개인주의를 넘어서: 전문직 문화가 피드백에 미치는 영향(Med Educ, 2013)
Beyond individualism: professional culture and its influence on feedback
Christopher Watling,1 Erik Driessen,2 Cees P M van der Vleuten,2 Meredith Vanstone3 & Lorelei Lingard4
도입
INTRODUCTION
Feedback from teachers to learners should be a vital part of any educational process. Kluger and DeNisi,1 in a meta-analysis of feedback interventions studied across a range of learning contexts, found that although feedback had a modestly beneficial effect on performance overall, it was actually harm- ful to performance about one third of the time. Feedback was especially likely to be harmful when it was perceived as threatening to self-esteem.
Missing from this growing literature on individual responsiveness to feedback is an examination of the social and cultural factors within the learning envi- ronment that may influence how feedback is han- dled. Learning and the exchange of feedback do not occur in a vacuum of individualism. Rather, they occur in a specific setting, context and profes- sional culture. Shulman has proposed the notion of signature pedagogies to understand the processes by which professions educate their own.10 These signa- ture pedagogies, with the rules, responsibilities and structures they contain, define what counts as knowledge in a profession and can promote effi- cient learning.10 The vulnerability of signature pedagogies is that they may force a wide range of learning into a limited range of teaching, thus dis- torting what is learned.10 Ultimately, signature peda- gogies involve choices, and these choices inevitably support certain outcomes while failing to address other potentially important aspects of professional preparation.10 The impact of these culturally dis- tinct pedagogical choices on how feedback is han- dled has not been examined.
To harness feedback’s power to shape learning, we must understand how and why learners respond or fail to respond. Studies of learning that take the individual learner as the unit of analysis make an inherently problematic assumption that learning is a purely internal cognitive process.11 The influences on feedback responses that exist within the psychol- ogy of individual learners, although important, are only part of the puzzle and by themselves offer insufficient explanations. In this study, we explored feedback in the three distinct professional cultures of medicine, teaching and music.
방법
METHODS
For this exploratory study, we used a constructivist grounded theory approach, in which the vantage points of participants and researchers alike are accounted for as data are interpreted.12 In the constructivist paradigm, particular attention is paid to reflexivity.13 Researchers must not only reflect on their own backgrounds and how these influence their approach to the subject, but must also share these reflections with readers in order to provide a meaningful interpretation of the work. The lead author (CW) is a doctor; his collaborators represent a range of non-medical disciplines including educa- tion (ED), psychology and psychometrics (CvdV), qualitative health research (MV) and rhetoric (LL). Two of the researchers (CW and LL) have signifi- cant training in music. Although all of the research- ers would consider teaching to be part of their professional identities, none has undergone the type of teacher training that supports the culture we studied.
Focus groups were our primary vehicle for data col- lection as we anticipated that the interactions among participants might be usefully revealing of culture.
In addition, we interviewed key informants within music and education in advance of focus groups to obtain necessary background information about how learning was structured in these fields and to understand the language of training. Background interviews were felt to be unnecessary in medicine, given the lead author’s first-hand experi- ence of this training culture and his co-authors’ experience in studying this culture.
Finally, we conducted additional individual interviews later in the research process to elaborate early focus group findings.
Our sampling strategy for both focus groups and interviews was purposive, with all participants recruited from one Canadian university.
For focus groups in medicine, we recruited both residents from a range of specialties and senior medical stu- dents, anticipating that the insights offered might vary depending on the level of training of the learners and the extent to which they had become part of the professional culture.
For focus groups in the context of music, we recruited undergradu- ate students. Because music students need to have a significant background in music in order to be accepted into an undergraduate programme, we reasoned that undergraduate students would be suf- ficiently acquainted with the professional culture of music to inform our research.
Teacher training at our university involves a 1-year programme, entry to which demands the completion of at least an undergraduate degree. Because we wanted to focus on the experience of the ‘practicum’ method of training, in which students go into schools to obtain real teaching experience, we recruited from students on this 1-year programme.
Initial recruit- ment was by an e-mail invitation sent to all senior medical students, residents, undergraduate music students and teacher training students at this university.
In total, data were derived from 50 participants.
A total of 41 learners (eight medical students, 12 res- idents, 13 music students and eight student teach- ers) participated in 12 focus groups (two with medical students, three with residents, four with music students and three with student teachers).
We conducted three background key informant interviews, including one with a music professor and two with education professors with experience as both teachers and educators of teachers.
