title: The quality of feedback during formative OSCEs depends on the tutors' profile.
abstract: BACKGROUND
  During their pre-clinical years, medical students are given the opportunity to practice clinical skills with simulated patients. During these formative objective structured clinical encounters (OSCEs), tutors from various backgrounds give feedback on students' history taking, physical exam, and communication skills. The aim of the study was to evaluate whether the content and process of feedback varied according to the tutors' profile.
  
  
  METHODS
  During 2013, all 2ndand 3rdyear medical students and tutors involved in three formative OSCEs were asked to fill in questionnaires, and their feedback sessions were audiotaped. Tutors were divided into two groups: 1) generalists: primary care, general internist and educationalist physicians 2) specialists involved in the OSCE related to their field of expertise. Outcome measures included the students' perceptions of feedback quality and utility and objective assessment of feedback quality.
  
  
  RESULTS
  Participants included 251 medical students and 38 tutors (22 generalists and 16 specialists). Students self-reported that feedback was useful to improve history taking, physical exam and communication skills. Objective assessment showed that feedback content essentially focused on history taking and physical exam skills, and that elaboration on clinical reasoning or communication/professionalism issues was uncommon. Multivariate analyses showed that generalist tutors used more learner-centered feedback skills than specialist tutors (stimulating student's self-assessment (p < .001; making the student active in finding solutions, p < .001; checking student's understanding, p < .001) and elaborated more on communication and professionalism issues (p < 0.001). Specialists reported less training in how to provide feedback than generalists.
  
  
  CONCLUSIONS
  These findings suggest that generalist tutors are more learner-centered and pay more attention to communication and professionalism during feedback than specialist tutors. Such differences may be explained by differences in feedback training but also by differences in practice styles and frames of references that should be further explored.
authors.affiliation: Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland. noelle.junod@hcuge.ch.|Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergencies, Geneva University Hospitals, 4 rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland. noelle.junod@hcuge.ch.
authors.forename: Noelle
authors.identifier: http://orcid.org/0000-0002-9124-8663
authors.initials: N
authors.lastname: Junod Perron
authors.affiliation: Service of General Internal Medicine, Department of General Internal Medicine, Rehabilitation and Geriatric Medicine, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Martine
authors.initials: M
authors.lastname: Louis-Simonet
authors.affiliation: Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: Bernard
authors.initials: B
authors.lastname: Cerutti
authors.affiliation: Unit of Primary Care Teaching and Research, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: Eva
authors.initials: E
authors.lastname: Pfarrwaller
authors.affiliation: Unit of Primary Care Teaching and Research, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: Johanna
authors.initials: J
authors.lastname: Sommer
authors.affiliation: Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.|Service of General Internal Medicine, Department of General Internal Medicine, Rehabilitation and Geriatric Medicine, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Nendaz
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003142:Communication; D003299:Cooperative Behavior; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000592:standards*; D004521:Educational Measurement; D005260:Female; D000068156:Formative Feedback; D006801:Humans; D008297:Male; D008487:Medical History Taking; D010808:Physical Examination; D018794:Problem-Based Learning / Q000379:methods*; D011361:Professional Competence / Q000592:standards*; D015397:Program Evaluation; D011446:Prospective Studies; D013337:Students, Medical; D011795:Surveys and Questionnaires; D013557:Switzerland; D013663:Teaching / Q000592:standards*
keywords: Feedback; Formative OSCE; Quality; Tutor