INTRODUCTION

eedback refers to the return of information aboutany related concurrent system or process whichtends to produce an effect pertaining to the

regulation or consecutive optimization of performance.Altogether it forms a complementary relevant andmeaningful interaction between learner and the system1,2.It should be both interactive and reinforcing as it guidesthe learner’s future performance.

ESSENTIAL COMPONENTS OF EDUCATIONALFEEDBACK:1,2,3.

Following are the components of feedback mechanism:1. Feedback should be undertaken with a common goalin mind by the trainer and the trainee2. It should be well timed and planned.3. It should be based on first hand data.4. It should be regulated in quantity and limited tobehaviors that are remediable.5. It should deal with specific performance, notgeneralizations.6. It should deal with decisions and actions, rather thanassumed intentions.Feedback is interpreted as a staged comprehensive systembetween the learner, tutor and the institution. All aimedfor one thing, to keep balance between the ongoing

education processes. Feedback also helps to identify thelearning problems in a supportive way. It constitutes theopinions, ideas and suggestions from all the entitieswhich are considered to be essential parts of a learningsystem. In contrary to the standard our ongoing educationsystem concentrates less on building effective feedbackprocess. The students have limited access to the wholeprocess. There is a lack of coordination both at the levelof learner and the instructor. As a result, there is consistentdeficit of professional knowledge development and itssharing. Feedback requires integration of opinions abouteducational process taken from learner, teacher and theinstitution. Later on the collected information is presentedin a format and its result is to be interpreted as positiveor negative in building efficient educational system.

POSSIBLE OUTCOMES ASSOCIATED WITHMEDICAL EDUCATIONAL FEEDBACK PROCESS

Following are the possible outcomes related tofeedback system .They may be interpreted both in positiveand negative format4,5,6,7,8.1. As an effective means of improving professionalmedical skills.2. As a fundamental component of advance continuingprofessional education medical practice.3. Goals may set upon precise standardization.4. Unskilled environment may read it as personaljudgment.5. May find to be as time consuming.6. Not consistent method due to lack of proper collection

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FEEDBACK IN PAKISTAN’S MEDICAL & DENTALEDUCATION SYSTEM

ABSTRACT: Feedback in medical and dental education system provides gateway to integrate the systemizedapproach towards incorporating the desired standards both by learner and tutor. It has standardization and particularcomponents to set goals towards achieving professional practice based upon advance education. It is deemed to benecessary for enhancing the educational values and yet equally provide means for patient care in more efficient andtargeted fashion.HOW TO CITE: Hafeez K, Wahaj A. Feedback in Pakistan’s Medical & Dental Education system. J Pak DentAssoc 2014; 23(4):175-178

1. Masters Program Faculty, BPP University, London. United Kingdom.2. Post graduate Orthodontic Fellowship Resident. Dr .Ishrat -ul- Ebad khan Institute ofOral Health Sciences.Karachi, Pakistan. < aiyshwj@gmail.com >Corresponding author: “Dr Kashif Hafeez ” < hafeezkashif@yahoo.co.uk >

Kashif Hafeez1 BDS, MFDRCSI, FFDRCSI, FDSRCSEdAiyesha Wahaj2 BDS

DENTAL EDUCATION

F

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of data output.

FEEDBACK CRITERIA FOR ENHANCINGPROFESSIONAL MEDICAL EDUCATION

Feedback acts to enhance educational system abilityto transform itself into a productive system .The feedbackcan be in both documented and electronic format.Professional regulatory bodies evaluate feedbackexclusively as an ongoing process7,8,9. The comprehensivestages through licensure, verification, data accountabilityand change in performance through these means favorthe future recognized change in terms of both supervisionand professional learning. Both tutors and students sharebenefits equally which include comprehensiveunderstanding of required curriculum with evidencebased practice. Medical educational constitutional policymust carry both educational development plans and allother contributory data, evaluate it in different steps tocheck its timely progress .This process should be effectivein all regions of the country7,8,9,10,11,12,13.

STAGED STANDARDIZATION IN EDUCATIONALFEEDBACK SYSTEM:12,13.

The staged standardization provides effective meansto integrate advance professional education into thecurrent education system. During the process,effectiveness is periodically assessed upon the feedbackprovided by both the learner and the institution. Following

staged standardization components need to be assessed:1. Teachers assessment based upon licensure.2. Need to enhance or upgrade through annual certificationor recertification process.3. Advanced professional development sessions.4. Practice evaluation based upon set standards andmonitoring.5. Teacher student interactions and assessment throughPerforma’s or electronic questionnaires.6. Constant monitoring of professional developmentthrough evidence based practice.

BASIC STEPS FOR TRAINERS

Davidoff and Berg(1990), has suggested four basicsteps for trainers in this process. The steps are asfollows:14.1. Plan,2. Teach/act,3. Observe and4. Reflect.Supervision is the critical part of an educational system.It provides the learner an appropriate way to explore itsexpertise with basic standards of care towards theirpatients or living environment. It constitutes one of thebuilding blocks of an institution. Any institution withoutproper supervision and standards, lack its basic abilityto benefit the entire educational system. There are lotsof other proponents but the learner needs supervisionprimarily. Every institution has its own set standardizedcriteria towards any subject or process. This can neverbe generalized in subjective manner until the data ofproper feedback is studied15.

