Factors influencing responsiveness to feedback: on the interplay between fear, confidence, and reasoning processes

Self-appraisal has repeatedly been shown to be inadequate as a mechanism for performance improvement. This has placed greater emphasis on understanding the processes through which self-perception and external feedback interact to influence professional development. As feedback is inevitably interpreted through the lens of one’s self-perceptions it is important to understand how learners interpret, accept, and use feedback (or not) and the factors that influence those interpretations. 134 participants from 8 health professional training/continuing competence programs were recruited to participate in focus groups. Analyses were designed to (a) elicit understandings of the processes used by learners and physicians to interpret, accept and use (or not) data to inform their perceptions of their clinical performance, and (b) further understand the factors (internal and external) believed to influence interpretation of feedback. Multiple influences appear to impact upon the interpretation and uptake of feedback. These include confidence, experience, and fear of not appearing knowledgeable. Importantly, however, each could have a paradoxical effect of both increasing and decreasing receptivity. Less prevalent but nonetheless important themes suggested mechanisms through which cognitive reasoning processes might impede growth from formative feedback. Many studies have examined the effectiveness of feedback through variable interventions focused on feedback delivery. This study suggests that it is equally important to consider feedback from the perspective of how it is received. The interplay observed between fear, confidence, and reasoning processes reinforces the notion that there is no simple recipe for the delivery of effective feedback. These factors should be taken into account when trying to understand (a) why self-appraisal can be flawed, (b) why appropriate external feedback is vital (yet can be ineffective), and (c) why we may need to disentangle the goals of performance improvement from the goals of improving self-assessment

Participation des médecins aux séances scientifiques planifiées

Background: Physician participation in regularly scheduled series (RSS), also known as grand rounds, was explored with a particular focus on physician perceptions about the elements that affected their engagement in RSS and the unanticipated benefits to RSS. Methods: A qualitative study using semi-structured interviews and thematic analysis examined physicians’ perception of their knowledge and educational needs and the factors that contributed to engagement in their local hospital RSS. Results: Physician engagement in RSS was affected by four major themes: Features that Affect the RSS’ Quality; Collegial Interactions; Perceived Outcomes of RSS; and Barriers to participation in RSS. Features that Affect RSS’ Quality were specific modifiable features that impacted the perceived quality of the RSS. Collegial Interactions were interactions that occurred between colleagues directly or indirectly as a result of attending RSS. Outcomes of RSS were specific outcome measures used in RSS sessions. Barriers were seen as reasons why physicians were unwilling or unable to participate in RSS. All of the elements identified within the four themes contributed to the development of physician engagement. Physicians also identified changes directly and indirectly due to RSS. Discussion: Specific features of RSS result in enhanced physician engagement. There are benefits that may not be accounted for in continuing medical education (CME) outcome study designsContexte : Nous examinons la participation des médecins aux séries de conférences planifiées (SCP) planifiées à l’avance, également connues sous le nom de séances scientifiques, plus particulièrement sous l’angle des perceptions des médecins quant aux éléments qui ont déterminé leur participation et quant aux avantages inattendus des SAR. Méthode : La perception qu'ont les médecins de leurs connaissances et de leurs besoins de formation, ainsi que des facteurs qui les ont poussés à participer aux SCP de leur hôpital sont examinés par le biais d’une étude qualitative comprenant des entretiens semi-dirigés et une analyse thématique. Résultats : Les facteurs qui déterminent la participation des médecins aux SCP se classent en quatre grands thèmes : les caractéristiques qui affectent la qualité des SCP, l’interaction entre collègues, les résultats perçus des SAR et les obstacles à leur participation aux SCP. Les premières sont des caractéristiques modifiables précises, qui influencent la qualité perçue des SCP. Les secondes sont les interactions entre collègues qui se produisent directement ou indirectement à la suite de la participation à une SCP. Les résultats des SCP sont des indicateurs de résultats précis utilisés dans les séances d’activités régulières. Sont considérés comme obstacles les raisons pour lesquelles les médecins ne voulaient pas ou ne pouvaient pas prendre part aux SCP. Tous les éléments décelés de chacun des quatre thèmes ont contribué à favoriser la participation des médecins. Les médecins ont également trouvé des changements qui sont directement ou indirectement liés aux SCP. Discussion : Certains traits spécifiques des SCP favorisent une participation accrue des médecins. Il est possible que les études de résultats du développement professionnel continu (DPC) ne tiennent pas compte de tous les avantages que les SCP procurent

Knowledge translation of an online tool to determine candidacy for epilepsy surgery evaluation

