Designing feedback processes in the workplace-based learning of undergraduate health professions education: a scoping review.

BACKGROUND: Feedback processes are crucial for learning, guiding improvement, and enhancing performance. In workplace-based learning settings, diverse teaching and assessment activities are advocated to be designed and implemented, generating feedback that students use, with proper guidance, to close the gap between current and desired performance levels. Since productive feedback processes rely on observed information regarding a student's performance, it is imperative to establish structured feedback activities within undergraduate workplace-based learning settings. However, these settings are characterized by their unpredictable nature, which can either promote learning or present challenges in offering structured learning opportunities for students. This scoping review maps literature on how feedback processes are organised in undergraduate clinical workplace-based learning settings, providing insight into the design and use of feedback. METHODS: A scoping review was conducted. Studies were identified from seven databases and ten relevant journals in medical education. The screening process was performed independently in duplicate with the support of the StArt program. Data were organized in a data chart and analyzed using thematic analysis. The feedback loop with a sociocultural perspective was used as a theoretical framework. RESULTS: The search yielded 4,877 papers, and 61 were included in the review. Two themes were identified in the qualitative analysis: (1) The organization of the feedback processes in workplace-based learning settings, and (2) Sociocultural factors influencing the organization of feedback processes. The literature describes multiple teaching and assessment activities that generate feedback information. Most papers described experiences and perceptions of diverse teaching and assessment feedback activities. Few studies described how feedback processes improve performance. Sociocultural factors such as establishing a feedback culture, enabling stable and trustworthy relationships, and enhancing student feedback agency are crucial for productive feedback processes. CONCLUSIONS: This review identified concrete ideas regarding how feedback could be organized within the clinical workplace to promote feedback processes. The feedback encounter should be organized to allow follow-up of the feedback, i.e., working on required learning and performance goals at the next occasion. The educational programs should design feedback processes by appropriately planning subsequent tasks and activities. More insight is needed in designing a full-loop feedback process, in which specific attention is needed in effective feedforward practices.

Percepción de la Kinesiterapia posterior a la Pandemia SARS-CoV-2 en Grupo de Médicos y Médicas de una Institución de Salud Chilena / Physiotherapy perception during SARS-CoV-2 pandemic

Introducción. La kinesiología es una profesión que busca identificar, maximizar la calidad de vida y potencial de movimiento; para prevenir, tratar o intervenir, habilitando y rehabilitando a las personas. Esta contribuye al bienestar físico, psicológico, emocional y social de las personas. En Chile, los kinesiólogos son parte fundamental del equipo de salud interprofesional. Es por esto que conocer la percepción que tienen los médicos sobre el que hacer kinesiológico es fundamental. Objetivo. Hasta el momento, no existe información al respecto, por lo que el objetivo de este estudio es identificar la percepción del estamento médico, sobre la kinesiología, en una de las principales instituciones de salud en Chile. Métodos. Para esto se planteó un estudio de carácter mixto, al incluir análisis cualitativo y cuantitativo. Aplicando una encuesta online, con preguntas tipo likert y preguntas de desarrollo, al estamento médico de la Red de Salud UC Christus, que evaluó la percepción de dichos profesionales sobre el quehacer de los kinesiólogos(as) durante la pandemia. La recolección de datos se llevó a cabo durante los meses de mayo a diciembre del 2021. Resultados. A través del análisis cualitativo del estudio, la pandemia por COVID-19 visibilizó la importancia de kinesiólogas y kinesiólogos, mejorando la impresión en grupo médico manifestándose en el aumento de derivación. Optimizando la percepción del trabajo kinesiológico dentro del equipo multidisciplinario de salud en el centro de salud encuestado. De las respuestas cuantitativas no se identificaron resultados significativos. Conclusión. este es un primer abordaje sobre el conocimiento del trabajo de los kinesiólogos(as) por parte del equipo médico en población chilena. Tras este estudio queda expuesta la importancia de que el equipo de salud conozca de mejor manera la profesión de kinesiología, en beneficio del paciente y del óptimo desempeño en un equipo multidisciplinario.

