2019 HSC Section 2 - Practice Management

ARTICLE IN PRESS

TABLE 4. Third-Party Feedback Assessment Form Approach 1 2

3

4

5

Confrontational, judgmental approach

Attempts to establish rapport with the learner; over-critical or too informal in their approach

Establishes and maintains rapport; uses a non-threatening, but honest approach; creates a psychologically safe environment

Set Goals/Expectations 1

2

3

4

5

No expectations or goals stated

Some allusion or passing reference to expectations or goals

Expectations and goals are clearly stated

Objective

1

2

3

4

5

Does not identify performance gaps or provide positive reinforcement

Focuses on errors and not purely on behaviors that can be changed; makes inferences about intent

Focuses on clinical skills; identi fi es posi- tive behaviors in addition to perfor- mance gaps, speci fi cally targeting behaviors that can be changed

Focus/Speci fi city

1

2

3

4

5

Consisted of broad generalizations; overarching and nonspeci fi c

Somewhat focused; speci fi c areas of improvement are unclear or not identi fi ed

Clear and focused; speci fi c areas of improvement identi fi ed

Application

1

2

3

4

5

No strategies identi fi ed for future improvement; no consolidation of key learning points

Some discussion of learning points and strategies for improvement; lack of application to future clinical practice

Reinforces key learning points and high- lights how strategies for improvement could be applied to future clinical practice

Quantity

1

2

3

4

5

Feedback is unhelpfully brief or unnecessarily lengthy

An adequate amount of feedback is given; could be more concise or comprehensive

Feedback is concise yet comprehensive

score in each category is summed to give a total score from 6 to 30, with higher scores correlating with higher quality feedback. Two trained raters evaluated each feed- back encounter using this form. High intraclass correla- tion (ICC) between author scores was achieved. The average measure ICC was 0.957, with a 95% confidence interval from 0.916 to 0.978 (F(36,36)=23.358, p < 0.001).) Scores that differed by more than three standard deviations were reconciled. The mean of the raters’ scores was used for statistical analysis. Delivery of feedback was analyzed using Verbal Response Modes (VRM) taxonomy. VRM is a comprehen- sive speech acts classification system which has been used previously in the literature to analyze such interactions as medical interviews, email communication, television adver- tisements, and psychotherapy. 16,17 VRM is used to classify and code speech acts, or utterances, based on 3 principles of classifications: source of experience, presumption about experience, and frame of reference. 17 The 3 classifications are each dichotomously defined as relating to the speaker or another who is the target of the speech act. In elucidat- ing the mode of an utterance, one is describing a “microrelationship” between the speaker and the other.

Importantly, the focus of VRM is not what is said, or the content of the speech, but rather how it is said and what is done when someone speaks. There are 8 speech act modes for the intent of an utterance that stem from answering the 3 questions: “Does the utterance concern the experience of the speaker or the other?”, “Does the utterance require presumption of the experience of the other or only that of the speaker?”, and “Does the utterance relay a personal viewpoint or a shared, common viewpoint?”. The 8 speech act intent modes, their coding through these 3 classifica- tions, and their descriptions are shown in Table 5 . Role Dimension Analysis then uses VRM to describe the major relationships present during speaking encoun- ters. Role Dimension Analysis was originally used to examine speech as it relates to role dynamics during medical interviews. 18 Each VRM code is classified as either Attentive or Informative , either Presumptuous or Unassuming , and either Directive or Acquiescent . The role dimension of Attentiveness vs. Informative- ness concerns the “source of experience” VRM classifi- cation. Utterances that concern the other person’s experience (Interpretations, Questions, Reflections, and Acknowledgments) are considered Attentive ; conversely,

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