We encountered unexpected challenges in recruiting student teachers to focus groups and felt that our data required enrichment beyond the three focus groups conducted; therefore, we conducted individual interviews with three recent graduates of the teacher training programme and one doctor who had completed teacher training and had worked as a teacher prior to medical training.
Finally, we interviewed two doctors with extensive training and professional experience in music to provide additional perspectives. The study received approval from the university’s research ethics board and all participants provided informed consent.
Focus groups and interviews were semi-structured, eliciting discussion and elaboration of the experi- ence of learning and receiving feedback within each professional culture.
Focus group discussions and interviews were recorded and transcribed verbatim without identifying information.
Data were analysed using the constant comparative approach customary in grounded theory.13 Analysis occurred alongside and informed data collection: initial transcripts were read in detail by two researchers (CW and MV), who identified emerging themes, some of which were specifically explored in subsequent focus groups and interviews.
As new data were collected, the same two researchers read each new transcript and re-examined earlier transcripts, developing in the process coding schemes for organising and classifying data.
By comparing and discussing their cod- ing approaches, these two researchers reached consensus on a robust coding system that could be applied to the entire dataset.
Periodic discussion of emerging themes with the entire research team informed the coding process and refined the approach to data collection.
Consistent with a theo- retical sampling approach, data collection continued until thematic saturation was achieved.13,14 As saturation is based on theoretical rather than statisti- cal considerations, the resulting numbers of partici- pants varied modestly across the three fields studied.
Once the complete dataset had been classi- fied using the refined coding scheme, the level of analysis was raised from the categorical to the conceptual by the examination and elaboration of the relationships among the concepts.
Finally, we con- sidered our conceptual analysis in light of existing theories of learning, exploring how our findings aligned with, elaborated or challenged these constructs.
RESULTS
우리의 분석은 전문적인 문화를 통해 피드백이 관리되는 방식에 있어 변수와 상수를 모두 보여주었습니다. 각 전문문화는 세팅, 학습자 역할, 교사 역할을 통해서 독특한 학습 맥락을 만들었고, 이것은 피드백이 처리되는 방식에 영향을주는 주었다. 이러한 차이에도 불구하고 신뢰성과 구성성은 상수로 나타났으며, 이것들은 모든 문화에서 학습자들이 피드백을 의미있는 것으로 인식하기 위해서는 필요했다. 그러나 신뢰와 구성성의 정의는 각 직업 문화마다 뚜렷했으며, 피드백이 이러한 특성을 갖도록 하는 지원은 문화에 따라 상당히 다양했다.
Our analysis revealed both variations and constants in how feedback is managed across professional cul- tures. Each professional culture, through the set- tings and opportunities for feedback it provided, and the roles it expected teachers and learners to play, created a distinct context for learning that influ- enced how feedback was handled. Despite these dif- ferences, credibility and constructiveness emerged as constants, identified by learners across cultures as essential for feedback to be perceived as meaning- ful. The very definitions of credibility and construc- tiveness, however, were distinct to each professional culture, and support for the occurrence of feedback with these critical characteristics varied considerably across cultures.
맥락
Context
학습 세팅
Settings for learning
의학 및 교사 훈련은 직장 환경에서 확고하게 학습을 배웠습니다. 의료 학습자는 순간적 피드백이 산발적으로 발생하는 까다로운 임상 환경에 몰입하여 학습함으로써 독립적으로 기능 할 수있는 기회를 중요하게 생각했습니다. 언제 피드백을 줄 수 있을지 예측할 수 없었기에, 의학은 피드백이 정기적으로 제공되도록 순환 종료 평가와 같은 공식 기회를 제공했습니다. 그러나 많은 학습자들은 이 공식화 된 피드백이 실질적으로 도움이 되지 못한다고 하였는데, 왜냐하면 이벤트에서 (시간적으로) 너무 멀리 떨어져 의미가 없고, 너무 구체적이지 못하고, 감독관이 상요하는 피드백 양식이 충분한 정보조차 가지고 있지 않은 학습자의 수행능력 측면에 대해 의견을 제시하도록 강제했기 때문이다.
Medicine and teacher training placed learning firmly in the workplace setting. Medical learners valued opportunities to function independently, learning by immersion in unruly clinical environ- ments in which in-the-moment feedback occurred only sporadically. Perhaps in response to the unpredictable nature of in-the-moment feedback, medicine provided formal opportunities, such as end-of-rotation evaluations, to ensure that feedback was given regularly. Many learners complained, however, that this formalised feedback lacked substance, either because it was non-specific or too far removed from the event to be meaningful, or because the feedback forms supervisors were required to use forced them to comment on aspects of learner performance about which they had insufficient information.
