Is problem-based learning an experimentation platform in Chinese medical schools?

Clinical teaching visits (CTVs) are a core element of Australian general practice training. They involve a medical educator or senior general practitioner external to the practice visiting the GP trainee (registrar) and undertaking a workplace-based assessment by directly observing patient consultations. CTVs provide a mechanism for identification of learning needs, provision of teaching, and delivery of formative assessment and feedback. Following the CTV, a written feedback report summarising the content and outcome of the visit is sent to the trainee and GP trainer (supervisor). Formative assessment and feedback are critical to the educational process and supporting learners to reach their maximum potential. The strategies and conditions for the delivery of effective feedback are well documented, and include a positive and respectful learning climate; a ‘‘two-way conversation’’; and an acknowledgement and reinforcement of good practice (Ramani & Krackov 2012). In 2014, as a regional provider of general practice training, we added a specific field to our CTV feedback template, titled ‘What I learnt from you’. This was in response to a number of corridor conversations in which medical educators reflected on how frequently they had picked up a clinical pearl from the trainee during the CTV. Subsequently, teaching visitors were encouraged to document a clinical point or practice tip which they felt was not only a strength of the trainee’s consultations, but something they hitherto did not know, or routinely apply. Since implementing this simple addition to the written feedback template, we have documented approximately 100 individual comments. About one-third relate to communication skills (e.g. specific phrases, body language); another third relate to organisational skills (e.g. clinical guidelines, patient handouts, note-taking, ‘apps’ for patient information); and the rest a mix of clinical (e.g. examination tips, clinical assessment tools, prescribing points) and consultation skills (e.g. approach to building rapport and safety netting). This enhanced written feedback was explicitly designed to build a trainee’s confidence beyond the traditional ‘What you’re doing well’ to ‘I actually taught them something!’. Additionally, we felt that it would help balance any negative feedback in the report. Though it has not been formally evaluated, anecdotally we believe that it is valued by trainees. We are unaware of this approach being used before in written feedback reports. We acknowledge the contribution of the medical educators and other teaching visitors in contributing to this activity.