What Feedback Content Do Clinical Teachers Address During OSTEs?

Figures & data

Table 1 Topics per Task and Medical Discipline

Discipline	Communication Focused Encounter	Interprofessional Interaction	Physical Exam	Technical Procedure
Gynaeco-obstetric	Breaking bad news: miscarriage	Physician-midwife at the bedside Bleeding during the delivery	Vaginal and pelvic exam	Shoulder dystocia
Internal Medicine	Breaking bad news: lung cancer	Physician-nurse at the bedside Hypotension in a woman hospitalized because of diarrhea	Abdominal exam	Ascites puncture
Family medicine	Difficult encounter: error disclosure	Family physician-psychiatrists-nurse, social worker Interprofessional meeting	Shoulder exam	Knee injection
Paediatrics	History taking with a teenager	Physician-nurse on the phone: Fever by a child post renal transplant	Psycho-motor exam of a 4-year-old child	Lumbar puncture
Psychiatry	Difficult encounter: drug addict patient asking for methadone in a waiting room	Psychiatrist – family physician-nurse-social worker Interprofessional meeting	–	–

Table 2 Categorisation of Elaboration Occurrences According to Tasks

	Communication N (%)	Collaboration IP N (%)	Physical Exam N (%)	Technical Procedure N (%)
Teaching related to the task	82 (70.1)	181 (68.0)	1142 (76.8)	152 (65.0)
Teaching physician roles/professionalism	13 (11.1)	14 (5.3)	8 (4.3)	9 (3.8)
Teaching clinical reasoning	21 (17.9)	66 (24.8)	26 (14.0)	54 (23.1)
Teaching theoretical concepts	1 (0.8)	3 (1.1)	9 (4.9)	18 (7.7)
Other	–	2 (0.8)	–	1 (0.4)
Total	117	266	185	234

Table 3 Generic Rating Grid Used to Assess the Feedback Content per Task

	Communication Focused Encounter (COM)	Interprofessional Interaction (IP)	Physical Exam (PE)	Technical Procedure (TP)
A	Structure	Structure	Structure	Structure
B	Exploration/validation of patient perspectives	Exploration/validation of other health professionals/patients	Precision/Accuracy	Precision/Accuracy
C	Verbal expression	Verbal expression	Communication - factual information	Communication - factual information
D	Non verbal expression	Non verbal expression	Communication: Verbal and nonverbal attention paid to patient comfort and emotions	Communication: Verbal and nonverbal attention paid to patient comfort and emotions
E	Other CanMEDS content: – Medical expertise including history taking, physical exam, clinical reasoning – Professionalism	Other CanMEDS content: – Medical expertise including history taking, physical exam, clinical reasoning – Professionalism	Other CanMEDS content: – Medical expertise including history taking, physical exam, clinical reasoning – Professionalism	Other CanMEDS content: – Medical expertise including history taking, physical exam, clinical reasoning – Professionalism
F	Teaching strategies	Teaching strategies	Teaching strategies	Teaching strategies
G	Other/ self-management	Other/ self-management	Other/ self-management	Other/ self-management

Table 4 Distribution of the Feedback Content

Targeted Content		3926 (73%)
Positive feedback		1070 (27%)
Negative feedback		2856 (73%)
Communication and Interprofessional tasks*	1559 (40%)	Physical Exam and Technical Procedure Tasks*	2367 (60%)
Structure	639 (41%)	Structure	331 (14%)
Patients or professionals’ perspectives	530 (34%)	Precision/accuracy	876 (37%)
Verbal expression	265 (17%)	Factual communication	781 (33%)
Nonverbal expression	125 (8%)	Verbal and nonverbal attention paid to patient comfort and emotions	379 (16%)
Other Clinical Content		1072 (20%)
Positive feedback		421 (39%)
Negative feedback		651 (61%)
History taking		138 (13%)
Physical exam		170 (16%)
Explaining/Planning		254 (24%)
Clinical reasoning		371 (35%)
Professionalism		139 (13%)
Learning Strategies		224 (4%)
Positive feedback		213 (95%)
Negative feedback		11 (5%)
Other/Self-Management		175 (3%)
Positive feedback		57 (33%)
Negative feedback		118 (67%)

Notes: *Occurrences: N(%). “Communication and interprofessional tasks” as well as “Physical exam and technical procedure” are both part of “Targeted content”.

Figure 1 Distribution of the type of teaching approaches used in the feedback phase (%).

Table 5 Percentage of Alignment Between Skills/Items Identified by OSTE Developers/Experts as Important (Either Positive or Negative) and Those Addressed by Participants During the Feedback Session

Tasks	Gyn-Obstetrics		Internal Medicine		Family Medicine		Paediatrics		Psychiatry
	n*	% (SD)	n*	% (SD)	n*	% (SD)	n*	% (SD)	n*	% (SD)
Communication	17	21 (0.08)	21	51 (0.19)	16	58 (0.20)	11	7 (0.09)	17	21 (0.08)
Interprofessional	17	29 (0.10)	22	31 (0.19)	12	60 (0.28)	10	30 (0.29)	12	56 (0.22)
Physical exam	18	33 (0.19)	28	25 (0.13)	24	45 (0.22)	23	28 (0.15)
Technical procedure	17	39 (0.38)	22	60 (0.29)	18	67 (0.23)	12	33 (0.28)

Notes: *n = number of participants who gave feedback on the task observed.