의료 훈련에서 의무화 된 형식적 피드백으로 인해, 실질성substance이 부족했고, 이는 일반적으로 피드백에 대해 학습자가 느끼는 가치를 시간이 지남에 따라 감소시키기도 했다.
This lack of substance, characteristic of much of the mandatory formalised feedback in medical training, could, over time, diminish the value that learners placed on feedback in general,
음악 내에서 학습 설정에는 일주일에 1 : 1 레슨뿐만 아니라 오랜 시간 동안 연습실에서 혼자 일하는 것이 포함되었습니다. 수업은 반복되는 성과, 피드백 및 교정 과정을 포함했습니다.
Within music, learning settings included weekly one-to-one lessons as well as long hours working alone in the practice room. Lessons involved a repeating process of performance, feedback and correction:
"..."아니, 충분하지 않아. ""네가 충분히 좋게하기 위해해야 할 일이야. "(음악 교수, 인터뷰 3)
‘…a combination of “No, that’s not good enough” [and] “This is what you need to do to make it good enough.”’ (Music professor, inter- view 3)
선생님의 역할
Role of the teacher
의학적 학습자는 감독자가 교사와 임상의로서의 이중 역할을 하고 있음을 인정했지만, 이러한 역할의 위계에 대해 거의 의문을 품지 않았다.
Medical learners acknowledged the dual roles of their supervisors as teachers and clinicians, leaving little doubt about the hierarchy of these roles:
학습자는 교육보다 진료에 우선을 두는 문화적 특권이 양질의 피드백의 availability에 영향을 미친다고 생각했다.
Learners recognised the impact of this cultural privi- leging of patient care over teaching on the availabil- ity of quality feedback:
세 문화권 중에서 유일하게 의학적 학습자는 때로는 그들의 존재가 교사들에게 부담이된다는 것을 느꼈습니다.
Uniquely among the three cultures, medical learn- ers sometimes even felt that their presence was a burden on their teachers:
교사 연수에서는 감독자가 보다 중심적 인 역할을 맡았는데, 여기에는 수업 할당 제어, 일관되게 학생의 성과 관찰 및 광범위한 피드백 제공이 포함되었습니다. 학생들은 자신이 받은 피드백을 이해하고 통합했음을 증명할 수있는 기회가 있다는 것을 중요하게 여겼다.
In teacher training, the supervisor assumed a more central role that included controlling lesson assign- ments, consistently observing the student’s perfor- mance and offering extensive feedback. Students, in turn, valued opportunities to demonstrate that they had understood and incorporated the feedback they received:
의학적 학습자처럼, 학생 선생님은 learned by doing했지만, 의학과는 달리, '하는 것'은 감독자의 지속적인 안내와 피드백에 의해 지원되었습니다.
더 선명하고 대조적으로, 음악 학생의 학습은 교사 중심이었습니다. 숙련 된 교사의 지시없이 성취도를 향상시키는 것은 상상도 할 수없는 것이었다. 선생님의 의견 이외에 학습에 대한 유용한 영향을 파악하려는 한 학생의 노력은 전형적이었습니다.
In even sharper contrast, music students’ learning was very much teacher-focused; to improve in per- formance without instruction from a skilled teacher was reportedly unimaginable. One student’s struggle to identify useful influences on learning other than input from a teacher was typical:
'항상 선생님에게 의지 할 수 있습니다. 선생님께 무엇을해야할지 항상 물어볼 수 있습니다. 그들은 당신을 안내 할 수 있습니다. '(음악 학생, FG6)
‘You can always rely on your teacher, you can always ask your teacher what to do; they can guide you.’ (Music student, FG6)
(음악에서) 교사의 역할은 없어서는 안되는 것이었고, 피드백은 필수적이었다.
As the teacher’s role was so indispensable, feedback was considered vital:
학습자의 역할
Role of the learner
의료 학습자는 피드백을 (능동적으로) 찾는 데 대한 책임감을 인정했으며,
Medical learners accepted some responsibility for seeking feedback,
"의견이 충분하지 않다고 말할 수는 있지만, 나는 많은 어려움이 학습자에게 있다고 생각합니다 ... 나는 항상 그것이 내게 수작업으로 제공 될 것이라고 기대할 수는 없습니다."(Resident, FG2)
‘We can say that there’s not enough feedback, but I think a lot of times the onus is on the lear- ner… I can’t just always expect it to be hand-fed to me.’ (Resident, FG2)
이와는 대조적으로 학습자가 피드백을 이끌어낼 책임을 져야한다는 생각은 다른 전문 문화에서는 낯선 것이었다. 교사 훈련에서 학습자가 요구할 필요없이 일상적으로 피드백을 제공했기 때문에 피드백을 찾는 행동은 피드백이 수신되는지 확인하기보다는 설명을 얻거나 특정 질문에 응답하기위한 것이 었습니다. 음악에서 피드백 추구 행동은 완전히 불필요한 것처럼 보였습니다.
