Helping Clinical Educators Provide Effective Feedback to Medical Trainees on Their Diagnostic Decision Making: An Educational Design Research Approach

An educational design research approach (EDR) was adopted to understand what type of feedback is most effective to enhance medical trainees’ diagnostic decision making (DDM) in authentic clinical settings and how this understanding can be used to improve the feedback provided by clinical educators. Research was conducted within the three phases of EDR: 1) preliminary, 2) developmental and 3) assessment. Findings from the preliminary research phase indicated that more structured and specific feedback which focused on self-regulated learning (SRL) and contextual factors would be advantageous for medical trainees. A conceptual model of feedback that incorporated these findings was developed to inform a Personalised Model of Feedback (PFM) intervention in the development phase. Despite a positive response to the PFM intervention, recruitment was poor which highlighted barriers to involving clinical educators in research and training. Six clinical educators used the PFM intervention to provide feedback to their medical trainees after DDM in the authentic clinical setting. Using a mixed methods approach, the assessment phase evaluated participants’ perceptions of the PFM intervention. Participants found the PFM intervention useful, usable and effective for providing feedback on DDM. After participation more feedback was provided on SRL, confidence and the influence of contextual factors on DDM. Clinical educators and medical trainees also had an increased awareness of the influence of contextual factors on DDM. Medical trainees viewed SRL focused feedback as effective and useful for improving DDM and used more SRL skills on hypothetical reasoning cases. This research has added to current research on the use of SRL to provide feedback. It is the first research to specifically address how feedback after DDM can be better provided to medical trainees and shows that the PFM feedback can be given as an add on to feedback usually provided. Further research is necessary to modify the conceptual model and the PFM intervention to improve its ease of use in the authentic clinical setting, its receptivity by clinical educators and to determine whether it leads to an improvement in medical trainees’ DDM.