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We compared students’ self-reported perception of learning with their actual learning under controlled conditions in largeenrollment introductory college physics courses taught using 1) active instruction (following best practices in the discipline) and 2) passive instruction (lectures by experienced and highly rated instructors). Both groups received identical class content and handouts, students were randomly assigned, and the instructor made no effort to persuade students of the benefit of either method. Students in active classrooms learned more (as would be expected based on prior research), but their perception of learning, while positive, was lower than that of their peers in passive environments. This suggests that attempts to evaluate instruction based on students’ perceptions of learning could inadvertently promote inferior (passive) pedagogical methods. For instance, a superstar lecturer could create such a positive feeling of learning that students would choose those lectures over active learning. Most importantly, these results suggest that when students experience the increased cognitive effort associated with active learning, they initially take that effort to signify poorer learning. That disconnect may have a detrimental effect on students’ motivation, engagement, and ability to self-regulate their own learning. Although students can, on their own, discover the increased value of being actively engaged during a semester-long course, their learning may be impaired during the initial part of the course. We discuss strategies that instructors can use, early in the semester, to improve students’ response to being actively engaged in the classroom.

This article reviews the corpus of research on feedback, with a focus on formative feedback--defined as information communicated to the learner that is intended to modify his or her thinking or behavior to improve learning. According to researchers, formative feedback should be nonevaluative, supportive, timely, and specific. Formative feedback is usually presented as information to a learner in response to some action on the learner's part. It comes in a variety of types (e.g., verification of response accuracy, explanation of the correct answer, hints, worked examples) and can be administered at various times during the learning process (e.g., immediately following an answer, after some time has elapsed). Finally, several variables have been shown to interact with formative feedback's success at promoting learning (e.g., individual characteristics of the learner and aspects of the task). All of these issues are discussed. This review concludes with guidelines for generating formative feedback.

Unnecessary antibiotic prescribing contributes to antimicrobial resistance. In this trial, we aimed to reduce unnecessary prescriptions of antibiotics by general practitioners (GPs) in England. In this randomised, 2 × 2 factorial trial, publicly available databases were used to identify GP practices whose prescribing rate for antibiotics was in the top 20% for their National Health Service (NHS) Local Area Team. Eligible practices were randomly assigned (1:1) into two groups by computer-generated allocation sequence, stratified by NHS Local Area Team. Participants, but not investigators, were blinded to group assignment. On Sept 29, 2014, every GP in the feedback intervention group was sent a letter from England's Chief Medical Officer and a leaflet on antibiotics for use with patients. The letter stated that the practice was prescribing antibiotics at a higher rate than 80% of practices in its NHS Local Area Team. GPs in the control group received no communication. The sample was re-randomised into two groups, and in December, 2014, GP practices were either sent patient-focused information that promoted reduced use of antibiotics or received no communication. The primary outcome measure was the rate of antibiotic items dispensed per 1000 weighted population, controlling for past prescribing. Analysis was by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN32349954, and has been completed. Between Sept 8 and Sept 26, 2014, we recruited and assigned 1581 GP practices to feedback intervention (n=791) or control (n=790) groups. Letters were sent to 3227 GPs in the intervention group. Between October, 2014, and March, 2015, the rate of antibiotic items dispensed per 1000 population was 126·98 (95% CI 125·68–128·27) in the feedback intervention group and 131·25 (130·33–132·16) in the control group, a difference of 4·27 (3·3%; incidence rate ratio [IRR] 0·967 [95% CI 0·957–0·977]; p<0·0001), representing an estimated 73 406 fewer antibiotic items dispensed. In December, 2014, GP practices were re-assigned to patient-focused intervention (n=777) or control (n=804) groups. The patient-focused intervention did not significantly affect the primary outcome measure between December, 2014, and March, 2015 (antibiotic items dispensed per 1000 population: 135·00 [95% CI 133·77–136·22] in the patient-focused intervention group and 133·98 [133·06–134·90] in the control group; IRR for difference between groups 1·01, 95% CI 1·00–1·02; p=0·105). Social norm feedback from a high-profile messenger can substantially reduce antibiotic prescribing at low cost and at national scale; this outcome makes it a worthwhile addition to antimicrobial stewardship programmes. Public Health England.

