RESUMEN
BACKGROUND: Programmatic assessment is increasingly being implemented within competency-based health professions education. In this approach a multitude of low-stakes assessment activities are aggregated into a holistic high-stakes decision on the student's performance. High-stakes decisions need to be of high quality. Part of this quality is whether an examiner perceives saturation of information when making a holistic decision. The purpose of this study was to explore the influence of narrative information in perceiving saturation of information during the interpretative process of high-stakes decision-making. METHODS: In this mixed-method intervention study the quality of the recorded narrative information was manipulated within multiple portfolios (i.e., feedback and reflection) to investigate its influence on 1) the perception of saturation of information and 2) the examiner's interpretative approach in making a high-stakes decision. Data were collected through surveys, screen recordings of the portfolio assessments, and semi-structured interviews. Descriptive statistics and template analysis were applied to analyze the data. RESULTS: The examiners perceived less frequently saturation of information in the portfolios with low quality of narrative feedback. Additionally, they mentioned consistency of information as a factor that influenced their perception of saturation of information. Even though in general they had their idiosyncratic approach to assessing a portfolio, variations were present caused by certain triggers, such as noticeable deviations in the student's performance and quality of narrative feedback. CONCLUSION: The perception of saturation of information seemed to be influenced by the quality of the narrative feedback and, to a lesser extent, by the quality of reflection. These results emphasize the importance of high-quality narrative feedback in making robust decisions within portfolios that are expected to be more difficult to assess. Furthermore, within these "difficult" portfolios, examiners adapted their interpretative process reacting on the intervention and other triggers by means of an iterative and responsive approach.
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Educación Basada en Competencias , Narración , Educación Basada en Competencias/métodos , Retroalimentación , Humanos , Encuestas y CuestionariosRESUMEN
Cats can be easily stressed in a clinical (training) setting and may show unpredictable reactions and patterns of defensive aggression. This can be a complicating factor in undergraduate veterinary training. Inexperienced veterinary students can evoke defensive feline behavior that negatively affects learning outcomes and animal welfare. As a result, restraint techniques and physical examination of cats was hardly practiced in pre-clinical training at Utrecht University. To overcome this, a new blended learning module was developed using a lecture on feline behavior; e-learning modules about feline behavior, handling, restraint, and physical examination skills; and redesigned practical sessions in which live animals and manikins were used. The aim of this study was to investigate how students' perceptions of competence and confidence changed regarding feline behavior, handling, restraint, and physical examination skills after the new module was implemented. Questionnaires were used for quantitative analysis, and focus groups were used for qualitative analysis. The results show that compared with students who followed the standard module, students who participated in the blended learning module scored higher in feeling confident with handling animals, feeling competent to perform physical examination on cats, and ability to assess whether a cat is stressed. Students with less experience with cats were more likely to show improvement in assessing a cat's stress level than students who had much experience with cats. The results demonstrate that the blended learning module improves students' learning outcomes regarding feline skills training and adds to reduction, refinement, and replacement of the use of live cats.
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Educación en Veterinaria , Animales , Gatos , Competencia Clínica , Humanos , Aprendizaje , Examen Físico/veterinaria , EstudiantesRESUMEN
INTRODUCTION: Programmatic assessment is a longitudinal, developmental approach that fosters and harnesses the learning function of assessment. Yet the implementation, a critical step to translate theory into practice, can be challenging. As part of the Ottawa 2020 consensus statement on programmatic assessment, we sought to provide descriptions of the implementation of the 12 principles of programmatic assessment and to gain insight into enablers and barriers across different institutions and contexts. METHODS: After the 2020 Ottawa conference, we surveyed 15 Health Profession Education programmes from six different countries about the implementation of the 12 principles of programmatic assessment. Survey responses were analysed using a deductive thematic analysis. RESULTS AND DISCUSSION: A wide range of implementations were reported although the principles remained, for the most part, faithful to the original enunciation and rationale. Enablers included strong leadership support, ongoing faculty development, providing students with clear expectations about assessment, simultaneous curriculum renewal and organisational commitment to change. Most barriers were related to the need for a paradigm shift in the culture of assessment. Descriptions of implementations in relation to the theoretical principles, across multiple educational contexts, coupled with explanations of enablers and barriers, provided new insights and a clearer understanding of the strategic and operational considerations in the implementation of programmatic assessment. Future research is needed to further explore how contextual and cultural factors affect implementation.
