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Using conversation analysis to explore feedback on resident performance.

Marrigje E Duitsman1, Marije van Braak2, Wyke Stommel3

  • 1Department of Internal Medicine, Radboudumc Health Academy, Radboud University Medical Center, Gerard van Swietenlaan 4, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. Marloes.Duitsman@radboudumc.nl.

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Summary

Effective clinical performance feedback in medical education requires moving beyond unidirectional methods. Dialogic feedback, where residents actively participate, is crucial for constructive learning and behavioral change.

Keywords:
Conversation analysisFeedback on resident’s performancePostgraduate medical educationProgram directorResident

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Area of Science:

  • Medical Education
  • Communication Studies
  • Sociology

Background:

  • Clinical performance feedback is vital for postgraduate medical education.
  • Supervisors often struggle to provide effective feedback, and residents find it lacks constructiveness.

Purpose of the Study:

  • To analyze real-world feedback conversations between program directors and residents.
  • To deepen the understanding of feedback provision in medical education.
  • To formulate recommendations for improving feedback practices.

Main Methods:

  • Analysis of eight recorded evaluation meetings using conversation analysis.
  • An ethno-methodological approach focusing on interactional patterns in spoken communication.

Main Results:

  • Feedback occurred in two forms: unidirectional and dialogic.
  • Unidirectional feedback was more prevalent than dialogic feedback.
  • Dialogic feedback allows residents to take ownership, fostering behavioral change, unlike unidirectional feedback which can be dominated by the director.

Conclusions:

  • Unidirectional feedback, especially when mitigated, is counterproductive to educational aims.
  • Dialogic feedback enhances resident engagement and learning outcomes.
  • Recommendations for improving feedback conversations are derived from linguistic analysis.