Background. Physiotherapy is a profession that seeks to identify and maximize the quality of life and movement potential; to prevent, treat or intervene, enabling and rehabilitating people. This contributes to the physical, psychological, emotional and social well-being of people. In Chile, physiotherapists are fundamental part of the interprofessional health team. This is why knowing the perception that doctors have about physiotherapists doing is fundamental. Objetive. Up to now, there is no information in this regard, so the objective of this study is to identify the perception of the medical establishment, on physiotherpy, in one of the main health institutions in Chile. Methods. A cross-sectional descriptive study was proposed. Applying an online survey to the medical establishment of a health centre, which evaluated the perception of these professionals about the work of physiotherapists during the pandemic. Data collection was carried out during the months of May to December 2021. Results. The Covid 19 pandemic optimized the perception of physiotherapist work within the multidisciplinary health team at the surveyed health center. Conclusion. this is a first approach on the knowledge of the work of physiotherapists by the medical team in the Chilean population. After this study, the importance of the health team knowing the kinesiology profession better is exposed, for the benefit of the patient and optimal performance in a multidisciplinary team.

Remote, asynchronous training and feedback enables development of neurodynamic skills in physiotherapy students.

BACKGROUND: During the COVID-19 pandemic, face-to-face teaching and learning of physiotherapy practical skills was limited. Asynchronous, remote training has been effective in development of clinical skills in some health professions. This study aimed to determine the effect of remote, asynchronous training and feedback on development of neurodynamic skills in physiotherapy students. METHODS: Longitudinal repeated measurements study, across four training sessions. Participants engaged in a remote training program for development of upper limb neurodynamic techniques. In this sequential training, participants viewed the online tutorial, practiced independently, and uploaded a video of their performance for formative assessment and feedback from a trained instructor via a checklist and rubric. RESULTS: Intra-subject analyses of 60 third-year physiotherapy students showed that the target standard of performance, with no further significant change in scores, was attained following session 2 for the checklist and session 3 for the rubric. This shows that two sessions are required to learn the procedures, and three sessions yield further improvements in performance quality. CONCLUSION: The remote, asynchronous training and feedback model proved to be an effective strategy for students' development of neurodynamic testing skills and forms a viable alternative to in-person training. This study contributes to the future of acquiring physiotherapy clinical competencies when distance or hybrid practice is required.

Barreras para las actividades de investigación en los programas de residencia: estudio de métodos mixtos / Barriers for research activities in residency programs: A mix-methods study

Introducción Las actividades de investigación tienen un impacto positivo en el rendimiento de los médicos residentes. Falta información sobre investigaciones desarrolladas por residentes de países en vías de desarrollo. Nuestro objetivo fue evaluar las barreras y facilitadores para la investigación en programas de residencia en una Facultad de Medicina de América Latina. Métodos Se llevó a cabo un diseño de estudio de metodología mixta. Utilizamos un enfoque de teoría fundamentada para la fase cualitativa, recopilando los datos a través de entrevistas semiestructuradas y grupos focales con profesores y residentes. Para la fase cuantitativa, se administraron encuestas a residentes y profesores. Para evaluar las propiedades psicométricas de las encuestas utilizamos análisis factorial y scree plot (validez); alfa de Cronbach y coeficiente de Correlación Intraclase (confiabilidad). Resultados Se realizaron grupos focales que incluyeron diez profesores y quince residentes, y se identificaron los siguientes dominios: a) facilitadores para la participación de los residentes, b) barreras, c) estrategias para introducir la investigación en el currículo, d) argumentos que respaldan las actividades de investigación durante la residencia, y e) perfil de los residentes motivados en la investigación. Tanto los residentes como el profesorado identificaron la falta de tiempo protegido y la ausencia de tutoría adecuada como las principales barreras. Se encontró una brecha de género relacionada con las publicaciones internacionales (34% vs 66% mujeres/hombres), las mujeres percibieron que las actividades de investigación 'compiten con otras actividades' (OR: 2.04, IC 95% 1.03 a 4.07). Conclusiones Los residentes y profesores de una universidad latinoamericana de alta productividad valoran mucho la investigación. La presencia de brecha de género, la falta de tiempo protegido y de tutorías destacan como las principales barreras. Las estrategias propuestas para mejorar la investigación dentro de los programas de residencia son: establecer un programa de tutoría interdisciplinario entre residentes e investigadores; promover las rotaciones electivas; y premiar propuestas que consideren la equidad de género.

