Abstract
Background
Health professions trainee feedback rarely includes the patient voice, despite patients being experts in their own experience. Research supports including the patient voice; however, literature on the value of in-practice patient feedback is lacking.
Activity
A form was designed and implemented for patients to evaluate dietetic interns teaching a group class. Interns were surveyed to provide feedback.
Results
Interns reported finding the feedback valuable and unique. The evaluations were felt to be credible.
Discussion
Results support engaging patients in feedback for dietetic interns. Research should address different contexts, competencies other than communication and professionalism, and the impact to patients.
Keywords: Feedback, Evaluation, Patient, Trainee
Background
Patient-centeredness is a guiding principle in competency frameworks for healthcare professionals [1, 2]. Literature has recently focused on patients as educators leading to strategic prioritization in our institution. Patients are recognized experts in their experiences and have been engaged to share their stories. Many professions engage patients throughout students’ educational journey in different ways. Patients participate as consultants in curriculum design, guest lecturers, and volunteers for students to practice technical and assessment skills [3]. Health professions have also incorporated standardized patients into curriculum and examinations [4]. Patients may also provide feedback through letters and surveys. Despite the variety of patient engagement when it comes to student evaluations, teachers and clinical preceptors are the evaluators of technical and “soft skills” related to practice competencies. Even though patients are the key stakeholders in the output of health professions education, rarely do they evaluate or provide feedback that is linked to a student’s evaluation. Medical students’ encounters with real patients have been found to be more instructive than standardized patients [5]. Students identified value in terms of learning communications skills from authentic patient encounters [5]. Our literature review revealed only one study [6] that evaluated health professions trainees’ perceptions about authentic patient feedback. The authors concluded that general practice registrars “highly value the role of patient feedback in interpersonal skill development” [6].
Sunnybrook Hospital is the home of an accredited post-graduate dietetic internship program. Over 10 months, interns rotate through different practice settings to meet entry to practice competencies [1]. Interns interact with standardized patients and receive feedback from them, their preceptors and interprofessional team members.
To align with strategic priorities, trends in the literature, and to assess credibility of patient feedback, a pilot to engage patients in providing feedback to interns was undertaken.
Activity
The gestational diabetes mellitus class in the obstetrics rotation was identified as a simple place to pilot patient feedback to interns. These weekly classes included six to eight patients. Interns taught the class independently in the last 1 or 2 weeks of their 4-week rotation. A questionnaire was developed for patients to complete at the end of the independently taught class (Fig. 1). Questions focused on communication and professionalism competencies. Health literacy principles [7] were used to design the questionnaire. At the beginning of class, the precepting dietitian asked patients to contribute to the learning of interns by completing the anonymous questionnaire at the end the intern-led classes. This allowed notice and opportunity for patients to see the tool prior to receiving the education and providing feedback.
Fig. 1.
The feedback tool for patients
The precepting dietitian collected the returned questionnaires, read them immediately following class, and then shared them with each intern. Interns were surveyed 1 to 3 years after graduating via email. They were asked: how was this feedback different from feedback you received from a preceptor or from a standardized patient? Was it valuable to receive feedback from the patients? Why or why not? What about the patient feedback did you value most and why? All of the responses were grouped by question, reviewed, and grouped according to the pre-determined domains (difference, value, and credibility) identified from the literature.
Our institution determined that ethics review and approval were not required for this project.
Results
Six of the eight interns who received feedback from at least one class over the 3-year trial period responded to the survey.
Responses to each question were summarized and supported by intern quotes.
Difference
Authentic patient feedback is different than preceptor or standardized patient feedback because “it addresses their (the patient) needs and how they feel you interacted with them on a professional and personal level.”; “…the standardized patient may not actually experience the magnitude of feelings that a patient living the experience would have. Thus, the feedback can lack integrity…”; and it provides “more practical suggestions, real life perspective of the information, less scientific focused and more soft skill focused.”
Value
Dietetic interns value patients’ feedback because “…as much as impressing our preceptors is important ultimately we’re there for the patients.”; patient feedback “holds me accountable for providing high quality care/instruction…”; “The comments were honest and it helped focus on what kinds of teach-back worked and engaged the patient, and what didn’t work.”; and “… it was this feedback that allowed me to unlock, change and improve, more than any feedback from a standardized patient or preceptor.”
Credibility
Patient’s feedback is credible in this context. “Their (the patients) feedback is usually very sincere, which in turn is important to me ...”; “…can help develop areas for improvement from a direct patient-centred focus.”
Discussion
These results align with evidence that authentic patient encounters offer a different [5] and valuable [6] experience for health professions trainees than standardized patients or preceptors [4]. Authentic feedback gave interns a perspective that has not been previously shared with them and they valued it.
It is well established that feedback is crucial to learning [8]. Students, however, will ignore feedback they do not find credible [9]. For feedback to be credible, it should ideally stem from direct observation of the task or event and be provided by a trustworthy source [10]. Patients both observed interns and received direct care from them, leading to well-informed feedback. This, along with the fact that patients are experts in their own experiences likely contributed to the credibility identified by the interns.
Communication and professionalism appear to be appropriate competencies to have focused on, as interns did not question the credibility of the feedback which may have been more likely had we investigated clinical or technical competencies.
Despite the interns’ positive perceptions, a limitation of this pilot was the small sample size. Extension of this inquiry will address this. Future inquiry should investigate other contexts and professions. Determining if other competencies can also be evaluated by patients would also be beneficial. Incorporating the patient’s voice into summative evaluations may add value and credibility to this type of feedback. Equally as important as benefiting trainees, the impact to patients should also be examined.
Although only a small pilot, these results indicate that this type of feedback should be sought in the future.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
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