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PhD (Problem (Assessment of quality is problematic - we should be aiming…
PhD
Problem
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WBAs as authentic assessments OF learning have been introduced. The use of WBAs as assessment FOR learning is still evolving.
Most assessments are treated by supervisors and trainee as a tick and flick exercise rather than a meaningful source of feedback. This is a cultural issue?
Most specialist doctors, in spite of the aim of the medical expert to encompass the scholar role, are trained to be expert (or dare I say experienced non-expert) clinicians. We are NOT taught to be assessors/teachers/feedback givers
The relationships in medical education are very complex. There are (often) unacknowledged power differentials between trainees and supervisors with dependent positions of the trainees. These power gradients then complicate the relationship of the feedback giver and receiver
Often new assessments are/have been introduced by colleges with little or no faculty development or training in the use of the instrument or assessment tool
Because of lack of training, many supervisors default to what Freire would consider the method of teaching "deposits" and learning/teaching as a one way street/conversation, of "pouring knowledge" into trainee heads, rather than learning be a co-constructed phenomenon
We are all human and make errors in judgement. Some of these errors in judgement/assessment are due to physical and cognitive blindspots/inattentional blindness. Sometimes we simply make bad decisions. Sometimes those decisions are perceived as being unfair. (Johari window; Chabris)
There is a tension in clinical medicine between supervision (safety) and service provision (efficiency).
We use experiential learning (Kolb) in medicine. However in the rushed clinical context, the learning opportunities are diminished due to lack of time, lack of awareness and the absence of people to act as sounding boards. (Beard)
Sometimes we simply don't have the opportunity to reflect
Critical feedback often incites a defensive posture from the receiver, or is rejected outright (possibly due to psychological self-defence mechanisms). We also have underlying irrational "self-talk" or inner dialogue (Ellis quoted by Egan quoted by Beard)
Because we are blind to some of our errors, we will be unable to reflect and learn from them (Beard; Dweck)
The environment (co-created by the patient, the trainee, the supervisor and the hospital/institution) may also hinder learning
On relationships - emotions and perception of the intent of the feedback giver can influence whether the feedback is received (Beard; Watling)
Anxiety, fear and stress also influence learning (Fineman in Beard)
Trainees are working under high levels of stress and anxiety (and high cognitive loads) when being directly supervised. Their thought processes are being mediated in System 2 as they are not yet experts. This adds to propensity to inattentional blindness, cognitive overload and suboptimal learning. It also creates a barrier to reflection-in-action (Schon)
Feedback given is often at level 3 of the communication iceberg (Beard) rather than at level 4 (feelings and emotions) and level 5 (deep rapport)
Questions
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Does video facilitating feedback help supervisors and trainees engage better in the marking rubric and what quality really looks like? If so, how?
Does the use of video in facilitating the feedback help democratise the supervisor/trainee relationship and if so how? Can it help to flatten the power structures by making the assessment task more transparent? Can it transform the act of giving feedback from a depositing culture to a co-creating of learning culture?
What effects will the use of video have on anxiety, fear and stress which can create barriers to learning?
What happens when we uncover physical blindspots (in the trainees) and inattentional blindness (in the supervisors and trainees) using video?
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