Introduction Research activities have a positive impact on the performance of residents. However, information on research conducted by residents from developing countries is scarce. Our study sought to identify the barriers and facilitators for developing research in medical residency programs in a Latin-American faculty of medicine. Methods A mixed methodology study design was carried out. We used a grounded theory approach for the qualitative phase, collecting data through semi-structured interviews and focus groups with faculty and residents. For the quantitative phase, surveys were administered to residents and teachers. We used factor analysis and scree plot (validity), Cronbach's alpha, and Intraclass correlation coefficient (reliability) to evaluate the surveys' psychometric properties. Results Focus groups involving ten faculty members and 15 residents were conducted, and the following domains were identified: a) facilitators for resident participation, b) barriers, c) strategies for introducing research into the curriculum, d) arguments supporting research activities throughout medical residency, and e) profile of research-motivated residents. Both residents and faculty members identified a lack of protected time and adequate mentoring as the major barriers. A gender gap was found related to international publications (34% vs. 66% women/men); women perceived that research activities 'compete with other activities' (OR: 2.04, 95% CI 1.03 to 4.07). Conclusions Research is highly valued by both residents and faculty members at a Latin-American university with a strong academic output. Major barriers to promoting research in this context include lack of protected time and effective mentoring, and gender gaps. Strategies proposed to improve research within medical residency programs include: establishing an interdisciplinary mentoring program between residents and researchers, promoting elective rotations, and rewarding proposals that consider gender equity.

Barriers for research activities in residency programs: A mix-methods study.

Introduction: Research activities have a positive impact on the performance of residents. However, information on research conducted by residents from developing countries is scarce. Our study sought to identify the barriers and facilitators for developing research in medical residency programs in a Latin-American faculty of medicine. Methods: A mixed methodology study design was carried out. We used a grounded theory approach for the qualitative phase, collecting data through semi-structured interviews and focus groups with faculty and residents. For the quantitative phase, surveys were administered to residents and teachers. We used factor analysis and scree plot (validity), Cronbach's alpha, and Intraclass correlation coefficient (reliability) to evaluate the surveys' psychometric properties. Results: Focus groups involving ten faculty members and 15 residents were conducted, and the following domains were identified: a) facilitators for resident participation, b) barriers, c) strategies for introducing research into the curriculum, d) arguments supporting research activities throughout medical residency, and e) profile of research-motivated residents. Both residents and faculty members identified a lack of protected time and adequate mentoring as the major barriers. A gender gap was found related to international publications (34% vs. 66% women/men); women perceived that research activities 'compete with other activities' (OR: 2.04, 95% CI 1.03 to 4.07). Conclusions: Research is highly valued by both residents and faculty members at a Latin-American university with a strong academic output. Major barriers to promoting research in this context include lack of protected time and effective mentoring, and gender gaps. Strategies proposed to improve research within medical residency programs include: establishing an interdisciplinary mentoring program between residents and researchers, promoting elective rotations, and rewarding proposals that consider gender equity.

Introducción: Las actividades de investigación tienen un impacto positivo en el rendimiento de los médicos residentes. Falta información sobre investigaciones desarrolladas por residentes de países en vías de desarrollo. Nuestro objetivo fue evaluar las barreras y facilitadores para la investigación en programas de residencia en una Facultad de Medicina de América Latina. Métodos: Se llevó a cabo un diseño de estudio de metodología mixta. Utilizamos un enfoque de teoría fundamentada para la fase cualitativa, recopilando los datos a través de entrevistas semiestructuradas y grupos focales con profesores y residentes. Para la fase cuantitativa, se administraron encuestas a residentes y profesores. Para evaluar las propiedades psicométricas de las encuestas utilizamos análisis factorial y scree plot (validez); alfa de Cronbach y coeficiente de Correlación Intraclase (confiabilidad). Resultados: Se realizaron grupos focales que incluyeron diez profesores y quince residentes, y se identificaron los siguientes dominios: a) facilitadores para la participación de los residentes, b) barreras, c) estrategias para introducir la investigación en el currículo, d) argumentos que respaldan las actividades de investigación durante la residencia, y e) perfil de los residentes motivados en la investigación. Tanto los residentes como el profesorado identificaron la falta de tiempo protegido y la ausencia de tutoría adecuada como las principales barreras. Se encontró una brecha de género relacionada con las publicaciones internacionales (34% vs 66% mujeres/hombres), las mujeres percibieron que las actividades de investigación 'compiten con otras actividades' (OR: 2.04, IC 95% 1.03 a 4.07). Conclusiones: Los residentes y profesores de una universidad latinoamericana de alta productividad valoran mucho la investigación. La presencia de brecha de género, la falta de tiempo protegido y de tutorías destacan como las principales barreras. Las estrategias propuestas para mejorar la investigación dentro de los programas de residencia son: establecer un programa de tutoría interdisciplinario entre residentes e investigadores; promover las rotaciones electivas; y premiar propuestas que consideren la equidad de género.

