4 REd — Teaching Resource for Rural Clinical Educators, Issue 17 March 2012
Review
Giving Students Effective Written
Feedback
By Deirdre Burke and Jackie Pieterick
McGraw Hill Open University Press 2010
Although this book focuses on feedback
for student written compositions, its
message is clear for any supervisors
giving feedback to students. It discusses
what feedback is, how it can be utilized as
a teaching tool and offers a number of
practical activities for students and tutors
to analyse written feedback to see if it is
understood and can be actioned. One
chapter includes case studies involving
students from Science, History, Education
and academic skills courses involving
different methods of feedback – online
and on paper. The annotated bibliography
could be useful for tutors who would like to
explore aspects of feedback in more depth
including how feedback advances student
learning.
Find out more For more information on how to apply
feedback in learning and teaching, go to
these university websites:
Centre for the Advancement of
Teaching and learning - University of
Western Australia
http://www.catl.uwa.edu.au/resources/
assessment
Scroll down the page to the links about
giving effective formative feedback and
grading class participation. .
Higher Education academy
http://www.heacademy.ac.uk/resources/
detail/assessment/feedback-resources
Provides links to how students view
effective feedback, feeding forward and
engaging students with feedback. Links
include a seminar series on assessment
and feedback.
What the literature says …
Emmerson, S., Tillard, G., Ormond, T.,
Ramsay, R. & Moore, B. (2011) Questions
posed within written feedback in clinical
education: a research note. The Open
Rehabilitation Journal 4, 28-31
An analysis of written feedback given to
novice and more advanced Speech
Pathology students. The advanced
students were given more high level
questions (according to Bloom’s
Taxonomy) to promote critical thinking
than the novice students. This promoted
discussion about the importance of
facilitating critical thinking for all levels of
students.
Parker, P. M .& Baughan, P. (2011).
Providing written feedback that students
will value and read. The international
journal of learning. 16(11), 253 - 262.
Teachers undertook a self-assessment,
writing feedback about their own essays
that was then analysed against criteria
from the literature review about effective
feedback. Despite 82% providing specific
feedback that met the criteria, only 4%
gave feedback that suggested areas for
development and review for all criteria.
Ferguson, P. (2011): Student perceptions
of quality feedback in teacher education.
Assessment & Evaluation in Higher
Education. 36:1, 51-62
A study of undergraduate and graduate entry education students’ perceptions of the effectiveness of written feedback. Students reported that written feedback that was timely and personalized regarding their specific piece of work was the best feedback option. This feedback needed to be positive, clear and constructive with a focus on acknowledging their successes and guiding them towards future improvement.
“Giving learners feedback is just about the most important dimension of the work of teachers in post-compulsory education.” Phil Race, educationalist
About REd
REd is published four times a year by the North West
Rural Medical Education Unit of the Monash
University School of Rural Health. It provides
resources and practical tools for clinical educators.
Back issues are available. Phone (03) 5440 9000 or
see our web site: www.med.monash.edu.au/med/srh/
medical-education/resources.html
If you would like each issue of REd sent directly to
you, contact [email protected]
ISSN: 1835-1891
Contents
1. Written Feedback in Health Professional Education
2. In Focus…Forward-looking Feedback
3. In Practice…Using FIT in clinical supervision
4. Review: Giving Students Effective Written Feedback What the literature says
Find out more
Written Feedback in Health Professional Education
Published by the North West Rural Medical Education Unit, Issue 17 March 2012
Formative Feedback
Feedback to learners about their
performance during a range of tasks is an
essential part of an effective learning and
teaching process. In clinical education,
feedback is provided in a number of ways,
including a grade on a test, during the
performance of a clinical skill or in
reflection after a learner has completed a
particular task. The common agreement
about feedback is that it should be specific
to the performance, timely and provide
enough (but not too much) information for
the student to use. What, then, is the role
of written feedback in clinical education?
This issue of REd investigates why written
feedback also needs to meet the criteria
for an effective learning tool, and presents
a practical model on how this can be done
in clinical education. It discusses its
usefulness as a reference point for
students to plan their future learning.
Pam Harvey and Natalie Radomski
North West Rural Medical Education Unit
“Feedback is the breakfast of champions.” Ken Blanchard, business consultant
2 REd — Teaching Resource for Rural Clinical Educators, Issue 17 March 2012
The term ‘feedback’ has a range of
definitions, beginning with its origins in
engineering and neuroscience (output
signals integrated with input signals) to
feedback as reinforcement based on
operant and classical conditioning in
psychology [1]
. Teacher and learner alike
often view feedback as a negative act but
its potential to guide student learning is
significant. Feedback should be more than
pure assessment: it should assist students
to redirect their actions towards a better
outcome. Contemporary views of
feedback discuss it in a constructivist
sense, with knowledge construction
occurring as learners and supervisors
share feedback in action for learning [2]
.
