This week’s episode is part two of the live recording from the 2019 International Conference on Residency Education (ICRE). The live events feature audience interaction which offers a different feel to the usual dynamics of our hosts. For this special event, Linda selected a paper that takes a look at feedback and debriefing: while both essential reflective exercises for learning and improving future performance, are they so different that they should remain separate or, should we consider merging the two into a shared framework? Listen in to the conversation here.
KeyLIME Session 240
Tavares et. al., Learning Conversations: An Analysis of Their Theoretical Roots and Their Manifestations of Feedback and Debriefing in Medical Education Acad Med. 2019 Jul 30
Linda Snell (@LindaSMedEd)
For experiential or work-based learning to be effective there must be reflection on experiences; feedback and debriefing are key facilitators of this reflective work.
Each is a type of learning conversation, which the authors define as ‘a dialogue informed by an educator’s observations of a learner’s behavior in actual or simulated clinical practice, conducted with the intention of improving future performance… educator attends to, processes, integrates, and then translates the
behaviors, then engages in dialogue or exchange of information with the learner with
the intent of improvement.” But many say these processes are different in process and setting (e.g. one vs bidirectional, sim vs real life). The authors suggest that the reason for this divide is that historically the theoretical underpinnings are different, and this may limit both the research on and the practice of these two types of learning conversations.
Feedback and debriefing – both essential for learning and improving future performance … are the underlying theories and actions unique, or is there a need to reconceptualize into a shared framework?
“ to examine the theoretical roots and manifestations related to feedback and debriefing … consider theoretical and contextual justifications for thinking about and studying each of these concepts as unique, and ask whether we can better understand learning conversations by keeping these concepts separate or can, instead, create a unifying conceptual framework that integrates the educational contributions of each.”
Key Points on the Methods
“selected these two strategies because of their long history, widespread use, and increasing focus in medical education research.”
“identified seminal works and foundational concepts to formulate a purposeful review and analysis exploring these dialogues’ theoretical roots and manifestations … considered conceptual and theoretical details within and across feedback and debriefing literatures and traced developmental paths to discover underlying and foundational conceptual approaches and theoretical similarities and differences.”
Feedback: Theoretical Roots and Their Manifestations: authors describe an evolution from Ende’s 1983 paper (more teacher-centric and unidirectional) through incorporating theories of motivation, task-related learning, reflection, self efficacy, reflection to a more bidirectional , cognitive theory-based process such as R2C2 (relationship, reaction, content, coaching).
Debriefing: Theoretical Roots and Their Manifestations: ‘guiding learners through a structured interactive reflective discussion with a systematic analysis of their experience.’ Aims to attain a shared
understanding. Influenced by theories from organization, social psychology and work of Kolb and Schon and Ericsson.
These approaches account for learner reactions or social interactions in a psychologically safe , supportive learning environment. more about understanding, revealing, and elaborating underlying mechanisms driving
behavior for a given clinical situation, to afford learners the opportunity to modify mental models and generalize response
Overlap: Integrating Feedback and Debriefing
(1) each derived from distinct theoretical roots, with variations in how they have been studied and enacted; (2) both draw on multiple, similar, educational theories, that are operationalized differently; (3) commonality between each now exists, with similar leveraging of cognitive and social theories
Differences may be in part of context: simulation vs clinical setting; control vs opportunistic; opportunity to review and repeat in sim.
Similar process informed by observation and experience that targets cognitive and affective domains within social contexts; both are formative activities with similar process and both have grappled with social aspects that shape learning, e.g safety, relationships, trust, and credibility, values.
Complementary aspects (debriefing traditions focus on psychological safety and guided reflection, while feedback traditions focus on relationship, credibility, and emotion.)may lead to a blended model: focused facilitation, learner self-assessment, and teaching/directive feedback.
The authors present a concept map.
The authors propose that “it is time to consider merging these educational strategies into a single category, learning conversations, treating any distinguishing features as resources from which to select for particular educational use or benefit.”
Future work should further delineate the theoretical, educational, and practical relevance of integrating these 2 concepts.
Spare Keys – other take home points for clinician educators
“Medical educators require a sophisticated repertoire of conversational strategies that can be tailored to support learning across an ever-expanding range of contexts and settings.”
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