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Curriculum , Aprendizaje , Consenso , Docentes , Humanos , LiderazgoRESUMEN
The transition from being a veterinary student to becoming a member of the veterinary profession is known to be challenging. Despite being licensed directly after graduation, many veterinarians do not feel fully equipped to practice unsupervised when they graduate. The increasing rate of attrition from veterinary practice, and a relatively high percentage of burnout during the first years in practice, has been suggested to be related to a lack of early career support. Over the past decade, medical education has adopted the concept of entrustable professional activities (EPAs). Recently, EPAs have been proposed to restructure veterinary education to help support the transition from veterinary student to practicing veterinarian. Implementing an EPA-based approach could help to bridge the gap between school and clinical practice, potentially preventing veterinary graduates from dropping out early on from what could have been a promising and exciting professional career.
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Educación en Veterinaria , Internado y Residencia , Animales , Competencia Clínica , Educación Basada en Competencias , Evaluación Educacional , Humanos , EstudiantesRESUMEN
The unusual and tiring physical activity of bovine transrectal palpation (TRP) requires a novel approach to improve students' TRP and pregnancy diagnosis (PD) skills. It has been shown that students who participated in an exercise program and students who had a grip strength (GS) of more than 30 kilograms performed better in bovine PDs. Participation in the exercise program increased students' sensitivity (ability to identify pregnant cows) but did not increase total arm muscle strength. To identify which muscles are used during TRPs and to improve the exercise program, an electromyographic (EMG) analysis was used to identify muscle activation patterns and muscle activity levels during bovine TRPs. Eight subject matter experts (SMEs) each palpated two live cows and one Breed'n Betsy® rectal examination simulator while an EMG Triggered Stimulator recorded muscle activity. Muscle activation was higher for forearm muscles compared with all other examined muscle groups (p < .001); was higher during retraction of the uterus and palpation of left and right uterine horn, compared with palpation of cervix, uterine body, left ovary, and right ovary (p < .001); and showed an endurance pattern. Findings have been used to modify the previously developed exercise program in effort to improve students' TRP and PD skills. The Bovine PD Improvement Exercise Program is available to students through an online application (http://icarus.up.ac.za/vetmlp/) and aims to not only improve GS and TRP accuracy but also stamina and well-being while adding fun to busy study schedules.
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Competencia Clínica , Educación en Veterinaria , Músculo Esquelético/fisiología , Palpación , Animales , Bovinos , Electromiografía , Terapia por Ejercicio , Femenino , Fuerza Muscular , Palpación/veterinaria , EmbarazoRESUMEN
Bovine pregnancy diagnosis (PD) by transrectal palpation (TRP) is an important skill for veterinary graduates. Factors influencing students' PD accuracy were investigated to optimize bovine PD by TRP training without increasing live animal exposure. The objective was to determine whether arm length and strength, proprioception, and exposure to a 6-week exercise training program were significantly associated with students' PD accuracy. Veterinary students (n = 128) who had previously received formal theoretical and practical training in bovine TRP and PD (live cows and TRP simulators) were assessed for PD accuracy on live cows. Prior to assessment, arm muscle strength measurement, an exercise program, and additional TRP sessions on Breed'n Betsy® simulators and live cows were offered to the students. Seventy-eight students volunteered to participate in the arm length measurement, muscle strength, and proprioception testing. Of these, 35 randomly allocated students completed a 6-week exercise program, after which muscle strength was reassessed. Each student performed PDs on six cows of which the pregnancy status, ranging from 6 weeks to 9 months pregnant or not pregnant, was predetermined by an experienced veterinarian. PD accuracy was measured as sensitivity and specificity, being defined as the proportion of pregnant or nonpregnant cows, respectively, correctly identified by the student. It is concluded that hand grip strength and participation in an exercise program are significant predictors of veterinary students' PD accuracy. Implementation of an exercise program aimed at improving grip strength in the veterinary curriculum is a novel approach to improve bovine TRP and PD training.