BackgroundGuidelines recommend that surgery be considered in patients with drug-resistant epilepsy, yet delays to epilepsy surgery still exist. A Web-based, evidence-informed clinical decision tool (www.toolsforepilepsy.com) was developed to help physicians determine which patients are appropriate for an epilepsy surgery evaluation. We evaluated the usability and feasibility of the tool with the intended end users in order to improve implementation into practice.MethodsUsability testing was conducted with relevant end users. After the tool was modified based on usability results, another group of end users trialed the tool in their clinical practice. This latter group of end users then participated in focus groups and semi-structured interviews to address barriers and facilitators to tool implementation. Finally, a stakeholder meeting was held with domain experts and end users to discuss further changes to the tool and implementation strategies.ResultsSix overall themes were identified through usability testing, and an additional 11 themes were identified through the focus groups and interviews. The tool was modified based on these findings, which were then presented at the stakeholder meeting of experts and end users for further refinement. The findings were also used to guide discussions of potential implementation strategies at the meeting.ConclusionThis study provides guidance on how to improve the usability of clinical decision tools by engaging end users, experts, and other key stakeholders. The modifications to the tool should facilitate its implementation in clinical practice and ultimately enhance the quality of care persons with epilepsy receive

OpenLabyrinth for Learning and Teaching

Short presentation about using OpenLabyrinth virtual patient platform for learning and teaching in other areas. Although OpenLabyrinth was designed specifically for virtual patients, any algorithmic pathway or decision tree can be represented - it does not have to be clinical at all. OLab also contains many options for presenting questions and quizzes, including Situational Judgement Testing, Script Concordance Testing and other survey designs.Ye

Physician engagement in regularly scheduled rounds

Background: Physician participation in regularly scheduled series (RSS), also known as grand rounds, was explored with a particular focus on physician perceptions about the elements that affected their engagement in RSS and the unanticipated benefits to RSS.&#x0D; Methods: A qualitative study using semi-structured interviews and thematic analysis examined physicians’ perception of their knowledge and educational needs and the factors that contributed to engagement in their local hospital RSS.&#x0D; Results: Physician engagement in RSS was affected by four major themes: Features that Affect the RSS’ Quality; Collegial Interactions; Perceived Outcomes of RSS; and Barriers to participation in RSS. Features that Affect RSS’ Quality were specific modifiable features that impacted the perceived quality of the RSS. Collegial Interactions were interactions that occurred between colleagues directly or indirectly as a result of attending RSS. Outcomes of RSS were specific outcome measures used in RSS sessions. Barriers were seen as reasons why physicians were unwilling or unable to participate in RSS. All of the elements identified within the four themes contributed to the development of physician engagement. Physicians also identified changes directly and indirectly due to RSS.&#x0D; Discussion: Specific features of RSS result in enhanced physician engagement. There are benefits that may not be accounted for in continuing medical education (CME) outcome study designs</jats:p

Physician engagement in regularly scheduled rounds

Background: Physician participation in regularly scheduled series (RSS), also known as grand rounds, was explored with a particular focus on physician perceptions about the elements that affected their engagement in RSS and the unanticipated benefits to RSS.Methods: A qualitative study using semi-structured interviews and thematic analysis examined physicians’ perception of their knowledge and educational needs and the factors that contributed to engagement in their local hospital RSS.Results: Physician engagement in RSS was affected by four major themes: Features that Affect the RSS’ Quality; Collegial Interactions; Perceived Outcomes of RSS; and Barriers to participation in RSS. Features that Affect RSS’ Quality were specific modifiable features that impacted the perceived quality of the RSS. Collegial Interactions were interactions that occurred between colleagues directly or indirectly as a result of attending RSS. Outcomes of RSS were specific outcome measures used in RSS sessions. Barriers were seen as reasons why physicians were unwilling or unable to participate in RSS. All of the elements identified within the four themes contributed to the development of physician engagement. Physicians also identified changes directly and indirectly due to RSS.Discussion: Specific features of RSS result in enhanced physician engagement. There are benefits that may not be accounted for in continuing medical education (CME) outcome study designs.Contexte : Nous examinons la participation des médecins aux séries de conférences planifiées (SCP) planifiées à l’avance, également connues sous le nom de séances scientifiques, plus particulièrement sous l’angle des perceptions des médecins quant aux éléments qui ont déterminé leur participation et quant aux avantages inattendus des SAR.Méthode : La perception qu'ont les médecins de leurs connaissances et de leurs besoins de formation, ainsi que des facteurs qui les ont poussés à participer aux SCP de leur hôpital sont examinés par le biais d’une étude qualitative comprenant des entretiens semi-dirigés et une analyse thématique.Résultats : Les facteurs qui déterminent la participation des médecins aux SCP se classent en quatre grands thèmes : les caractéristiques qui affectent la qualité des SCP, l’interaction entre collègues, les résultats perçus des SAR et les obstacles à leur participation aux SCP. Les premières sont des caractéristiques modifiables précises, qui influencent la qualité perçue des SCP. Les secondes sont les interactions entre collègues qui se produisent directement ou indirectement à la suite de la participation à une SCP. Les résultats des SCP sont des indicateurs de résultats précis utilisés dans les séances d’activités régulières. Sont considérés comme obstacles les raisons pour lesquelles les médecins ne voulaient pas ou ne pouvaient pas prendre part aux SCP. Tous les éléments décelés de chacun des quatre thèmes ont contribué à favoriser la participation des médecins. Les médecins ont également trouvé des changements qui sont directement ou indirectement liés aux SCP.Discussion : Certains traits spécifiques des SCP favorisent une participation accrue des médecins. Il est possible que les études de résultats du développement professionnel continu (DPC) ne tiennent pas compte de tous les avantages que les SCP procurent