A comprehensive approach to identify challenges for clinical reasoning development in undergraduate dental students and their potential solutions.

INTRODUCTION: Clinical reasoning is a core competence in health professions that impacts the ability to solve patients' health problems. Due to its relevance, it is necessary to identify difficulties arising from different sources that affect clinical reasoning development in students. The aim of this study was to explore a comprehensive approach to identify challenges for clinical reasoning development in undergraduate dental students and their potential solutions. METHODS: Mixed methods were used in four stages: (1) students and clinical teachers focus groups to identify challenges to clinical reasoning development; (2) literature review to explore potential solutions for these challenges; (3) Delphi technique for teacher consensus on pertinence and feasibility of solutions (1-5 scale); and (4) teachers' self-perception of their ability to implement the solutions. RESULTS: Three categories and seven subcategories of challenges were identified: (I) educational context factors influencing the clinical reasoning process; (II) teacher's role in clinical reasoning development; and (III) student factors influencing the clinical reasoning process. From 134 publications identified, 53 were selected for review, resulting in 10 potential solutions. Through two Delphi rounds, teachers rated the potential solutions very highly in terms of relevance (4.50-4.85) and feasibility (3.50-4.29). Finally, a prioritisation ranking of these solutions was generated using their scores for relevance, feasibility, and teachers' self-perception of their ability to implement them. CONCLUSIONS: The present comprehensive approach identified challenges for clinical reasoning development in dental students and their potential solutions, perceived as relevant and feasible by teachers, requiring further research and follow-up actions to address them.

The best mirror of the students' longitudinal performance: Portfolio or structured oral exam assessment at clerkship?

OBJECTIVE: This study aimed to compare the strength of association (i.e., explained variability) of the cumulative grade point average (GPA) with the grades obtained in the clerkship portfolio and the final structured oral exam by dental students. METHODS: A prospective longitudinal study was designed to analyze quantitative data from three cohorts of dental school students. Univariate and multivariate linear regression models were built to evaluate the association between the students' cumulative GPA with the grades obtained in their clerkship portfolio and the final structured oral exam. RESULTS: In total, 171 students in the last year of the undergraduate program were considered (76% women, age average 24.8 ± 1.6 years). The dental students' grades of both portfolio and structured oral exam were significantly associated with the GPA score but with different strengths of association. The clerkship portfolio was more strongly associated with cumulative GPA than the structured oral exam (R2  = 19.6% versus R2  = 7.6%). On the opposite, the association between the structured oral exam and GPA can be interpreted as a lower precision in its practical significance and thus reflecting different concurrent validity. CONCLUSIONS: Considering the results of this study, it could probably incline the balance toward the portfolio because it may be closer to a programmatic assessment model, with timely feedback, development of metacognition, and the achievement of formative process measurement rather than evidence of a single instance of examination.

Adaptation, psychometric properties, and implementation of the Mini-CEX in dental clerkship.