By contrast, the idea that learners should take responsibility for inviting feedback was more foreign to the other professional cultures. In teacher train- ing, feedback was provided routinely without the learner needing to ask for it, so feedback-seeking behaviour, when it occurred, was intended to obtain clarification or to respond to specific questions, rather than to ensure that feedback would be received at all. In music, feedback-seeking behaviour appeared to be entirely unnecessary.
'아니. (피드백은) 당신이 원하든 원치 않든간에 온다. '(음악 학생, FG9)
‘No. It comes whether you want it or not.’ (Music student, FG9)
신뢰도
Credibility
모든 문화에서 학습자들이 피드백을 얼마나 신뢰하는지가 그것이 의미있는 영향을 줄 수 있는 가능성에 강력한 영향을 미쳤다. 그러나 '신뢰성'이 모든 학습자에게 동일한 의미를 지니지는 않았다. 오히려 신뢰성에 대한 개념은 피드백이 제공된 전문 문화의 지울 수 없는 특성을 지니고 있었다. 예를 들어, 문화마다 피드백의 신뢰도에 영향을 주는 것이 달랐다. 의학 학습자들은 가르치는 능력이 중요하다는 것을 인정하면서도, 피드백의 신뢰성을 결정 짓는 강력한 요소로 감독자의 임상 기술을 꼽았다.
Learners across cultures identified the perceived credibility of the feedback they received as a power- ful influence on its likelihood of meaningfully impacting them. Credibility, however, did not have the same meaning for all learners; rather, notions of credibility bore the indelible stamp of the pro- fessional culture in which feedback was provided. For example, the culture shaped how teachers acquired credibility as sources of feedback. Medical learners, although they acknowledged teaching abil- ity as a desirable attribute, identified the clinical skills of their supervisors as a stronger determinant of the credibility of their feedback.
'교수가 환자와 상호 작용하는 것을 보았을 때 나는 그들의 행동이나 다른 사람들과 의사 소통하는 방식에 의구심을 표한다. 나는 그들의 피드백을 viable하다고 생각하지 않는다.'(Resident, FG2)
‘If I’ve seen them interacting with patients… and I’m questioning their performance or the way they communicate with other people, I don’t take their feedback as viably.’ (Resident, FG2)
'... 우리는 놀랍게도 실제로 교실에 오지 않은 교수진이 있습니다. 신뢰성은 그럴 때 떨어진다 '(교육 교수, 인터뷰 2)
‘…we have some faculty, surprisingly, who have never actually been in a classroom. I would say that’s where the credibility falls down.’ (Educa- tion professor, interview 2)
의학과 교수법과는 대조적으로, 음악 학생들은 훌륭한 연주 기술을 가진 학생들보다 교육용 기술이 잘 발달 된 교사를 선호했습니다. 음악 교사의 경우, 도움이되었지만 불충분 한 수행 능력; 교사는 또한 학생의 성과를 향상시키기위한 지침을 제공 할 수 있어야했습니다.
By sharp contrast with medicine and teaching, music students preferred teachers with well-developed instructional skills over those with virtuoso perfor- mance skills. For music teachers, the ability to per- formwas helpful but insufficient; a teacher also needed to be able to provide guidance to advance the student’s performance.
음악은 우리가 공부 한 세 가지 문화 중 유일하게 교사의 신뢰도가 부분적으로 교사의 학생의 수행능력에 의해 결정되었습니다. 열매를 맺는 학생들을 많이 보았던 선생님 (음악 학생, FG8)에 대한 음악 학생의 존경심은 강사 또는 멘토로서의 능력에 중점을두고 있으며, 자기자신의 능력에서 벗어났습니다. 한 사람.
Music was the only one of the three cultures we studied in which a teacher’s credibility was deter- mined, in part, by the performance of that teacher’s students. Music students’ respect for ‘the teachers you see who have had a lot of fruitful students’ (music student, FG8) signalled a shift in emphasis towards a teacher’s abilities as an instructor or men- tor, and away from his or her abilities as a per- former.
문화는 또한 신뢰가 위협받을 수있는 상황을 만들었습니다. 의학 학습자는 종종 관찰되지 않은 결과에 대한 피드백을 받았다.