‘Feedback’ can be given to a learner in a
number of different ways. It might be the
results of a formal test, the insights of
other students or part of a self-reflection
process. Eva et al. state that ‘accurate
external feedback is crucial if one hopes
to facilitate improvement’ [3]
, and
emphasise that self-assessment alone is
too dependent on self-concept. Feedback
should be ‘as close as possible to that
which will be experienced in actual
performance’ [1]
. Although the setting and
range of activities performed by learners
receiving feedback may vary, feedback
should be specific to the task in a
particular setting.
Written feedback is an important aspect of
guiding a student’s learning. In the clinical
years, feedback is mostly oral and based
on student’s clinical performance. End of
placement reports, mini-practical
examinations and tutor evaluations can all
involve formative (and summative) written
comments, and this has an important role
in assisting the student’s progress.
Generic comments (positive and
negative), although giving students a
general sense of how they have
performed, do not help to focus on
particular aspects of learning.
Providing written feedback to students
when clinical educators are working in
busy clinical settings can be difficult, but
meaningful feedback is essential [4]
to help
students ‘modify and improve their
performance over time’ [5]
. Effective
feedback for learning needs to be forward-
looking (i.e. where and how am I going?)
and action-focussed with specific
strategies to help students with their
ongoing learning [2]
. Written feedback also
provides students with an individualised
record of their learning needs and
performance goals that they can revisit
after verbal feedback has taken place. It
has a different role to verbal feedback
presented during, or at the end of, a
clinical encounter and provides an
important mechanism for reflection and
self-regulated learning[2]
.
Students in community-based placements
often have multiple clinical supervisors in
diverse healthcare settings. Written
feedback that is forward-looking and
action-focussed is critical for meaningful
clinical learning.
1. Grierson, L.E.M., We're talking about feedback...aren't we? Advances in Health Science Education, 2012. 17: p. 1-4. 2. Burke, D. and J. Pieterick, Giving Students Effective Written Feedback. 2010, England: McGraw-Hill Education. 192. 3. Eva, K.W., et al., Factors influencing responsiveness to feedback: on the interplay between fear, confidence, and reasoning processes. Advances in Health Science Education, 2012. 17: p. 15-26. 4. Kogan, J.R., E.S. Holmboe, and K.E. Hauer, Tools for direct observation and assessment of clinical skills of medical trainees: a systematic review. JAMA, 2009. 302(12): p. 1316-1326. 5. Richardson, B.K., Feedback. Academic Emergency Medicine, 2004. 11(12): p. 1283.e1-1283.e5.
In Focus … Forward-looking Feedback
Key terms
Feeding forward:
a process by
which students
indicate on an
assignment/task
how they have
attempted to follow
up on previous
feedback and how
they now seek
feedback on their
efforts.
Recursive
feedback:
specific feedback
on certain aspects
of tasks, allowing
students to
respond to
feedback and re-
do particular
sections. Tutors
check with
students that they
understand the
meaning of the
feedback before
redoing the
assessment.
3 REd — Teaching Resource for Rural Clinical Educators, Issue 17 March 2012
In Practice … Using F.I.T. in clinical supervision
Key concepts
Holistic Rubric:
a framework of
criteria for
providing general
feedback on the
total process.
Analytical
Rubric:
a framework of
criteria for
providing feedback
on individual
components of the
process.
Enhanced
feedback:
a type of feedback
that uses goal
setting, and
evidence about a
person’s current
achievements in
relation to that
goal, to provide
some
understanding of
how to bridge the
gap between the
two.
Figure 1: the FIT model
Figure 2: Feedback using FIT
Components of
FIT Explanation of Components
Framework Context of patient consultation with student
Identification Focussed acknowledgement of the student’s achievements
and why
To do Guided actions to progress student learning
There are many student feedback and assessment tools used in clinical education (e.g.
mini-CEX, end of placement assessments and tutor evaluation forms) that ask
supervisors to write comments about learners’ clinical performance. Without guidelines
on how to do this, comments are often too generic to be of specific help in the
progression of students’ learning.
F.I.T. is a simple and time effective model for recording written feedback. It has three
suggested components: a summary of the clinical encounter in which to contextualise
and evaluate student performance (the Framework); focussed Identification of student
achievements; and guiding ‘To-do’ actions to progress student’s learning over time (see
figure 1).
The three parts of F.I.T. provide a structured model for clinical educators to present
written feedback in a brief but focussed way. Examples of written comments using FIT
are shown in Figure 2.
Components of
FIT Model
Written Feedback
Example 1
Written Feedback
Example 2
Framework
F: Constipation in young
male construction worker
F: Freehand excision with
primary closure, nylon sutures,
wound dressing
Identification
I: It was good that you let
the patient tell his story
without interrupting in first
minute
I: Appropriate needle holder
technique and safe
management of sharps
To do
T: Remember – having two
other health points to
discuss adds value and
decreases dead time. Be
prescriptive when
suggesting taking fibre,
drinking water
T: Practice consistency of
needle depth to improve
wound approximation
(Harvey, Radomski and O’Connor, 2011)