title: Identifying educator behaviours for high quality verbal feedback in health professions education: literature review and expert refinement.
abstract: BACKGROUND
  Health professions education is characterised by work-based learning and relies on effective verbal feedback. However the literature reports problems in feedback practice, including lack of both learner engagement and explicit strategies for improving performance. It is not clear what constitutes high quality, learner-centred feedback or how educators can promote it. We hoped to enhance feedback in clinical practice by distinguishing the elements of an educator's role in feedback considered to influence learner outcomes, then develop descriptions of observable educator behaviours that exemplify them.
  
  
  METHODS
  An extensive literature review was conducted to identify i) information substantiating specific components of an educator's role in feedback asserted to have an important influence on learner outcomes and ii) verbal feedback instruments in health professions education, that may describe important educator activities in effective feedback. This information was used to construct a list of elements thought to be important in effective feedback. Based on these elements, descriptions of observable educator behaviours that represent effective feedback were developed and refined during three rounds of a Delphi process and a face-to-face meeting with experts across the health professions and education.
  
  
  RESULTS
  The review identified more than 170 relevant articles (involving health professions, education, psychology and business literature) and ten verbal feedback instruments in health professions education (plus modified versions). Eighteen distinct elements of an educator's role in effective feedback were delineated. Twenty five descriptions of educator behaviours that align with the elements were ratified by the expert panel.
  
  
  CONCLUSIONS
  This research clarifies the distinct elements of an educator's role in feedback considered to enhance learner outcomes. The corresponding set of observable educator behaviours aim to describe how an educator could engage, motivate and enable a learner to improve. This creates the foundation for developing a method to systematically evaluate the impact of verbal feedback on learner performance.
authors.affiliation: Health Professions Education and Educational Research (HealthPEER), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia. christina.johnson@monashhealth.org.|Monash Doctors Education, Monash Health, Monash Medical Centre, Clayton, Melbourne, Australia. christina.johnson@monashhealth.org.
authors.forename: Christina E
authors.initials: CE
authors.lastname: Johnson
authors.affiliation: Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Keating
authors.affiliation: Centre for Research on Assessment and Digital Learning, Deakin University, Geelong, Australia.|Faculty of Arts and Social Sciences, University of Technology Sydney, Ultimo, Australia.|Institute of Work-Based Learning, Middlesex University, London, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Boud
authors.affiliation: School of Human, Health and Social Science, Central Queensland University, Rockhampton, Australia.
authors.forename: Megan
authors.initials: M
authors.lastname: Dalton
authors.affiliation: Faculty of Health Science, Youth and Community Studies, Holmesglen Institute and Healthscope Hospitals, Holmesglen, Melbourne, Australia.
authors.forename: Debra
authors.initials: D
authors.lastname: Kiegaldie
authors.affiliation: Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Hay
authors.affiliation: Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
authors.forename: Barry
authors.initials: B
authors.lastname: McGrath
authors.affiliation: Faculty of Education, Monash University, Melbourne, Australia.
authors.forename: Wendy A
authors.initials: WA
authors.lastname: McKenzie
authors.affiliation: School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.
authors.forename: Kichu Balakrishnan R
authors.initials: KB
authors.lastname: Nair
authors.affiliation: Health Professions Education and Educational Research (HealthPEER), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
authors.forename: Debra
authors.initials: D
authors.lastname: Nestel
authors.affiliation: Department of Nutrition and Dietetics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
authors.forename: Claire
authors.initials: C
authors.lastname: Palermo
authors.affiliation: Health Professions Education and Educational Research (HealthPEER), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Molloy
mesh_terms: D003697:Delphi Technique; D004501:Education, Medical / Q000379:methods / Q000592:standards; D005180:Faculty, Medical / Q000523:psychology*; D000068156:Formative Feedback; D006801:Humans; D014705:Verbal Behavior
keywords: Clinical practice; Delphi process; Educator behaviour; Feedback; Health professions education