Culture also created circumstances under which credibility might be threatened. Medical learners frequently received feedback on unobserved perfor- mances:
반대로 음악 학생은 자신의 공연을 보거나 들은 적이 없는 교사가 제공 한 피드백을 상상하지 못했으며, 그러한 것을 묻는 것 자체를 놀랍게 여겼다. 마찬가지로, 교육 문화에서, 직접 관찰없이 피드백을 창출 할 수 있다는 생각은 매우 낯선 것이었다.
Music students, by contrast, could not provide any examples of feedback being given by a teacher who had not seen or heard their performance; their sur- prise at even being asked this question suggested that this approach to feedback was alien to their cul- ture. Similarly, in the education culture, the very idea that feedback could be created without this level of observation was foreign:
의학에서는 관찰의 빈도가 적음에도 불구하고, 학습자는 여전히 관찰과 피드백의 신뢰성 사이의 강한 연관성을 확인했다.
Despite the infrequency of observation in medicine, learners still identified a strong link between obser- vation and the perceived credibility of subsequent feedback:
'나는 어떤 피드백이 정확하다고 생각한다면, 피드백에 매우 개방적이다. 특히 나를 관찰 한 사람이 지적할 경우에 그렇다.'(Resident, FG1)
‘I’m pretty open to [feedback], especially if I know it’s very accurate… and it’s being pointed out by a person who has observed me.’ (Resident, FG1)
구성성
Constructiveness
세 문화권 모두에서 학습자는 건설적인 것으로 인식되는 피드백을 선호했으나, '건설적'을 어떻게 정의하는가는 문화마다 다양했다. 음악에서 건설적인 것으로 여겨지는 피드백은 비판적이거나 교정적인쪽으로 기울어졌으며 학생들은 칭찬은 도움이되지 않는 것으로 평가 절하되었습니다.
Across all three cultures, learners preferred feed- back that they perceived as constructive, but again there were cultural variations in how constructive- ness was defined. Feedback that was considered to be constructive in music tended towards the critical or corrective, and students devalued praise as unhelpful:
음악 학생들은 교정적 피드백을 (부정적 피드백이 아닌) '긍정적 인 비판'(음악 학생, FG6)으로 개념화하였다. 대조적으로, 교사 훈련에서 건설적인 피드백은 긍정적인 측면에 확고하게 뿌리를 내리고, 좋은 성과를 강화하고 비평은 개선을 위한 제안으로 프레임하는 것이었다.
Music students appeared to readily appreciate the benefits of corrective feedback, conceptualising it as ‘positive criticism’ (music student, FG6) rather than as negative feedback. By contrast, feedback consid- ered to be constructive in teacher training was firmly rooted in positivity, reinforcing good perfor- mance and framing criticism as suggestions for improvement.
'그녀는 언제나 '두 가지 장점과 한 가지 고칠 점'을 말한다. 당신은 항상 두 가지 긍정적 인 말을하고 다음 단계를 수행합니다. 그래서 항상 건설적입니다. '(학생 교사, FG10)
‘She’d always do the “two stars and a wish”. You always say two positive things and then you do the next step. So, it’s always very constructive.’ (Student teacher, FG10)
의학에서 칭찬과 비판은 환경에 따라 건설적인 것으로 간주 될 수 있습니다. 긍정적 피드백은 특히 훈련 초기에 자신감을 확립하거나 구축 할 때 건설적인 것으로 간주되었습니다. 교정 피드백은 주의가 필요한 약점을 강조 할 때 건설적으로 여겨졌다.
In medicine, both praise and criticism could be considered constructive, depending on the circum- stances. Positive feedback was viewed as construc- tive when it established or built confidence, especially early in training. Corrective feedback was viewed as constructive when it highlighted weak- nesses requiring attention
모든 문화에서 공통적인 핵심 구성는 피드백을 행동 계획과 통합하는 것이었습니다. 개선을 위한 전략을 간략히 제시 한 실행 계획은 교정적 피드백조차도 건설적인 것으로 인식하게 해주었다. 그러나 행동계획의 퀄리티는 문화마다 달랐다. 음악 학생들은 상세하고 도움이되는 행동 계획을 빈번하게 언급했고,
A key element of constructiveness, common across cultures, was the incorporation of an action plan with feedback. An action plan, outlining a strategy for improvement, could permit even corrective feedback to be perceived as constructive. Cultures varied, however, in the typical quality of their action plans and thus in the extent to which the constructiveness of feedback was supported. Music students, in particular, spoke frequently of detailed and helpful action plans,
대조적으로 의학 학습자는 명시 적 행동 계획과 관련된 피드백의 사례를 떠올리기 위해 애를 썼다. 최악의 경우 실천 계획은 존재하지 않았으며, 기껏해봐야 디테일이 부족한 계획에 불과했다.
