Effective feedback

When the process of providing feedback is carried out well, the feedback can motivate learners and help them to improve their performance. Constructive feedback is information-specific, issue-focused, and based on observations. Constructive feedback will identify strengths (what the student has done well) and areas for improvement (where the student might have done better). The process of providing learners with constructive feedback should be part of the overall interaction between teacher and learner, should include student's self assessment and not be a one-way communication from teacher to learner.

Price (2010) suggests that feedback can serve a number of purposes

1. Correction (helping students to put things right by taking corrective action);
2. Reinforcement (a stimulus providing positive or negative reinforcement to behavior);
3. Forensic Diagnosis (diagnosing problems with the work so that students can see how to improve);
4. Benchmarking (identifying a gap between current performance and the standard of expected performance); an
5. Longitudinal development (supporting improvements in the next assignment and beyond).

It is important that both staff and students are clear about a) the purpose(s) of feedback and b) the value of feedback. Lack of understanding of purpose can lead to feedback that is confusing and ultimately ineffective. Lack of understanding of the value of feedback can result in teachers failing to meet students' learning needs and in students failing to see the value of feedback for their short term and long term development. Ultimately teaching staff want to see students apply feedback in subsequent work and students want to see applicability of feedback in the "content and timing of feedback provided." The surest way to achieve this is to have a developed relationship between teachers and students.

Types of Feedback

Feedback can be informal, in day-to-day encounters between teachers and students or it can be more formal as part of written or clinical assessment of learners' performance. Feedback can also take a variety of forms and come from a number of sources. For example, feedback can be written, verbal or numerical and depending on context it can come from academics, clinical educators, health professionals and from patients (e.g. communication and attitude).

Directive feedback tells the learner what needs to be corrected. For example, a clinical educator might notice that a student has omitted a step in the procedure for e.g. male catheter insertion whilst practicing on simulated patient. Directive feedback would point out the mistake and tell the student how to remedy the mistake.

Facilitative feedback involves providing comments and suggestions to support self-correction. For example, a teacher might notice a student making a mistake whilst practicing e.g. male catheter insertion on a simulated patient. Facilitative feedback might consist of asking the student to review the steps in the procedure.

Archer (2010) suggests that facilitative feedback may work better for high achievers than for novice learners and that delayed feedback (wait until the task is completed) may be more appropriate for high acheivers engaged in complex tasks. These considerations do not provide the definitive answer on how to give feedback. However, they do indicate the need to consider how and when feedback is being given.

Giving Effective Feedback

While effective feedback is, to some degree, determined by context and student ability, the following "rules" will broadly apply in a more formal feedback session.

Clinical education settings are diverse and include small group settings, practical skills training and bedside teaching situations. In these situations, feedback needs to be delivered at an appropriate time and place and feedback needs to be constructive. Those involved in medical education might consider the fact that medical students and professionals tend to be high achievers and that medicine centers on personal clinical interactions. Particular models recommend themselves for oral feedback in this setting. For example, a model for two-way interaction between educator and learner that provides constructive goal oriented criticism may help to overcome perceived shortcomings in feedback provided in medical education settings (See Archer 2010).