Learning in Health and Social Care最新文献

Feedback is now accepted as a key factor affecting learning and is a key feature of interpersonal communication. The term is absent from the older dictionaries, because it first began in electronics and then became a basic concept in the broader field of cybernetics before it filtered through into psychology to attain the wider significance it carries today. In cybernetics, feedback was first associated with self-regulatory systems. Then, systems theory raised the level of complexity to include the input of information from outside the system that was relevant to its performance. From there it filtered through into both behavioural and cognitive theories of learning from experience. Feedback from experience is not necessarily dependent on interpersonal communication. People can try things out, make mistakes, celebrate success and learn without any witnesses. Such feedback is largely determined by what is noticed, what is regarded as significant, how it is interpreted and whether it is stored in long-term memory and/or contributes to current or future actions. When other people are involved in giving feedback, the same factors apply to the recipient of the feedback, but the perspective of the giver of feedback, or of any observers, may be very different. The feedback given is not the same as the feedback received.

In education and workplace settings, the term ‘feedback’ is now mainly used in the context of formative assessment, where its main purpose is intended to be the provision of guidance on the quality of a person's understanding and/or performance. This could apply either to a specific situation, decision or event, or to an ongoing process of learning or working in a particular context. Although feedback ranges from the broad and global to the narrow and very precise, it has a strong emotional dimension, which may lead to feedback intended to be narrow being interpreted as being broad. Moreover, even when the provider of feedback stresses that it is the action or performance that is the subject of the feedback, many recipients interpret it as being a comment on their person. Thus, messages intended for guidance may be interpreted as judgemental.

Another problem arising from too close a link between feedback and formative assessment is that formative assessment is usually conceived in quasi-formal terms and provided by people with some authority. Much feedback is informal and provided by a wider range of people, including senior people not having authority over the learner. Sometimes important feedback messages can be indirect. For example, the allocation of work is often perceived as indicating a judgement of a person's capability, and personal agency in seeking such work may lead to more rapid learning, or even earlier promotion. At the other end of the scale is the undue importance attributed to second-hand reports of conversations and chance remarks by insecure learners who feel starved of feedback.

The relationship

Physiotherapy programmes are expected to develop reflective practitioners. Research has indicated that the reflections of senior students and clinicians are different from students beginning their clinical experience. However, most of these studies are cross-sectional in nature. The purpose of this qualitative study was to describe the changes in the reflections of a group of physiotherapy students from their first to their third clinical placements. Subjects were 15 female students (mean age: 20.1 years) in an undergraduate physiotherapy programme in the United Arab Emirates. They wrote weekly entries in a journal during their first and third clinical placements. They described an event, their reaction to it and how it might affect their future behaviour. Two evaluators independently read and coded the content of all journals, and then worked together to categorize the data, rate the level of reflection of each weekly entry and develop themes. The levels of reflection and the themes from the two time periods were compared. Quotes from individual students from both time periods illustrated the changes in reflections. Students’ highest level of reflection for each entry ranged from level 1 (only described the event) to level 4 (gained a new understanding), with a slightly higher mean level of reflection during the third clinical placement. Themes derived from the journals were Professional behaviour, Learning, Self-development, and Ethical issues, in the first placement, and Communication, Ethics, Learning, and Scope of practice, in the third placement. In the latter placement, students were more confident and more focused on the client compared with their first placement. Although the overall themes were somewhat similar in the first and third clinical placements, students broadened their perception of the roles and responsibilities of physiotherapists and of the ultimate impact of their actions on the patient.

In a revision of a vocational and education and training (VET) programme for rescue officers, practical training in the rescue company was supplemented with periods of training in hospital wards. The purposes of this were to teach the rescue officers basic nursing and to qualify them to inform the patients in the ambulances about the procedures at the hospital. An evaluation of the revised programme showed that these two purposes were fulfilled. However, the trainees also described another kind of outcome, which could be called awareness of own practice. The practical training in the hospital seems to provide a profitable space for reflection. In this article, the trainees’ learning from their practical training in the hospitals is investigated in order to explain why the hospital succeeds as a space for reflection.