Medical learners, by contrast, struggled to provide examples of feedback linked to an explicit action plan. Action plans were non-existent at worst and under-detailed at best:
'의학에서 의사 소통은 매우 모호 할 수 있습니다. "더 많이 읽어야합니다."또는 "지식 기반이 부족합니다."(의사와 음악가, 인터뷰 8)
‘In medicine it can be very vague, like: “You need to read more” or “Your knowledge base is lack- ing.”’ (Doctor and musician, interview 8)
'그것이 부정적인 이유나 내가 그것을 어떻게 긍정적으로 만들 수 있는지에 대한 피드백이없는 부정적인 진술 일 뿐이라면, 그것은 나에게 와닿지 않을 것이며, 나는 그것을 수행하지 않을 것입니다.'(Resident, FG1)
‘If it’s just a negative statement without any feed- back on why it’s negative or how I can make it positive, then it wouldn’t stick with me, and I wouldn’t carry it on.’ (Resident, FG1)
고찰
DISCUSSION
피드백은 단순히 개인 간의 대화가 아닙니다. 그것은 복잡한 정보 교환이며, 사회 문화적 상황이 의미를 형성합니다. 지금까지 교육 문화가 피드백에 미치는 영향은 의학 교육 연구자들에게는별로 관심을받지 못했다. 이것은 아마도 학습에 대한 개인 수준의 이론에 특권을 부여하는 오랜 경향과 일치 할 것이다 .15,16 의학에서의 임상 교육은 주로 경험적이며 따라서 임상 학습의 성격을 탐구하는 연구의 대부분은 개인이 자신이 경험 한 것을 어떻게 해석하고 이해하는지에 초점을 맞추고있다. 반면에 사회 문화적 학습 이론은, 학습이 특정 상황에 놓여있는 것으로 학습을 본다. 학습에 대한 개인 이론 및 사회 문화적 이론은 서로 대립 할 필요가 없다 .20) 오히려, 개인의 학습과 경험에 대한 개인의 해석과 학습이 이루어지는 문화, 상황 및 환경은 학습 결과 형성에 기여한다.
Feedback is not merely a conversation between indi- viduals; it is a complex information exchange, the social and cultural contexts of which shape its meaning for learners. Until now, the effect of train- ing culture on feedback has received little attention by medical education researchers, which is perhaps consistent with the field’s longstanding tendency to privilege individual theories of learning.15,16 Although clinical education in medicine is primarily experiential and therefore heavily contextualised, most of the work exploring the nature of clinical learning has focused on how individuals interpret and make sense of the experiences they have.8,17 Socio-cultural learning theories, by contrast, view learning as situated within specific contexts and cul- tures.16,18,19 Individual and socio-cultural theories of learning need not be placed in opposition to one another.20 Rather, both the individual’s own inter- pretations of the events and experiences that com- prise his or her learning and the culture, context and environment in which the learning takes place contribute to shaping learning outcomes.21
의학교육에서 피드백은 개인의 피드백 전달 기술에 초점을 맞추는 경향이 있으나, 이는 피드백 개선에 문제가 된다. 사회 문화적 렌즈를 통해 볼 때 부적절한 개인을 타겟팅하는 접근법이 명확 해집니다. 피드백 전달은 확실히 강화 될 수 있지만, 교육자는 개별 학습자가 갖는 피드백에 대한 인식orientation에 영향을 줄 수있는 능력이 제한적입니다. 따라서 피드백의 영향력을 강화할 수있는 가장 좋은 기회는 이를 뒷받침 할 수 있는 문화적 발판을 마련하는 것입니다.
Our elaboration of feedback’s critical cultural dimension exposes as problematic many of our cur- rent approaches to improving feedback in medical education, which tend to focus on the feedback delivery skills of individuals.22,23 Viewed through a socio-cultural lens, the inadequacies of approaches targeting individuals become clear. Although feed- back delivery can certainly be strengthened, educa- tors have only a limited ability to influence the feedback orientation of individual learners. The richest opportunities to strengthen the impact of feedback may therefore involve creating the neces- sary cultural scaffolding to support it.
Shulman은 서명 교육에 관한 연구에서 다른 직업의 교수법에 대한 비교가 효과적 일 수 있으며, 기존에 고려되지 않았던 교육 향상에 대한 새로운 접근법을 제시 할 수 있다고 설명합니다. 교사 교육과 음악과 함께 의학의 학습 문화에 대한 우리의 비교 적 고려는 서명 교육이 다른 결과를지지하면서 다른 결과를지지하는 선택을 포함한다는 Shulman의 전제를 명백하게 보여줍니다.
