title: Insightful Practice: a robust measure of medical students' professional response to feedback on their performance.
abstract: BACKGROUND
  Healthcare professionals need to show accountability, responsibility and appropriate response to audit feedback. Assessment of Insightful Practice (engagement, insight and appropriate action for improvement) has been shown to offer a robust system, in general practice, to identify concerns in doctors' response to independent feedback. This study researched the system's utility in medical undergraduates.
  
  
  METHODS
  
  
  
  METHODS
  28 fourth year medical students reflected on their performance feedback. Reflection was supported by a staff coach. Students' portfolios were divided into two groups (n = 14). Group 1 students were assessed by three staff assessors (calibrated using group training) and Group 2 students' portfolios were assessed by three staff assessors (un-calibrated by one-to-one training). Assessments were by blinded web-based exercise and assessors were senior Medical School staff.
  
  
  METHODS
  Case series with mixed qualitative and quantitative methods. A feedback dataset was specified as (1) student-specific End-of-Block Clinical Feedback, (2) other available Medical School assessment data and, (3) an assessment of students' identification of prescribing errors. Analysis and statistical tests: Generalisability G-theory and associated Decision D- studies were used to assess the reliability of the system and a subsequent recommendation on students' suitability to progress training. One-to-one interviews explored participants' experiences.
  
  
  METHODS
  The primary outcome measure was inter-rater reliability of assessment of students' Insightful Practice. Secondary outcome measures were the reaction of participants and their self-reported behavioural change.
  
  
  RESULTS
  The method offered a feasible and highly reliable global assessment for calibrated assessors, G (inter-rater reliability) > 0.8 (two assessors), but not un-calibrated assessors G < 0.31. Calibrated assessment proved an acceptable basis to enhance feedback and identify concern in professionalism. Students reported increased awareness in teamwork and in the importance of heeding advice. Coaches reported improvement in their feedback skills and commitment to improving the quality of student feedback.
  
  
  CONCLUSIONS
  Insightful practice offers a reliable and feasible method to evaluate medical undergraduates' professional response to their training feedback. The piloted system offers a method to assist the early identification of students at risk and monitor, where required, the remediation of students to get their level(s) of professional response to feedback back 'on track'.
authors.affiliation: Quality, Safety and Informatics Research Group, Population Health Sciences, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, UK. d.y.murphy@dundee.ac.uk.
authors.forename: Douglas
authors.initials: D
authors.lastname: Murphy
authors.affiliation: Nursing, Midwifery & Allied Health Professionals Research Unit (NMAHP), Innovation Park, University of Stirling, Stirling, FK9 4NF, UK. sullivanpsc@aol.com.
authors.forename: Patricia
authors.initials: P
authors.lastname: Aitchison
authors.affiliation: Quality, Safety and Informatics Research Group, Population Health Sciences, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, UK. v.z.hernandezsantiago@dundee.ac.uk.
authors.forename: Virginia
authors.initials: V
authors.lastname: Hernandez Santiago
authors.affiliation: Quality, Safety and Informatics Research Group, Population Health Sciences, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, UK. p.g.davey@dundee.ac.uk.
authors.forename: Peter
authors.initials: P
authors.lastname: Davey
authors.affiliation: Ninewells Hospital, Dundee, DD1 9SY, UK. g.j.mires@dundee.ac.uk.
authors.forename: Gary
authors.initials: G
authors.lastname: Mires
authors.affiliation: Ninewells Hospital, Dundee, DD1 9SY, UK. d.nathwani@dundee.ac.uk.
authors.forename: Dilip
authors.initials: D
authors.lastname: Nathwani
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D004501:Education, Medical / Q000379:methods / Q000458:organization & administration*; D000068156:Formative Feedback; D006801:Humans; D017145:Models, Educational; D000068616:Professionalism / Q000592:standards*; D013337:Students, Medical / Q000523:psychology*