‘Next steps are…’: An exploration of coaching and feedback language in EPA assessment comments

Abstract

Purpose

Entrustable Professional Activities (EPA) assessments are intended to facilitate meaningful, low-stakes coaching and feedback, partly through the provision of written comments. We sought to explore EPA assessment comments provided to internal medicine (IM) residents for evidence of feedback and coaching language as well as politeness.

Methods

We collected all written comments from EPA assessments of communication from a first-year IM resident cohort at the University of Toronto. Sensitized by politeness theory, we analyzed data using principles of constructivist grounded theory.

Results

Nearly all EPA assessments (94%) contained written feedback based on focused clinical encounters. The majority of comments demonstrated coaching language, including phrases like ‘don’t forget to,’ and ‘next steps are,’ followed by specific suggestions for improvement. A variety of words, including ‘autonomy’ and ‘independence’ denoted entrustment decisions. Linguistic politeness strategies such as hedging were pervasive, seemingly to minimize harm to the supervisor-trainee relationship.

Conclusion

Evidence of written coaching feedback suggests that EPA assessment comments are being used as intended as a means of formative feedback to promote learning. Yet, the frequent use of polite language suggests that EPAs may be higher-stakes than expected, highlighting a need for changes to the assessment culture and improved feedback literacy.

Keywords:

• Written
• feedback
• internal medicine

Disclosure statement

The authors report no conflicts of interest. The authors are responsible for the content and writing of the article.

Glossary

Feedback: Specific information about the comparison between a trainee's observed performance and a standard, given with the intent to improve the trainee's performance.

Additional information

Notes on contributors

Leora Branfield Day

Leora Branfield Day, MD, MMEd, is a general internal medicine resident, Department of Medicine, University of Toronto, Canada.

James Rassos

James Rassos, MD, MHPE, is an assistant professor of medicine, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, and Staff Physician, St. Michael’s Hospital, Toronto, Canada.

Maxime Billick

Maxime Billick, MDCM, is a fourth-year chief medical resident, internal medicine training program, Department of Medicine, University of Toronto, Canada.

Shiphra Ginsburg

Shiphra Ginsburg, MD, PhD, is a professor of medicine, Department of Medicine; scientist, Wilson Centre for Research in Education, Temerty Faculty of Medicine, University of Toronto, and Staff Physician, Mount Sinai Hospital, Toronto, Canada; and Canada Research Chair in Health Professions Education.