10.1097/SLA.0b013e31827eee6e

Triano, J. J., Scaringe, J., Bougie, J., & Rogers, C. (2006). Effects of visual feedback on manipulation performance and patient ratings. Journal of Manipulative and Physiological Therapeutics, 29(5), 378–385.

van de Ridder, J. M. M., Stokking, K. M., McGaghie, W. C., & Ten Cate, O. T. J. (2008). What is feedback in clinical education? Medical Education, 42(2), 189– 197. doi: 10.1111/j.1365-2923.2007.02973.x

Van Sickle, K. R., Smith, B., McCluskey, D. A., Baga, I., Smith, C. D., & Gallagher, A. G. (2005). Evaluation of a tensiometer to provide objective feedback in knot-tying performance. The American Surgeon, 71(2), 1018–1023.