BackgroundThere is a poorly understood relationship between Leadership WalkRounds (WR) and domains such as safety culture, employee engagement, burnout and work-life balance.MethodsThis cross-sectional survey study evaluated associations between receiving feedback about actions taken as a result of WR and healthcare worker assessments of patient safety culture, employee engagement, burnout and work-life balance, across 829 work settings.Results16 797 of 23 853 administered surveys were returned (70.4%). 5497 (32.7% of total) reported that they had participated in WR, and 4074 (24.3%) reported that they participated in WR with feedback. Work settings reporting more WR with feedback had substantially higher safety culture domain scores (first vs fourth quartile Cohen’s d range: 0.34–0.84; % increase range: 15–27) and significantly higher engagement scores for four of its six domains (first vs fourth quartile Cohen’s d range: 0.02–0.76; % increase range: 0.48–0.70).ConclusionThis WR study of patient safety and organisational outcomes tested relationships with a comprehensive set of safety culture and engagement metrics in the largest sample of hospitals and respondents to date. Beyond measuring simply whether WRs occur, we examine WR with feedback, as WR being done well. We suggest that when WRs are conducted, acted on, and the results are fed back to those involved, the work setting is a better place to deliver and receive care as assessed across a broad range of metrics, including teamwork, safety, leadership, growth opportunities, participation in decision-making and the emotional exhaustion component of burnout. Whether WR with feedback is a manifestation of better norms, or a cause of these norms, is unknown, but the link is demonstrably potent.

Background Providing health professionals with quantitative summaries of their clinical performance when treating specific groups of patients (“feedback”) is a widely used quality improvement strategy, yet systematic reviews show it has varying success. Theory could help explain what factors influence feedback success, and guide approaches to enhance effectiveness. However, existing theories lack comprehensiveness and specificity to health care. To address this problem, we conducted the first systematic review and synthesis of qualitative evaluations of feedback interventions, using findings to develop a comprehensive new health care-specific feedback theory. Methods We searched MEDLINE, EMBASE, CINAHL, Web of Science, and Google Scholar from inception until 2016 inclusive. Data were synthesised by coding individual papers, building on pre-existing theories to formulate hypotheses, iteratively testing and improving hypotheses, assessing confidence in hypotheses using the GRADE-CERQual method, and summarising high-confidence hypotheses into a set of propositions. Results We synthesised 65 papers evaluating 73 feedback interventions from countries spanning five continents. From our synthesis we developed Clinical Performance Feedback Intervention Theory (CP-FIT), which builds on 30 pre-existing theories and has 42 high-confidence hypotheses. CP-FIT states that effective feedback works in a cycle of sequential processes; it becomes less effective if any individual process fails, thus halting progress round the cycle. Feedback’s success is influenced by several factors operating via a set of common explanatory mechanisms: the feedback method used, health professional receiving feedback, and context in which feedback takes place. CP-FIT summarises these effects in three propositions: (1) health care professionals and organisations have a finite capacity to engage with feedback, (2) these parties have strong beliefs regarding how patient care should be provided that influence their interactions with feedback, and (3) feedback that directly supports clinical behaviours is most effective. Conclusions This is the first qualitative meta-synthesis of feedback interventions, and the first comprehensive theory of feedback designed specifically for health care. Our findings contribute new knowledge about how feedback works and factors that influence its effectiveness. Internationally, practitioners, researchers, and policy-makers can use CP-FIT to design, implement, and evaluate feedback. Doing so could improve care for large numbers of patients, reduce opportunity costs, and improve returns on financial investments. Trial registration PROSPERO, CRD42015017541

Background Clinical decision-making (CDM) refers to physicians’ ability to gather, evaluate, and interpret relevant diagnostic information. An integral component of CDM is the medical history conversation, traditionally practiced on real or simulated patients. In this study, we explored the potential of using Large Language Models (LLM) to simulate patient-doctor interactions and provide structured feedback. Methods We developed AI prompts to simulate patients with different symptoms, engaging in realistic medical history conversations. In our double-blind randomized design, the control group participated in simulated medical history conversations with AI patients (control group), while the intervention group, in addition to simulated conversations, also received AI-generated feedback on their performances (feedback group). We examined the influence of feedback based on their CDM performance, which was evaluated by two raters (ICC = 0.924) using the Clinical Reasoning Indicator – History Taking Inventory (CRI-HTI). The data was analyzed using an ANOVA for repeated measures. Results Our final sample included 21 medical students (age mean = 22.10 years, semester mean = 4, 14 females). At baseline, the feedback group (mean = 3.28 ± 0.09 [standard deviation]) and the control group (3.21 ± 0.08) achieved similar CRI-HTI scores, indicating successful randomization. After only four training sessions, the feedback group (3.60 ± 0.13) outperformed the control group (3.02 ± 0.12), F (1,18) = 4.44, p  = .049 with a strong effect size, partial η 2  = 0.198. Specifically, the feedback group showed improvements in the subdomains of CDM of creating context ( p  = .046) and securing information ( p  = .018), while their ability to focus questions did not improve significantly ( p  = .265). Conclusion The results suggest that AI-simulated medical history conversations can support CDM training, especially when combined with structured feedback. Such training format may serve as a cost-effective supplement to existing training methods, better preparing students for real medical history conversations.

