Education Research: A Qualitative Analysis of Communication-Focused Feedback Provided to Child Neurology Residents During an Objective Structured Clinical Examination.

Background and Objectives: Child neurology is a specialty with unique challenges in communication. Child neurologists face many complex disorders with a wide array of prognoses and treatments as well as the need to communicate at various developmental levels. Limited literature exists regarding effective communication training during child neurology residency. Our aim was to evaluate feedback provided to child neurology residents by standardized patients (SPs) and faculty during a communication-focused objective structured clinical examination (OSCE) for common themes and identify which elements of communication feedback are most valuable to the residents. Methods: The child neurology residency at Nationwide Children's Hospital previously developed a set of OSCE cases to assess residents' communication skills. Using a qualitative approach, we used content analysis to identify themes from the feedback residents received from SPs and faculty observers. After themes were identified, we held a focus group with residents to determine which themes contained helpful feedback. Results: Residents found feedback from both SPs and faculty observers to be important, and how information was delivered was identified as the most impactful type of feedback. Residents appreciated positive feedback from SPs and faculty, especially when aimed at reinforcing a specific behavior that was performed well. Feedback that residents identified as particularly helpful, although not commonly provided, was the recognition of a potential unconscious bias in an encounter. Feedback the residents found less useful was discussing the medical specifics of the case. The most frequently provided types of feedback were not necessarily the most helpful feedback for both SP and faculty feedback. Discussion: OSCEs can be an effective tool to provide child neurology residents with immediate feedback on their communication skills with difficult conversations in a safe environment. Residents find value in feedback from both the SPs and faculty observers. Certain elements of feedback are more helpful than others. This knowledge could be used to develop an assessment tool to guide feedback from child neurology-specific communication simulation.