BACKGROUND: Workplace-based assessment is a key component of dental-student clerkships, allowing students to demonstrate clinical proficiency. PURPOSE: This study adapts the Mini-Clinical Evaluation Exercise (Mini-CEX) to a dentistry-program clerkship, analyzing the results and examining the psychometric properties of Mini-CEX. METHODS: First, Delphi panel methodology was used to ensure content validity. Mini-CEX was then piloted in the dental-clerkship program, with each student assessed by at least 2 supervisors and a peer student. Subsequently, psychometric properties, acceptability, and observation time were analyzed. RESULTS: The study was conducted between July and November 2019. Overall, 140 Mini-CEX evaluation exercises were carried out on 30 students by 84 supervisors and 56 peers. The adapted instrument was found to be unidimensional, obtaining an acceptable internal consistency (α = 0.74). As the assessor type changed, there were differences in observation time; the medians (Q1-Q3) were 10 minutes (5-15) for supervisors and 30 minutes (20-45) for peer students (P < 0.001). This difference was also observed in assessor perceptions (P < 0.001), with supervisors scoring a median of 6 (6-6.75) and peer students scoring a median of 7 (6-7). No differences were found between supervisor and peer scores. CONCLUSION: The adapted version of Mini-CEX can objectively assess the clinical performance of dental students, achieving validity and reliability values similar to those obtained in the original instrument.

Razonamiento clínico inductivo o deductivo: una propuesta cualitativa en kinesiología / nductive or deductive clinical reasoning: a proposal qualitative in kinesiology

Introducción: a través del proceso de razonamiento clínico, los profesionales de la salud evalúan críticamente sus intervenciones, siendo esta habilidad necesaria para reconocer qué factores son relevantes para el usuario, a fin de realizar juicios clínicos apropiados que contribuyan a la condición de salud óptima del paciente. La literatura indica que el proceso en un estudiante puede no ser lineal, siendo necesario retroceder y buscar nuevas soluciones y patrones para determinar una elección terapéutica. Objetivo: describir el proceso de razonamiento clínico realizado en estudiantes de ciclo intermedio de Kinesiología en la Universidad de Concepción. Método: investigación cualitativa y descriptiva. 7 estudiantes de tercer y cuarto año de la Universidad de Concepción participaron en la recolección de datos, siguiendo un proceso de consentimiento informado. Se aplicó un cuestionario sociodemográfico y se analizaron los problemas kinesiológicos de un caso clínico mediante asociación libre. Los registros se obtuvieron con una grabadora y luego se realizó un análisis de contenido utilizando CAQDAS Atlas-ti 7.5.2. Resultados: a partir de la lectura de los documentos grabados, surgieron 335 unidades asociadas al razonamiento clínico de los estudiantes de Kinesiología. Estas unidades se agruparon en 58 códigos y estos a su vez, en 2 categorías: razonamiento deductivo y razonamiento inductivo. Discusión: el análisis del proceso es esencial para identificar qué estrategias buscan los estudiantes para resolver en un caso clínico, qué diferencias y particularidades existen entre los estudiantes, y qué metodologías de enseñanza son las más adecuadas para guiar apropiadamente las decisiones terapéuticas que enfrentarán los profesionales de la salud en forma diaria.(AU)

Introduction: Through the clinical reasoning process, health professionals critically evaluate their interventions, being these skills required to recognize which factors are relevant to the user, in order to make appropriate clinical judgments that contribute to the optimal health condition of the user. The literature shows that the student´s process may not be linear, needing to go back and look for new solutions and patterns to determine a therapeutic choice. Objective: Describe the process of clinical reasoning carried out in Physiotherapy students who study in the intermediate cycle at the University of Concepción. Method: Qualitative and descriptive research. 7 students from third and fourth year at the Universidad de Concepción started the sample collection, following an informed consent process. A socio-demographic questionnaire was applied, and kinesthetic problems of a clinical case were analyzed by free association. Records were obtained with a tape recorder and then a content analysis was performed using CAQDAS Atlas-ti 7.5.2. Results: From the listening of the recorded documents, 335 units emerged associated with the clinical reasoning of the Physiotherapy students. These units were grouped into 58 codes and these in turn, in 2 categories: deductive reasoning and inductive reasoning. Discussion: Analysis of the process is essential to identify which strategies students seek to resolve a case, what differences and particularities exist among students, and which teaching strategies are best suited to adequately guide the therapeutic decisions they will face as health professionals on a daily basis.(AU)