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Using peer feedback in a formative objective structured clinical examination

doctor relationship and then engage in a group discussion to identify themes and learning points. Reflection triggers are clerkship-specific and thus may entail reflecting on clinical encounters that have involved intense emotional responses (psychiatry), unpredictable outcomes (surgery) or unexpected aspects of the doctor role (medicine), but all have bearing on aspects of the relationship between patient and doctor or on aspects of the professional role. Why the idea was necessary There is an emerging literature emphasising the potential utility of tools for: (i) assessing the quality of reflection, and (ii) providing feedback aimed at enhancing learning through systematic reflection. We sought to develop a simple and user-friendly rubric for providing feedback on reflective essays written in the context of our clerkship-based course. What was done We adapted and expanded a typology of reflection developed by Jay and Johnson for use in teacher education. Our rubric includes four dimensions. Each dimension presents prompts to guide assessment and feedback. Dimension 1 is descriptive and is concerned with the clarity of the elaboration of the reflection topic as a problem or question for enquiry. Prompts are: Is it clear what triggered the reflection? Can you complete the following sentence from the writer’s standpoint: In the course of this reflection, I would like to learn more about... ? What is the writer’s dilemma or puzzle? Dimension 2 is comparative and refers to the consideration of relevant alternative perspectives of the problem. Prompts are: Does the writer include all relevant personal perspectives, including her or his own? Are perspectives justified by data? Are perspectives juxtaposed in a way that promotes additional reflection? Dimension 3 is personal and is concerned with the expression of personal intellectual and emotional engagement in the reflection. Prompts are: Is there evidence of personal struggle on cognitive and emotional levels? Is it apparent why the writer chose this particular incident for reflection? What is at stake for the writer? Dimension 4 is critical and relates to commitment to strengthen or alter one’s personal understanding and subsequent related behaviours. Prompts are: Is there an explicit statement of what was learned? Is there evidence of movement from previously held assumptions or of the deepening of beliefs? Is there a plan for action or commitment towards personal or systemic change? Evaluation of results and impact Feedback to date on the rubric includes: (i) presentations at a local faculty development seminar in March 2008 and at the Association of American Medical Colleges (AAMC) Annual Meeting, November 2008 (n » 10 and n » 30, respectively); (ii) the experience of faculty staff in using the rubric to critique reflections and give feedback to nine students in spring 2009, and (iii) a focus group of five of these students conducted in April 2009, and recorded and transcribed for review. In these settings, students and faculty members using the rubric overwhelmingly found it to be a conceptually straightforward and helpful ‘roadmap’, as one respondent termed it, for communicating about reflective writings.