In his work on signature peda- gogies, Shulman10 comments that comparisons of the pedagogies of different professions may be fruit- ful and may offer approaches to improving educa- tion that might not otherwise have been considered. Our comparative consideration of medi- cine’s learning culture alongside that of teacher education and music starkly demonstrates Shul- man’s premise that signature pedagogies involve choices that support certain outcomes while con- straining others.10
교사 교육 및 음악과 비교하여, 우리는 의학의 현재 훈련 문화가 사실상 피드백 문화가 아니라는 것을 발견했습니다. 이것은 새로운 발견이 아닙니다. 다른 연구자들은 다른 학습 문화와의 비교를 통해 개선 노력에 대한 명확한 시각을 제시한다 : 우리는 의학교육 문화에서 피드백의 신뢰성과 구성 성을 제한하는 특징을 교정 할 필요가있다. 교사 교육 및 음악 문화와 비교하면 의학의 피드백 문화에서 신뢰와 건설이 주요 취약성임을 알 수 있습니다. 또한, 이러한 취약점은 우리가 학습의 맥락을 어떻게 설정했느냐에 따라 존재합니다.
In comparison with teacher education and music, we found that medicine’s current training culture is not, in fact, a feedback culture. This is not a new finding; others have decried medicine’s failings in the feedback arena.24,27 What our study offers, through its comparison with other learning cultures, is a clear sightline for improvement efforts: we need to remedy the features of our culture that limit the credibility and constructiveness of feedback. By com- parison with the cultures of teacher education and music, we can see that credibility and constructive- ness, rather than representing strengths of medi- cine’s feedback culture, are its key vulnerabilities. Moreover, these vulnerabilities exist because of how we have set up the context of learning.
음악에있어 장기적인 교사-학습자 관계가 피드백의 중요성을 강조하면서도, 피드백 신뢰도와 구성성에 대한 인식을 용이하게 한다는 사실은 왜 우리가 그러한 관계(장기적 교사-학습자 관계)가 발전 할 수있는 상황을 만들어 내지 못하는지를 묻게됩니다. 선생님 교육 선생님이 학생들의 수업 시간에 앉아서 학습자가 가르치는 것을 지켜 볼 수 있도록 보호 해주기 때문에 행동 지침과 함께 상세한 학습 피드백을 제공한다는 것으로부터, 왜 우리의 임상 교육 문맥은 학습자의 수행을 관찰하고 논평하는 데 아주 적은 시간만을 기울였는지를 묻게 한다.
Knowing that the longstanding teacher–learner relationship in music facilitates a perception of feed- back credibility and constructiveness – even when feedback is pointedly critical – should lead us to ask why we aren’t creating contexts in which such rela- tionships can develop. Knowing that teacher educa- tion preceptors provide daily detailed feedback coupled with action plans to their learners – because their time is protected to enable them to sit at the back of the class and watch the learner teach – should lead us to ask why our clinical teaching con- text allots very little time and attention to observing and commenting on the learner’s performance.
우리는 시간 제약, 교수법에 대한 부적절한 보상, 개발력이 부족한 교원지도 기술과 같은 운영상의 어려움의 중요성을 기각하지 않습니다. 이러한 매우 실제적인 문제는 학습자의 직접적인 관찰이나 학습자의 피드백을 수반하는 상세한 행동 계획의 작성을 실제로 제한 할 수 있습니다. 그러나 이러한 운영 문제만으로는 피드백이 환자에게 어떻게 다루어 지는지에 대한 의미있는 변화를 이끌어 내기위한 노력이 불충분하다는 설명이 부족합니다.
We do not dismiss the importance of operational challenges such as time constraints, inadequate compensation for teaching, and underdeveloped faculty instructional skills; these very real issues may indeed limit the direct observation of learners or the creation of detailed action plans to accompany learners’ feedback. We believe, however, that these operational issues alone provide insufficient expla- nations for the inertia that plagues efforts to create meaningful change around how feedback is han- dled in medicine.
왜 의학의 문화가 피드백의 신뢰성과 건설성에 대한 취약성을 지속시키는지를 완전히 이해하려면, 직업의 근본적인 가치에 대한 신중한 검토가 필요합니다. 의학은 의사의 자율성과 독립성을 평가한다 .15,28 감독자가 학습자 성과를 일상적으로 관찰하는 것이, 교사와 학습자가 자율성을 존중하고 기대하는 문화에 편안하게 맞을 지 고려해 보아야 한다. 예컨대 학습자가 환자 진료에서 자율성을 갖고자 할 때, 교육받기를 거부하면서 caregiver와 manager로서의 역할을 위태롭게 만들 수 있다.