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Educación en Veterinaria , Animales , Brazo , Bovinos , Competencia Clínica , Ejercicio Físico , Terapia por Ejercicio/veterinaria , Femenino , Fuerza de la Mano , Humanos , Fuerza Muscular , Embarazo , Propiocepción , EstudiantesRESUMEN
Competency-based medical education is an educational innovation implemented in health professions worldwide as a means to ensure graduates meet patient and societal needs. The focus on student-centered education and programmatic outcomes offers a series of benefits to learners, institutions and society. However, efforts to establish a shared, comprehensive competency-based framework in veterinary education have lagged. This article reports on the development and outcome of a competency-based veterinary education (CBVE) framework created through multi-institutional collaboration with international input from veterinary educators and veterinary educational leaders. The CBVE Framework is designed to reflect the competencies expected of new graduates from member institutions of the Association of American Veterinary Medical Colleges (AAVMC). The CBVE Framework consists of nine domains of competence and 32 competencies, each supplemented with illustrative sub-competencies to guide veterinary schools in implementing competency-based education in their local context. The nine domains of competence are: clinical reasoning and decision-making; individual animal care and management; animal population care and management; public health; communication; collaboration; professionalism and professional identity; financial and practice management; and scholarship. Developed through diverse input to facilitate broad adoption, the CBVE Framework provides the foundation for competency-based curricula and outcomes assessment in veterinary education internationally. We believe that other groups seeking to design a collective product for broad adoption might find useful the methods used to develop the CBVE Framework, including establishing expertise diversity within a small-to-medium size working group, soliciting progressive input and feedback from stakeholders, and engaging in consensus building and critical reflection throughout the development process.
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Educación Basada en Competencias , Educación en Veterinaria , Animales , Competencia Clínica , Comunicación , Curriculum , Facultades de Medicina VeterinariaRESUMEN
Entrustable professional activities (EPAs) have been proposed as a practical framework for the implementation of competency-based education. As veterinary education moves toward a competency-based approach, core EPAs provide a context for assessment of workplace activities. This article reports on the development of eight core clinical EPAs for veterinary education created through multi-institutional collaboration, with international input from veterinary educators and veterinary educational leaders. These core EPAs are intended as minimal expectations for clinical activities that should be assessed for every graduate of Association of American Veterinary Medical Colleges member institutions. Adoption of the core EPAs and the associated Competency-Based Veterinary Education (CBVE) framework by veterinary schools is intended to promote Day One graduate competence and thereby enhance patient care and client service.
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Educación en Veterinaria , Internado y Residencia , Animales , Competencia Clínica , Educación Basada en Competencias , Educación de Postgrado en Medicina , Evaluación Educacional , Facultades de Medicina VeterinariaRESUMEN
Purpose: According to the principles of programmatic assessment, a valid high-stakes assessment of the students' performance should amongst others, be based on a multiple data points, supposedly leading to saturation of information. Saturation of information is generated when a data point does not add important information to the assessor. In establishing saturation of information, institutions often set minimum requirements for the number of assessment data points to be included in the portfolio. Methods: In this study, we aimed to provide validity evidence for saturation of information by investigating the relationship between the number of data points exceeding the minimum requirements in a portfolio and the consensus between two independent assessors. Data were analyzed using a multiple logistic regression model. Results: The results showed no relation between the number of data points and the consensus. This suggests that either the consensus is predicted by other factors only, or, more likely, that assessors already reached saturation of information. This study took the first step in investigating saturation of information, further research is necessary to gain in-depth insights of this matter in relation to the complex process of decision-making.
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Educación Basada en Competencias/estadística & datos numéricos , Evaluación Educacional/estadística & datos numéricos , Competencia Clínica , Retroalimentación Formativa , HumanosRESUMEN
Purpose: Despite the adoption of competency-based education in some veterinary schools over the past 15 years, only recently has a concerted effort been directed toward this in veterinary education internationally.Methods: In 2015, educational leaders from the Association of American Veterinary Medical Colleges (AAVMC) member schools came together with a strong call to action to create shared tools for clinical competency assessment.Results: This resulted in the formation of the AAVMC Competency-Based Veterinary Education (CBVE) Working Group, which then embarked on the creation of a shared competency framework and the development of eight core entrustable professional activities (EPAs) linked to this framework.Conclusions: This paper will report on the development of these EPAs and their integration with the concurrently-developed CBVE Framework.
