1. Conferences
  1. Learning at City Conference

Session 2E

Paper 1

Can service users enhance our provision of student feedback?

Dr Rakhee Shah - Lecturer | School of Health Sciences

Dr Irene Citori - Lecturer | School of Health Sciences

Content: Final year undergraduate optometry students examine members of the public during primary care clinics whilst being observed by visiting clinical tutors (VCTs). Upon completion of the examination, students receive individualised feedback from the VCT with details on areas for improvement, including their communication. Unannounced SPs have proven successful in measuring the quality of clinical care within optometry for qualified optometrists.2 Students value the feedback provided by SPs3;4;5.  In this pilot study, feedback on students’ communication provided by unannounced SPs was compared to that provided by VCTs. Two SPs received intensive training on all elements of the eye examination to enable accurate reporting of the content of the eye examination including communication skills. SPs presented unannounced (incognito) as patients seeking routine eye examinations. The SPs provided objective patient-centred feedback on their examination through completion of a pre-designed checklist for each encounter.

Results: Qualitative thematic analysis has been performed on sixty-four sets of feedback (thirty-two each from SPs and VCTs). Five overarching themes emerged through analysis of feedback around communication. SPs and VCTs mostly agreed and commented positively on the students’ professionalism (polite and able to put patient at ease). SPs commented positively on whether the student introduced themselves. Both groups commented on the student’s ability to understand and address the reason for attendance (SPs more so than the VCTs), use of technical language and the students’ body language (eye contact during the examination). The SPs generally provided more detailed subjective feedback around the emerging themes on communication when compared to the VCTs.

Recommendations/Conclusions: Performing eye examinations on unannounced SPs who provide individualised feedback on the students’ ability to articulate clinical findings and future management in a patient friendly manner during the final year of undergraduate training can provide an additional training and assessment resource.

Session learning outcomes

Whilst this is an optometry-based project, patient-practitioner communication is a vital skill in all healthcare professions and strongly contributes to overall patient satisfaction. Providing feedback to students on their performance during undergraduate training is important and forms an integral part of teaching and learning for students. SPs are unique in that they can be trained to give feedback from a patient’s perspective1 to cover different aspects of their interaction with the student.

We believe that the results and conclusions of the present study can be applied to other healthcare undergraduate programmes that are predominantly patient facing. In addition to this, we will discuss how similar approaches could be used in non-client facing programmes to develop student communication skills (e. g. roleplay).The overall aim is to promote student progression by augmenting current practice with this additional mode of student feedback. Indeed, with further exploration and development of the themes presented in this paper, the findings may have wider reaching applications across all university programmes with the potential to involve stakeholders and other service users in programme delivery.


  1. Barrows HS (1993) An overview of the uses of standardized patients for teaching and evaluating clinical skills. AAMC. Acad Med 68, 443–51
  2. Shah R, Edgar D, Spry P, Harper RA, Kotecha A, Rughani S, Evans BJ. (2009) Glaucoma detection: The content of optometric eye examinations for a presbyopic patient of African racial descent. Br J Ophthalmol; 93(4): 492-6.
  3. Anderson HA, Young J, Marrelli D et al. (2014) Training students with patient actors improves communication: a pilot study. Optom Vis Sci 91, 121–8.
  4. Kneebone R, Kidd J, Nestel D et al. (2002). An innovative model for teaching and learning clinical procedures. Med Educ 36, 628–34

Paper 2

Professionalism and positive motivation: Law students’ emotional responses to challenging encounters in a live clinic setting.

Professor Nigel Duncan - Professor of Legal Education | City Law School

We must assist our students to develop self-awareness of their responses to challenging circumstances encountered in the live clinical modules we offer, their development of professional empathy and through reflection on their learning informed by self-determination theory for this to become a key element of their professional identity.

There is increasing interest globally in the notion of psychological well-being and its impact on our personal and professional lives. A large body of international scholarship has now established that levels of psychological distress are unacceptably high in the legal profession and at law school. This paper presents an attempt to explore the experience of students undertaking clinical work with real clients as part of their Bar Professional Training Course at City Law School. These students have been representing clients in the employment and social security tribunals and helping victims of domestic violence to prepare their cases for court.

The research, over three years, explores their responses to clients facing emotional distress and in some cases to aggressive opponents or unsympathetic judges. Each iteration used a survey and a focus group. After each iteration of the research student learning was addressed in the light of findings. This creates both a research opportunity, in evaluating those interventions, and a methodological problem, in that this experience and the researcher’s own continuing study of the issues, makes comparison between the different iterations hard to make with confidence.

Findings explore students’ understanding of their own developing empathy and professionalism using a theoretical model based on self-determination theory. This seeks to help them to maintain and develop the well-being necessary to thrive.

My understanding of this field has been assisted by an interdisciplinary workshop organised with colleagues from the School of Health Sciences which suggests that this may be of value to teachers and students in many areas where we prepare professionals to meet challenging encounters.

My talk will be supported by a PowerPoint presentation with opportunities for colleagues to ask questions throughout. I will aim for it to last a little over 20 minutes, leaving an opportunity for discussion towards the end.

In particular I hope participants can explore the application of this research to other disciplines and professions. They may also gain an understanding of the demands of modern legal practice with vulnerable clients.

Key words:

Qualitative research methodology; Well-being; Resilience; Empathy and professionalism; Self-determination theory.


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  • Cunningham, Clark, (2013) ‘What do clients want from their lawyers?’ Journal of Dispute Resolution 143-158
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  • Glenda MacDonald et al.,, ‘A Work-Based Educational Intervention to Support the Development of Personal Resilience in Nurses and Midwives’ (2012) 32(4) Nurse Education Today 378
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  • Vilayanur S Ramachandran, ‘The Neurology of Self-Awareness’ (2007) The Edge
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    Sheldon, Kennon M., and Lawrence S. Krieger. (2007) "Understanding the negative effects of legal education on law students: A longitudinal test of self-determination theory." Personality and Social Psychology Bulletin 33.6: pp 883-897
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  • Lauren Wispé, ‘The Distinction Between Sympathy and Empathy: To Call Forth a Concept, a Word Is Needed’ (1986) 50(2) Journal of Personality and Social Psychology 314,