Skip to content

Research at St Andrews

Insightful Practice: a robust measure of medical students' professional response to feedback on their performance

Research output: Contribution to journalArticlepeer-review


Douglas Murphy, Patricia Aitchison, Virginia Hernandez Santiago, Peter Davey, Gary Mires, Dilip Nathwani

School/Research organisations


Background: Healthcare professionals need to show accountability, responsibility and appropriate response to audit feedback. Assessment of Insightful Practice (engagement, insight and appropriate action for improvement) has been shown to offer a robust system, in general practice, to identify concerns in doctors' response to independent feedback. This study researched the system's utility in medical undergraduates.

Methods: Setting and participants: 28 fourth year medical students reflected on their performance feedback. Reflection was supported by a staff coach. Students' portfolios were divided into two groups (n∈=∈14). Group 1 students were assessed by three staff assessors (calibrated using group training) and Group 2 students' portfolios were assessed by three staff assessors (un-calibrated by one-to-one training). Assessments were by blinded web-based exercise and assessors were senior Medical School staff. Design: Case series with mixed qualitative and quantitative methods. A feedback dataset was specified as (1) student-specific End-of-Block Clinical Feedback, (2) other available Medical School assessment data and, (3) an assessment of students' identification of prescribing errors. Analysis and statistical tests: Generalisability G-theory and associated Decision D- studies were used to assess the reliability of the system and a subsequent recommendation on students' suitability to progress training. One-to-one interviews explored participants' experiences. Main outcome measures: The primary outcome measure was inter-rater reliability of assessment of students' Insightful Practice. Secondary outcome measures were the reaction of participants and their self-reported behavioural change.

Results: The method offered a feasible and highly reliable global assessment for calibrated assessors, G (inter-rater reliability)∈>∈0.8 (two assessors), but not un-calibrated assessors G∈<∈0.31. Calibrated assessment proved an acceptable basis to enhance feedback and identify concern in professionalism. Students reported increased awareness in teamwork and in the importance of heeding advice. Coaches reported improvement in their feedback skills and commitment to improving the quality of student feedback.

Conclusions: Insightful practice offers a reliable and feasible method to evaluate medical undergraduates' professional response to their training feedback. The piloted system offers a method to assist the early identification of students at risk and monitor, where required, the remediation of students to get their level(s) of professional response to feedback back 'on track'.


Original languageEnglish
Article number125
Number of pages11
JournalBMC Medical Education
Publication statusPublished - 1 Aug 2015

    Research areas

  • Continuous professional development, Feedback, Patient safety, Professionalism, Remediation

Discover related content
Find related publications, people, projects and more using interactive charts.

View graph of relations

Related by author

  1. Treatment of uncomplicated UTI in males: a systematic review of the literature

    Farrell, K., Tandan, M., Hernandez Santiago, V., Gagyor, I., Braend, A. M., Skow, M., Vik, I., Jansaker, F., Hayward, G. & Vellinga, A., 11 Jan 2021, In: BJGP Open.

    Research output: Contribution to journalArticlepeer-review

  2. Point-of-care tests for urinary tract infections: protocol for a systematic review and meta-analysis of diagnostic test accuracy

    Fraile Navarro, D., Sullivan, F., Azcoaga-Lorenzo, A. & Hernandez Santiago, V., 3 Jun 2020, In: BMJ Open. 10, 6, 4 p., e033424.

    Research output: Contribution to journalArticlepeer-review

  3. Use of an electronic clinical decision support system in primary care to assess inappropriate polypharmacy in young seniors with multimorbidity: Observational, descriptive, cross-sectional study

    MULTIPAP group, Aragon MultiPAP Group, Madrid MultiPAP Group: Marta Alcaraz-Borrajo, Lopez-Rodriguez, J. A., Sanz-Cuesta, T., Aza-Pascual-Salcedo, M., Bujalance-Zafra, M. J., Cura-Gonzalez, I., Hernández-Santiago, V., Rico-Blázquez, M., Tello-Bernabé, M. E. & Rumayor-Zarzuelo, M., 3 Mar 2020, In: Journal of Medical Internet Research. 8, 3, 10 p., e14130.

    Research output: Contribution to journalArticlepeer-review

  4. Changes in resistance among coliform bacteraemia associated with a primary care antimicrobial stewardship intervention: a population-based interrupted time series study

    Hernandez-Santiago, V., Davey, P. G., Nathwani, D., Marwick, C. A. & Guthrie, B., 7 Jun 2019, In: PLoS Medicine. 16, 6, 19 p., e1002825.

    Research output: Contribution to journalArticlepeer-review

  5. Exploring the training and scope of practice of GPs in England, Germany and Spain

    Glonti, K., Struckmann, V., Alconada, A., Pettigrew, L. M., Hernandez-Santiago, V., Minue, S., Risso-Gill, I., McKee, M. & Legido-Quigley, H., Mar 2019, In: Gaceta Sanitaria. 33, 2, p. 148-155

    Research output: Contribution to journalArticlepeer-review

Related by journal

  1. BMC Medical Education (Journal)

    Veronica O'Carroll (Reviewer)

    17 Jan 2020

    Activity: Publication peer-review and editorial work typesPeer review of manuscripts

Related by journal

  1. Does access to a portable ophthalmoscope improve skill acquisition in direct ophthalmoscopy? A method comparison study in undergraduate medical education

    Gilmour-White, J. A., Picton, A., Blaikie, A., Denniston, A. K., Blanch, R., Coleman, J. & Murray, P. I., 13 Jun 2019, In: BMC Medical Education. 19, 8 p., 201.

    Research output: Contribution to journalArticlepeer-review

  2. National survey of clinical communication assessment in medical education in the United Kingdom (UK)

    Laidlaw, A. H., Salisbury, H., Doherty, E. M. & Wiskin, C., 13 Jan 2014, In: BMC Medical Education. 14, 10.

    Research output: Contribution to journalArticlepeer-review

  3. How do United Kingdom (UK) medical schools identify and support undergraduate medical students who ‘fail’ communication assessments? A national survey

    Wiskin, C., Doherty, E., von Fragstein, M., Laidlaw, A. H. & Salisbury, H., 8 Jul 2013, In: BMC Medical Education. 13, 95.

    Research output: Contribution to journalArticlepeer-review

  4. Graduate attributes in the disciplines of Medicine, Dentistry and Veterinary Medicine: a survey of expert opinions

    Laidlaw, A. H., Guild, S. & Struthers, J., 5 Jun 2009, In: BMC Medical Education. 9, 6 p., 28.

    Research output: Contribution to journalArticlepeer-review

ID: 251478279