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Educación Basada en Competencias , Educación en Veterinaria/normas , Docentes/psicología , Relaciones Interprofesionales , Competencia Clínica , Educación Basada en Competencias/métodos , Educación Basada en Competencias/normas , Educación en Veterinaria/métodos , Humanos , Facultades de Medicina VeterinariaRESUMEN
The reliability of high-stakes assessment of portfolios containing an aggregation of quantitative and qualitative data based on programmatic assessment is under debate, especially when multiple assessors are involved. In this study carried out at the Faculty of Veterinary Medicine, Utrecht University, the Netherlands, two independent assessors graded the portfolios of students in their second year of the 3-year clinical phase. The similarity of grades (i.e., equal grades) and the level of the grades were studied to estimate inter-rater reliability, taking into account the potential effects of the assessor's background (i.e., originating from a clinical or non-clinical department) and student's cohort group, gender, and chosen master track (Companion Animal Health, Equine Health, or Farm Animal/Public Health). Whereas the similarity between the two grades increased from 58% in the first year the grading system was introduced to around 80% afterwards, the grade level was lower over the next 3 years. The assessor's background had a minor effect on the proportion of similar grades, as well as on grading level. The assessor intraclass correlation was low (i.e., all assessors scored with a similar grading pattern [same range of grades]). The grades awarded to female students were higher but more often dissimilar. We conclude that the grading system was well implemented and has a high inter-rater reliability.
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Educación de Pregrado en Medicina , Educación en Veterinaria , Evaluación Educacional , Educación de Pregrado en Medicina/normas , Educación en Veterinaria/normas , Femenino , Humanos , Masculino , Países Bajos , Reproducibilidad de los Resultados , EstudiantesRESUMEN
Entrustable professional activities (EPAs) are professional tasks that can be entrusted to a student under a given level of supervision once he or she has demonstrated competence in these tasks. The EPA construct was conceived to increase transparency in objectives for clinical workplace learning and to help ensure patient safety and the quality of care. A first step in implementing EPAs in a veterinary curriculum is to identify the core EPAs of the profession. The aim of this study was to develop EPAs for farm animal health. An initial set of 36 EPAs for farm animal health was prepared by a team of six veterinarians and curriculum developers and used in a modified Delphi study. In this iterative process, the EPAs were evaluated until higher than 80% agreement was reached. Of 83 veterinarians who participated, 39 (47%) completed the Delphi procedure. After two rounds, the panel reached consensus. A small expert group further refined and reorganized the EPAs for educational purposes into seven core EPAs for farm animal health and 29 sub-EPAs. This study is an important step in optimizing competency-based training in veterinary medicine. Future steps are to implement EPAs in the curriculum and train supervisors to assess students' ability to perform EPAs with increasing levels of independence.
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Educación Basada en Competencias , Educación en Veterinaria , Evaluación Educacional , Animales , Animales Domésticos , Competencia Clínica , Educación Basada en Competencias/métodos , Curriculum , Técnica Delphi , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND: Entrustable Professional Activities (EPAs) combine feedback and evaluation with a permission to act under a specified level of supervision and the possibility to schedule learners for clinical service. This literature review aims to identify workplace-based assessment tools that indicate progression toward unsupervised practice, suitable for entrustment decisions and feedback to learners. METHODS: A systematic search was performed in the PubMed, Embase, ERIC, and PsycINFO databases. Based on title/abstract and full text, articles were selected using predetermined inclusion and exclusion criteria. Information on workplace-based assessment tools was extracted using data coding sheets. The methodological quality of studies was assessed using the medical education research study quality instrument (MERSQI). RESULTS: The search yielded 6,371 articles (180 were evaluated in full text). In total, 80 articles were included, identifying 67 assessment tools. Only a few studies explicitly mentioned assessment tools used as a resource for entrustment decisions. Validity evidence was frequently reported, and the MERSQI score was 10.0 on average. CONCLUSIONS: Many workplace-based assessment tools were identified that potentially support learners with feedback on their development and support supervisors with providing feedback. As expected, only few articles referred to entrustment decisions. Nevertheless, the existing tools or the principals could be used for entrustment decisions, supervision level, or autonomy.
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Toma de Decisiones , Educación en Veterinaria , Lugar de Trabajo , Animales , Competencia Clínica , Educación Basada en Competencias , Curriculum , Retroalimentación , HumanosRESUMEN
In medical education, students are increasingly regarded as active seekers of feedback rather than passive recipients. Previous research showed that in the intentions of students to seek feedback, a learning and performance goal can be distinguished. In this study, we investigated the intentions (defined as level and orientation of motivation) of different performing students (low, average, and high performing students) to seek feedback in the clinical workplace using Self-Determination Theory. We conducted a quantitative study with students in their clinical clerkships and grouped them based on their performance. The level of motivation was measured by the number of Mini-CEXs each student collected. The orientation of motivation was measured by conducting the Academic Self-Regulation Questionnaire. We found that high performing students were more motivated and demonstrated higher self-determination compared to low performing students.