Effective pathology report feedback is vital for trainee education but is often limited by information technology systems that lack integrated educational support. Most laboratory information systems do not retain resident draft reports after report finalization and lack workflows for structured feedback, hindering self-assessment and progress tracking. To develop and implement a feedback system that allows pathology trainees to compare their preliminary diagnostic reports with finalized faculty reports and corresponding digital slides. A custom feedback system was developed, integrating with Cerner Millennium (laboratory information system) and the Paige digital pathology platform. Trainees flagged cases by simulating a report finalization command, which stored their preliminary diagnosis. An automated report compared the resident and faculty diagnoses side by side and included direct links to the relevant digital slides. A total of 3854 cases from 13 trainees were analyzed for diagnostic concordance, categorized as accurate, mostly accurate, partially accurate, or inaccurate. Overall diagnostic accuracy was 68.8% (2650 of 3854), increasing to 86.1% (3317 of 3854) when \"mostly accurate\" cases were included. Accuracy varied by trainee (range, 55.5% [238 of 429]-78.3% [553 of 706]) and organ system (highest in neuropathology at 83.8% [31 of 37], lowest in placenta at 46% [46 of 100]). System usage also varied, with some trainees reviewing more than 700 cases and others fewer than 10. Report comparison allowed for assessment of both diagnostic accuracy and report quality. This integrated feedback system enables scalable, trainee-centered evaluation of diagnostic performance and report writing, fostering reflective learning in daily practice. The database generated through this system further provides opportunities for deeper data exploration, identification of educational trends, and development of competency-based assessment frameworks.

Several types of audits have been used to promote quality improvement (QI) in hospital care. However, in-depth studies into the mechanisms responsible for the effectiveness of audits in a given context is scarce. We sought to understand the mechanisms and contextual factors that determine why audits might, or might not, lead to improved quality of hospital care. A realist review was conducted to systematically search and synthesise the literature on audits. Data from individual papers were synthesised by coding, iteratively testing and supplementing initial programme theories, and refining these theories into a set of context-mechanism-outcome configurations (CMOcs). From our synthesis of 85 papers, seven CMOcs were identified that explain how audits work: (1) externally initiated audits create QI awareness although their impact on improvement diminishes over time; (2) a sense of urgency felt by healthcare professionals triggers engagement with an audit; (3) champions are vital for an audit to be perceived by healthcare professionals as worth the effort; (4) bottom-up initiated audits are more likely to bring about sustained change; (5) knowledge-sharing within externally mandated audits triggers participation by healthcare professionals; (6) audit data support healthcare professionals in raising issues in their dialogues with those in leadership positions; and (7) audits legitimise the provision of feedback to colleagues, which flattens the perceived hierarchy and encourages constructive collaboration. This realist review has identified seven CMOcs that should be taken into account when seeking to optimise the design and usage of audits. These CMOcs can provide policy makers and practice leaders with an adequate conceptual grounding to design contextually sensitive audits in diverse settings and advance the audit research agenda for various contexts. CRD42016039882.

Changes in surgical training have raised concerns about residents' operative exposure and preparedness for independent practice. One way of addressing this concern is by optimizing teaching and feedback in the operating room (OR). The objective of this study was to perform a systematic review on perioperative teaching and feedback. A systematic literature search identified articles from 1994 to 2014 that addressed teaching, feedback, guidance, or debriefing in the perioperative period. Data was extracted according to ENTREQ guidelines, and a qualitative analysis was performed. Thematic analysis of the 26 included studies identified four major topics. Observation of teaching behaviors in the OR described current teaching practices. Identification of effective teaching strategies analyzed teaching behaviors, differentiating positive and negative teaching strategies. Perceptions of teaching behaviors described resident and attending satisfaction with teaching in the OR. Finally models for delivering structured feedback cited examples of feedback strategies and measured their effectiveness. This study provides an overview of perioperative teaching and feedback for surgical trainees and identifies a need for improved quality and quantity of structured feedback. •Feedback is important to help residents develop and hone their operative skills.•There is a lack of standardization and structure in the delivery of feedback to trainees.•This review examines the current perioperative teaching and feedback practices.•There is a need for more structured implementation of feedback for trainees to enhance perioperative teaching.

Simulation is an integral component of health care education. Research suggests a positive relationship between simulation and learning outcomes. Kirkpatrick's framework is a four-level model based on the premise that learning resulting from training programs can be classified into four levels: reaction, learning, behavior, and results. Evaluation of educational impact provides valuable feedback to educators that may assist with development and improvement of teaching methods. This review is based on the PRISMA guidelines for conducting a systematic review. Inclusion criteria included articles (a) written in the English language, (b) published between 2000 and 2016, (c) describing a debriefing intervention after high-fidelity patient simulation, and (d) based in health care. Thirteen studies met criteria for inclusion in the review. Results indicated a paucity of studies at the highest levels of evaluation, indicating an area where future research is needed to assist with the development and improvement of simulation education. [J Nurs Educ. 2018;57(7):393-398.].