A fuller understanding of why medicine’s profes- sional culture allows vulnerabilities around the cred- ibility and constructiveness of feedback to persist requires a thoughtful examination of some of the fundamental values of the profession. Medicine val- ues doctor autonomy and independence.15,28 We might consider whether the routine observation of learner performance by supervisors will fit comfort- ably in a culture in which teachers and learners value and expect autonomy. One study, for exam- ple, identified learners’ desires for autonomy in patient care as a barrier to improving bedside teach- ing, noting that learners may avoid teaching situa- tions that they perceive might jeopardise their roles as caregivers and managers.29
점점 더 의학은 또한 자기주도적학습을 주요 가치로 삼고있다 .30 광범위하게 사용되는 역량 틀은 의학적 학습자가 지식 격차를 스스로 식별하고이를 치료할 계획을 세울 수있는 기술을 개발할 것이라는 기대를 강조한다 .31,32 우리는 교사가 의미있는 행동계획을 세우는데 만성적으로 실패하는 원인이 자기주도적 문화의 부산물이 아닐지 고민해봐야 한다.
Increasingly, medicine also espouses self-directed learning as a professional value.30 Widely used competency frameworks high- light the expectation that medical learners will develop the skills to self-identify knowledge gaps and create plans to remedy them.31,32 We must con- sider whether the chronic failure of teachers to pro- duce the meaningful action plans that would make their feedback constructive might be a byproduct of this culture of self-directedness, which may view such detailed instruction as unnecessary, counter- productive or coddling.
마지막으로, 의학의 전문 문화는 탁월한 교육 기술을 가진 의사에게 주어지는 보상이 적다. 학습자가 교수 능력에 상관없이 피드백을 위해 가장 훌륭한 수행자를 바라는 한, 의료 교사는 가르침이 암시하는 역할 모델로 봉사 할 수 있습니다. 그러나 가장 강력한 역할 모델은 임상 적 역량뿐만 아니라 그들이하는 일을 어떻게, 왜하는지 설명 할 수있게 해주는 교육자로서의 기술을 갖추어 그 방향으로 학습자를 인도하는 것입니다 .33,34
Finally, medicine’s profes- sional culture may not reward doctors who develop exceptional instructional skills; as long as learners look to the best performers for feedback, regardless of their teaching ability, medical teachers may be con- tent to serve as role models whose teaching is impli- cit. The strongest role models, however, possess not only clinical competence, but also the teaching skills that enable them to explain how and why they do what they do and to guide learners towards the example they set.33,34
포커스 그룹과 인터뷰 데이터는 본질적으로 의미있는 피드백을 구성하는 요소에 대한 참가자의 시각 만 제공한다는 점에서 제한적입니다. 이러한 인식은 피드백이 실제로 효과적인지 여부를 반드시 나타내는 것은 아니다.
Focus group and interview data are inherently limited in that they provide only the participants’ perspectives about what constitutes meaningful feedback; these percep- tions do not necessarily indicate whether feedback is actually effective.
결론
CONCLUSIONS
피드백은 학습에 상당한 가치가 있지만 교사와 학습자 간의 직접적인 거래를 나타내지는 않습니다. 오히려 피드백은 복잡한 개인 및 대인 관계 및 문화적 및 맥락적 요소의 영향을받습니다. 학습을 향상시키기 위해 피드백 사용을 최적화하려면 개인이 프로세스를 인식하는 방법뿐만 아니라 해당 프로세스가 사용되는 문화에 따라 가치를 평가하는 방법에 대한 인식이 필요합니다.
Feedback has considerable value for learning, but it does not represent a straightforward transaction between teacher and learner. Rather, feedback is affected by complex individual and interpersonal dynamics and by cultural and contextual factors. Optimising the use of feedback to enhance learning requires an appreciation not only of how the pro- cess is perceived by individuals, but also of how it is valued by the culture in which its use is situated.
Med Educ. 2013 Jun;47(6):585-94. doi: 10.1111/medu.12150.
Beyond individualism: professional culture and its influence on feedback.
Author information
- 1
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada. chris.watling@schulich.uwo.ca
Abstract
CONTEXT:
METHODS:
RESULTS:
CONCLUSIONS:
© 2013 John Wiley & Sons Ltd.
- PMID:
- 23662876
- DOI:
- 10.1111/medu.12150
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