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Prácticas Clínicas , Retroalimentación , Motivación , Estudiantes de Medicina/psicología , Lugar de Trabajo , Competencia Clínica , HumanosRESUMEN
CONTEXT: Narrative feedback documented in performance evaluations by the teacher, i.e. the clinical supervisor, is generally accepted to be essential for workplace learning. Many studies have examined factors of influence on the usage of mini-clinical evaluation exercise (mini-CEX) instruments and provision of feedback, but little is known about how these factors influence teachers' feedback-giving behaviour. In this study, we investigated teachers' use of mini-CEX in performance evaluations to provide narrative feedback in undergraduate clinical training. METHODS: We designed an exploratory qualitative study using an interpretive approach. Focusing on the usage of mini-CEX instruments in clinical training, we conducted semi-structured interviews to explore teachers' perceptions. Between February and June 2013, we conducted interviews with 14 clinicians participated as teachers during undergraduate clinical clerkships. Informed by concepts from the literature, we coded interview transcripts and iteratively reduced and displayed data using template analysis. RESULTS: We identified three main themes of interrelated factors that influenced teachers' practice with regard to mini-CEX instruments: teacher-related factors; teacher-student interaction-related factors, and teacher-context interaction-related factors. Four issues (direct observation, relationship between teacher and student, verbal versus written feedback, formative versus summative purposes) that are pertinent to workplace-based performance evaluations were presented to clarify how different factors interact with each other and influence teachers' feedback-giving behaviour. Embedding performance observation in clinical practice and establishing trustworthy teacher-student relationships in more longitudinal clinical clerkships were considered important in creating a learning environment that supports and facilitates the feedback exchange. CONCLUSION: Teachers' feedback-giving behaviour within the clinical context results from the interaction between personal, interpersonal and contextual factors. Increasing insight into how teachers use mini-CEX instruments in daily practice may offer strategies for creating a professional learning culture in which feedback giving and seeking would be enhanced.
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Prácticas Clínicas/métodos , Competencia Clínica , Evaluación Educacional/métodos , Retroalimentación Formativa , Adulto , Conducta , Comunicación , Femenino , Humanos , Relaciones Interpersonales , Entrevistas como Asunto , Masculino , ConfianzaRESUMEN
This Guide was written to support educators interested in building a competency-based workplace curriculum. It aims to provide an up-to-date overview of the literature on Entrustable Professional Activities (EPAs), supplemented with suggestions for practical application to curriculum construction, assessment and educational technology. The Guide first introduces concepts and definitions related to EPAs and then guidance for their identification, elaboration and validation, while clarifying common misunderstandings about EPAs. A matrix-mapping approach of combining EPAs with competencies is discussed, and related to existing concepts such as competency milestones. A specific section is devoted to entrustment decision-making as an inextricable part of working with EPAs. In using EPAs, assessment in the workplace is translated to entrustment decision-making for designated levels of permitted autonomy, ranging from acting under full supervision to providing supervision to a junior learner. A final section is devoted to the use of technology, including mobile devices and electronic portfolios to support feedback to trainees about their progress and to support entrustment decision-making by programme directors or clinical teams.
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Educación Basada en Competencias/organización & administración , Curriculum , Educación Médica Continua , Guías como Asunto , Lugar de Trabajo , Toma de Decisiones , Técnica Delphi , Retroalimentación , Humanos , Entrevistas como Asunto , Desarrollo de Programa , Encuestas y CuestionariosRESUMEN
Many veterinary curricula use seminars, interactive educational group formats in which some 25 students discuss questions and issues relating to course themes. To get indications on how to optimize the seminar learning process for students, we aimed to investigate relationships between factors that seem to be important for the seminar learning process, and to determine how these seminar factors account for differences in students' achievement scores. A 57-item seminar evaluation (USEME) questionnaire was administered to students right after they attended a seminar. In total, 80 seminars distributed over years 1, 2, and 3 of an undergraduate veterinary medicine curriculum were sampled and 988 questionnaires were handed in. Principal factor analysis (PFA) was conducted on 410 questionnaires to examine which items could be grouped together as indicators of the same factor, and to determine correlations between the derived factors. Multilevel regression analysis was performed to explore the effects of these seminar factors and students' prior achievement scores on students' achievement scores. Within the questionnaire, four factors were identified that influence the seminar learning process: teacher performance, seminar content, student preparation, and opportunities for interaction within seminars. Strong correlations were found between teacher performance, seminar content, and group interaction. Prior achievement scores and, to a much lesser extent, the seminar factor group interaction appeared to account for differences in students' achievement scores. The factors resulting from the present study and their relation to the method of assessment should be examined further, for example, in an experimental setup.
