Tools, insights and feedback

Another year, another volume of The Clinical Teacher, and some new types of articles. Because of the lead time for journals, I am writing this in Minneapolis in November, where I will be staying for 4 months at the National Center for Interprofessional Practice and Education. There is a lot going on: health care reform; the Ebola crisis (with three cases so far in the USA, and difficult to predict what will happen, although many more cases are expected in West Africa); escalating medical costs; disagreements about workforce numbers (and how much of the problem of access to health care is related to how many workers there are and how much is related to poor distribution); and concerns about the quantity and quality of clinical placements across all the professions. These problems are similar to those in other parts of the world, and members of the health care professions need to ensure that society has the most up-to-date information; they should work together as colleagues and always be exemplary role models for the next generations. In this edition of the journal we introduce the new Insights articles. These are reflective pieces on important topics in clinical education, based in good scholarship and with references to relevant evidence. Since we called for Insights last year, we have received many submissions on a huge variety of topics and from all grades of health professionals. The quality has been variable and what has often been lacking is the reflection and the message for the readers: busy clinical teachers. Like all good writing Insights should grab readers from the first sentence, drawing them into the story. Amit Parekh does this at the start of the article on X-ray teaching in Africa. We can all relate to: ‘It was the hardest teaching session I have ever delivered’.1 We want to know why it was hard, how the teacher overcame the difficulty, and what was learned in the process. The authors from Mexico tell a tale of how to use resources that come to hand as teaching tools when there is a limited budget.2 This paper references one of the founders of the Mayo Clinic and Benjamin Franklin, demonstrating that writers also need to be well read to engage their readers. We also unveil the Clinical Teacher’s Toolbox papers: articles focusing on tools for clinical teachers with the aim of enhancing learning, teaching and writing. We hope they are practical and engaging. The first is a new look at feedback. This topic is covered regularly in health professional education journals, and continues to challenge and confuse learners and teachers. In evaluation surveys, students frequently cite the provision of feedback as one of the least well done features of their courses. Many reasons have been suggested for this, including that students don't understand what feedback is, that they are rarely observed interacting with patients so any feedback is not specific or timely, that feedback really is done badly. In their original article in this issue, Pincavage and Cifu note that it is difficult to obtain sufficient written feedback for and about students on clinical rotations from their supervisors.3 They looked at the outcome of giving feedback about feedback, to improve its quality, and found that there was improvement amongst the lower performing faculty members. In the ‘toolbox’ article by David Boud, he discusses how feedback may and should contribute to the continuing learning of students, and the need to ensure that it actually does bring about change through a feedback loop.4 Boud has been involved in research and teaching development in higher and professional education for over three decades, and has written widely on this topic. For those of us brought up on Pendleton's guidelines and Ende's process,5, 6 methods mainly used for delivering feedback at a given moment in time, Boud's approach may be challenging for time-poor clinical teachers; however, the article should certainly stimulate discussion and we hope you will find it useful. The Insights paper on course evaluation also features feedback: the feedback from learners to their teachers.7 Again, this type of feedback should be a dialogue, and learners need to know that their feedback had led to change in future iterations of the course or programme. Response rates for evaluation surveys are notoriously low if participants do not feel that their feedback is likely to be used in any way to shape change. Although not specifically a toolbox paper, the article by one of our newer associate editors looks at a framework for helping educators develop, design and manage simulation.8 Hossein Khalili is an academic nurse based in Ontario, whose recently awarded PhD focused on interprofessional socialisation, and he is passionate about the importance of simulation in the development of collaborative practice skills across the health professions. The mention of collaborative practice brings me back to the start of this editorial. One of the most rewarding aspects of my clinical and academic role is the opportunity to meet and work with a wide range of people from diverse professions and disciplines, from many countries, and with varying outlooks on education and health care. Working in a team (such as with The Clinical Teacher) and with wider collaborations (such as across institutions and nations) continually challenges my beliefs, biases and ways of working. We never stop learning; we should never stop seeking out feedback and acting on it. We welcome your feedback on this edition of the journal, and aim to act upon it so that the journal goes from strength to strength.

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