title: Feedback-giving behaviour in performance evaluations during clinical clerkships.
abstract: BACKGROUND
  Narrative feedback documented in performance evaluations by the teacher, i.e. the clinical supervisor, is generally accepted to be essential for workplace learning. Many studies have examined factors of influence on the usage of mini-clinical evaluation exercise (mini-CEX) instruments and provision of feedback, but little is known about how these factors influence teachers' feedback-giving behaviour. In this study, we investigated teachers' use of mini-CEX in performance evaluations to provide narrative feedback in undergraduate clinical training.
  
  
  METHODS
  We designed an exploratory qualitative study using an interpretive approach. Focusing on the usage of mini-CEX instruments in clinical training, we conducted semi-structured interviews to explore teachers' perceptions. Between February and June 2013, we conducted interviews with 14 clinicians participated as teachers during undergraduate clinical clerkships. Informed by concepts from the literature, we coded interview transcripts and iteratively reduced and displayed data using template analysis.
  
  
  RESULTS
  We identified three main themes of interrelated factors that influenced teachers' practice with regard to mini-CEX instruments: teacher-related factors; teacher-student interaction-related factors, and teacher-context interaction-related factors. Four issues (direct observation, relationship between teacher and student, verbal versus written feedback, formative versus summative purposes) that are pertinent to workplace-based performance evaluations were presented to clarify how different factors interact with each other and influence teachers' feedback-giving behaviour. Embedding performance observation in clinical practice and establishing trustworthy teacher-student relationships in more longitudinal clinical clerkships were considered important in creating a learning environment that supports and facilitates the feedback exchange.
  
  
  CONCLUSIONS
  Teachers' feedback-giving behaviour within the clinical context results from the interaction between personal, interpersonal and contextual factors. Increasing insight into how teachers use mini-CEX instruments in daily practice may offer strategies for creating a professional learning culture in which feedback giving and seeking would be enhanced.
authors.affiliation: a Utrecht University , The Netherlands .
authors.forename: Harold G J
authors.initials: HG
authors.lastname: Bok
authors.affiliation: b University of Groningen , The Netherlands .
authors.forename: Debbie A D C
authors.initials: DA
authors.lastname: Jaarsma
authors.affiliation: c Maastricht University , The Netherlands .
authors.forename: Annemarie
authors.initials: A
authors.lastname: Spruijt
authors.affiliation: a Utrecht University , The Netherlands .
authors.forename: Peter
authors.initials: P
authors.lastname: Van Beukelen
authors.affiliation: c Maastricht University , The Netherlands .
authors.forename: Cees P M
authors.initials: CP
authors.lastname: Van Der Vleuten
authors.affiliation: c Maastricht University , The Netherlands .|d VU University Medical Centre , The Netherlands.
authors.forename: Pim W
authors.initials: PW
authors.lastname: Teunissen
mesh_terms: D000328:Adult; D001519:Behavior; D002982:Clinical Clerkship / Q000379:methods*; D002983:Clinical Competence; D003142:Communication; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D000068156:Formative Feedback; D006801:Humans; D007398:Interpersonal Relations; D007407:Interviews as Topic; D008297:Male; D035502:Trust