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Educación en Veterinaria , Evaluación Educacional , Enseñanza , Curriculum , Humanos , Encuestas y CuestionariosRESUMEN
INTRODUCTION: Health care professionals work and learn in complex environments. Some are able to continue learning from their practice and the challenges it presents, whereas others refrain from investing more effort when faced with setbacks. This paper discusses a social cognitive model of motivation that helps to explain the different kinds of behaviour that emerge when individuals are confronted with challenges. SELF-THEORIES: Self-theories (people's theories on what competence is and means for the self) play a major role in establishing the goals people set for themselves, the emotions they experience and the meanings they attach to situations. These self-views are often not explicitly articulated and are therefore called 'implicit' ('self-') theories. Social cognitive research suggests there are two distinct ways of thinking about one's personal attributes: entity theorists view a trait as a fixed, concrete internal entity, whereas incremental theorists instead believe a trait to be something malleable that can be developed or cultivated through effort. Holding an entity theory leads one to set performance goals and to harbour concerns about performing well and making a good impression. Holding an incremental theory tends to lead one to set learning goals, and to focus less on performance and more on spending time and effort in determining which strategies work. DISCUSSION: The current literature on self-theories is used to explore the relevance of these theories in medical education in three contexts: (i) it is argued that, in order to support lifelong learning, both individual and organisational efforts fit best with an incremental outlook on professional development; (ii) if it is to move forward in the domain of feedback-seeking behaviour, medical education might benefit from a better understanding of the interactions among self-theories, feedback behaviour, and the pervading role of organisational culture, and (iii) the impact of self-theories on assessors' evaluations of performance.
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Conducta , Cultura , Emociones , Objetivos , Médicos/psicología , Competencia Clínica , Humanos , Aprendizaje , Motivación , Autoimagen , Desarrollo de PersonalRESUMEN
CONTEXT: Why and how do students seek feedback on their performance in the clinical workplace and which factors influence this? These questions have remained largely unanswered in research into workplace learning during clinical clerkships. Research on feedback has focused mainly on feedback providers. Whether and how feedback recipients actively seek feedback are under-examined issues. Research in organisational psychology has proposed a mechanism whereby feedback seeking is influenced by motives and goal orientation mediated by the perceived costs and benefits of feedback. Building on a recently published model of resident doctors' feedback-seeking behaviour, we conducted a qualitative study to explore students' feedback-seeking behaviours in the clinical workplace. METHODS: Between April and June 2011, we conducted semi-structured face-to-face interviews with veterinary medicine students in Years 5 and 6 about their feedback-seeking behaviour during clinical clerkships. In the interviews, 14 students were asked about their goals and motives for seeking feedback, the characteristics of their feedback-seeking behaviour and factors influencing that behaviour. Using template analysis, we coded the interview transcripts and iteratively reduced and displayed the data until agreement on the final template was reached. RESULTS: The students described personal and interpersonal factors to explain their reasons for seeking feedback. The factors related to intentions and the characteristics of the feedback provider, and the relationship between the feedback seeker and provider. Motives relating to image and ego, particularly when students thought that feedback might have a positive effect on image and ego, influenced feedback-seeking behaviour and could induce specific behaviours related to students' orientation towards particular sources of feedback, their orientation towards particular topics for and timing of feedback, and the frequency and method of feedback-seeking behaviour. CONCLUSIONS: This study shows that during clinical clerkships, students actively seek feedback according to personal and interpersonal factors. Perceived costs and benefits influenced this active feedback-seeking behaviour. These results may contribute towards the optimising and developing of meaningful educational opportunities during clerkships.