title: The process of feedback in workplace-based assessment: organisation, delivery, continuity.
abstract: OBJECTIVE
  Feedback in workplace-based clinical settings often relies on expert trainers' judgements of directly observed trainee performance. There is ample literature on effective feedback, but in practice trainees in workplace-based training are not regularly observed. We aimed to examine external conditions that impact feedback in observational workplace-based assessment (WBA).
  
  
  METHODS
  Interviews were conducted and the resulting data analysed using a qualitative, phenomenological approach. Between October 2009 and January 2010, we interviewed 22 postgraduate general practice trainees at two institutions in the Netherlands. Three researchers analysed the transcripts of the interviews.
  
  
  RESULTS
  A three-step scheme emerged from the data. Feedback as part of WBA is of greater benefit to trainees if: (i) observation and feedback are planned by the trainee and trainer; (ii) the content and delivery of the feedback are adequate, and (iii) the trainee uses the feedback to guide his or her learning by linking it to learning goals. Negative emotions reported by almost all trainees in relation to observation and feedback led to different responses. Some trainees avoided observation, whereas others overcame their apprehension and actively sought observation and feedback. Active trainers were able to help trainees overcome their fears. Four types of trainer-trainee pairs were distinguished according to their engagement in observation and feedback. External requirements set by training institutions may stimulate inactive trainers and trainees.
  
  
  CONCLUSIONS
  In line with the literature, our results emphasise the importance of the content of feedback and the way it is provided, as well as the importance of its incorporation in trainees' learning. Moreover, we highlight the step before the actual feedback itself. The way arrangements for feedback are made appears to be important to feedback in formative WBA. Finally, we outline several factors that influence the success or failure of feedback but precede the process of observation and feedback.
authors.affiliation: Department of Primary Care and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands. e.pelgrim@elg.umcn.nl
authors.forename: Elisabeth A M
authors.initials: EA
authors.lastname: Pelgrim
authors.forename: Anneke W M
authors.initials: AW
authors.lastname: Kramer
authors.forename: Henk G A
authors.initials: HG
authors.lastname: Mokkink
authors.forename: Cees P M
authors.initials: CP
authors.lastname: van der Vleuten
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards*; D004503:Education, Medical, Graduate / Q000379:methods* / Q000592:standards; D004521:Educational Measurement / Q000379:methods* / Q000592:standards; D005246:Feedback; D006801:Humans; D007396:Internship and Residency / Q000379:methods* / Q000592:standards; D009426:Netherlands; D013337:Students, Medical / Q000523:psychology; D017132:Workplace / Q000523:psychology