“In an effort to ensure that feedback occurs regularly, medicine’s learning culture tends to formalise feedback interactions between teachers and learners. As a result, learners may view feedback as a bureaucratic requirement more than as a learning opportunity, a circumstance that does not nurture learners’ internal motivation. Learners also worry that seeking feedback will not only burden their already overly busy clinician teachers, but may also limit their independence or be mistaken for lack of confidence. Consequently, the feedback process may hold few rewards for learners.”
I was really struck by the truth of LaDonna and Watling’s words in this paragraph. By making workplace-based assessment (WBA) an assessment at all times, are we doing our learners a disservice? (I actually prefer the GMC terminology introduced in 2012 – supervised learning event) After reflecting on this question, I think we are.
Previously, I used to believe that feedback and assessment sat on a spectrum, that there was no real dichotomy; that you could have assessment for learning and assessment of learning. That is, formative and summative assessment. I believed that you could marry the two together, and everyone could be happy. Educators would get the assessments they need, and trainees would get the feedback they need.
However, I’ve realised that this isn’t the case. I would estimate that a minority of supervisors truly use WBA as they are intended (as assessment for learning) and the majority end up using them as only one-way assessments messages (i.e. no or minimal dialogue). The problem might be tied up in the language (the word assessment has certain connotations), or it might lie with the supervisors (their training, their lived experiences, etc.) and the power they wield over the trainees. But my reading on mnemic neglect and self-serving bias leads me to believe there are powerful psychological self-defence mechanisms at play in the trainee that may simply be too powerful to overcome. I’ve come to realise that our colleagues in the business/legal professions (Stone and Heen) are right in separating feedback into appreciation, coaching and evaluation.
Therefore my question is – How do we de-formalise feedback? How can we decouple feedback from assessment? For I have come to believe that in and of itself, assessment brings with it a sense of formality, and a sense of being judged. (And really, who likes being judged?) I think we are getting glimpses of it with things like John Young’s phone app which purposely asks supervisors for just one thing that the trainee can work on going forward.
I think we are also seeing it come through in the educational alliance – an agreement on learning goals, the methods of getting there, and a positive view of the relationship between trainee and supervisor. But ultimately, I think that we need to re-think the dual purpose of WBAs. I think we need to use coaching (Heen definition – anything aimed to help you learn) as our model for teaching/giving feedback and give it a different name such as supervised learning event or supervised coaching moment, and separate out the assessment component (and perhaps delegate some of this task to the patients who ultimately bear the cost of poor assessment practices in medical education).
Dr Andrew Huang's Blog 