FROM SCORES TO SENSE-MAKING: HOW SUPERVISORS’ FEEDBACK PRACTICES MEDIATE THE RELATIONSHIP BETWEEN WORKPLACE-BASED ASSESSMENT AND TRAINEE LEARNING IN INTERNAL MEDICINE RESIDENCY TRAINING IN PUBLIC SECTOR TEACHING HOSPITALS OF KPK, PAKISTAN

Abstract

Purpose: To examine how supervisor feedback practices mediate the relationship between workplace-based assessment (WBA) data - numerical scores and narrative comments- and trainee learning in the fellowship of College of Physicians and Surgeons (FCPS) Internal medicine training programme and to determine the association between written feedback quality and the observed dynamics of trainee-supervisor feedback dialogue in peripheral public-sector hospitals in Khyber Pakhtunkhwa (KPK), Pakistan.

Method: A sequential explanatory mixed-method design was employed. In the Quantitative phase, 120 WBA forms completed by 30 trainee and 15 supervisors were evaluated for Likert-scale, narrative comments quality, specificity, actionability and word count; Spearmen rank correlation and clustered regression analysis examined associations. In the qualitative phase, 10 purposively sampled trainee-supervisor dyads were directly observed during post-WBA feedback conversation, with structured rating of conversation duration, dialogue exchange, trainee-initiated questions, action planning and sense-making. Inter-rater reliability was established using Cohen’s kappa prior to independent coding.

Result: Mean WBA score was 3.50 (SD, 0.87), while mean narrative feedback quality was notably lower at 2.75 (SD, 0.94); specifically and actionability sub-scores fell further below the midpoint at 2.49 (SD, 1.00) and 2.52 (SD, 0.94) respectively. Median comment word count was 14 words (IQR, 5-25). Feedback quality correlated with specificity (ρ=0.56, p<0.01) and word count (ρ=0.48, p<0.01). At dyad level, higher written feedback was associated with longer conversations (ρ=0.72), more dialogic turns (ρ=0.71), greater trainee question frequency (ρ=0.86), and stronger observed sense-making (ρ=0.59)

Conclusion: written feedback on WBA forms meaningfully mediate from assessment data to trainee learning in the FCPS training context. Where supervisors wrote specific, behaviorally grounded comments with a clear next step, trainees engaged more- they asked more questions, stayed longer in conversation and understood more of what was expected of them.