PENDLETON METHOD OF FEEDBACK

A common model for giving feedback in clinicaleducation settings was developed by Pendleton (1984)16.It includes basic rules which encompasses objectivesboth from trainer and learner perspective. The methodis as follows:1. Check, learner wants the feedback and is ready for it2. Let the learner give comments/background to thematerial that is being assessed.3. The learner states what was done well.4. The learner states what could be improved.5. The observer(s) state how it could be improved.

Feedback in Pakistan’s Medical & Dental Education SystemHafeez K / Wahaj A

FIGURE 1: feedback and its relation with education process

The figure 1; shows the steps how feedback interlinks andimproves the outcome of medical educational process if employedin an effective manner. It impacts the professional standard ofan institution and also helps to build the reform plans whichprioritize patient safety with advance clinical professionalpractice.

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6. An action plan for improvement is made.These rules explain the feedback system from thebeginning and give the charge back to the learner. Thiscan be utilized in short feedback sessions or for detailedlong sessions.

FEEDBACK FOR GROUPS

When providing feedback for groups, an interactivesession is very beneficial. This states to develop acomprehensive statement or interaction between thelearners and the educator. The process essentially isconstructed upon the learners own self-assessment, itshould be detailed and collaborative, it help learners totake responsibility for their own learning needs. Astructured approach requires the need that both thetrainees and trainer must target what is expected of themduring the feedback sessions. The salient points for givingfeedback to groups are as follows15.. Initiate .with the agenda of the trainees. Target the outcomes what the session of discussion istrying to achieve.. Encourage the trainees to do self assessment and comeup with problem solving firstly.. Interact with the whole group for problem solving.. Feedback should be detailed and descriptive.. Feedback should include, what has worked previouslyand what can be done in the future.. Alternatives should be suggested.. Solutions should be rehearsed to gain confidence. Supportive attitude should be adopted.

. The whole group learns from this interactive session.

. Concepts, principles and research evidence should bequoted as and when needed.. In the end, a structured plan and summary should bediscussed.

COMPARATIVE PROFESSIONAL MEDICALEDUCATION ASSESMENT

Our professional medical & dental educational systemneed strategic staged evaluation which is found to beessential worldwide. Professional educational criterianeeds uniform standardization through core to layer.Optimization of proper feedback in every institutionneeds to be established. Comprehensive assessmentthrough various means to effectively check professionalcompetency is required. Medical educational policyneeds to be established which evaluates data constructionand its continuous upgrading at various professionaleducational levels. Professional educational system fromprimary till advance professional level must compriseof staged developmental sessions both for students andteachers. The only process which keeps the learner andthe tutor interlinked is feedback communication betweenthem. Educational criteria at all levels and their proofevaluation are required to assess the required progressin this regard. Process of decision making needs to beevaluated. Uniform constitutional data required to be setto analyze educational system from both student andteacher perspective so that it provides balanced productiveresults at professional evidence based practice.

POSSIBLE LIMITATIONS

The following are the basic possible limitations inimplication of both interactive and reinforcing feedbackprocess in professional medical education:17,18.1. Unsupported educational frame work2. Concerns about resulting consequence3. Time limit4. Unprofessional clinical skills5. Lack of knowledge about particular medicaleducational system.6. Lack of evidence based clinical practice

RECOMMENDATIONS

Feedback sessions should be made mandatory during

Feedback in Pakistan’s Medical & Dental Education SystemHafeez K / Wahaj A

Fig2: Pendleton Feedback Loop

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the training years and these sessions should form thebasis of trainee's career progression. Every institution intheir constitution should emphasize the importance oflearner’s led feedback. Tutors should realize that this isan opportunity for the trainees to reflect upon them andsuggest what is beneficial for them. A sense of confidencebuilding is felt when trainer talks about the positives ofthe trainee's progress. During the session the prediscussion summary allows to remember the key points.The session should be learner lead so trainee shouldrealize that he is involved in all stages of the session.Problem solving should be done by the trainee; itreinforces the ownership of the problem. The traineeshould formulate the future course of action that willaugment his commitment and agreement to the futureplans.Continuation of the learning process should been forcedin the end.

REFERENCES

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1-7.7. Isaacson JH et al Resident Perceptions of theevaluation process. Society of General Internal Medicine.J Gen Intern Med 1995;10(suppl):89.8. Eichna LW: Medical-school education, 1975- 1979:A student's perspective. N Engl J Med 1980;303:727-734.9. Nadler DA: Feedback and Organization Development:Using Data-Based Methods. Reading,Mass, Addison-Wesley Pub Co Inc, 1977.10. Hyman RT: Improving Discussion Leadership. NewYork, Teachers College Press, 1980.11. American Board of Internal Medicine, Benson JA Jr,Bollet AJ, Faber SJ, et al: Clinical Competence in InternalMedicine. Ann Intern Med 1979;90:402-411.12. Klein RH, Babineau R: Evaluating the competenceof trainees: It's nothing personal. Am J Psychiatry1974;131:788-791.13. Beer M: Performance appraisal: Dilemmas andpossibilities. Organizational Dynamics, 1981, winter, pp24-36.14. Davidoff, S., Berg, O.V.D. (1990) changing yourteaching: the challenge of the classroom: Centaurpublications.15. Kilminster, S., Cottrell, D., Grant, J., Jolly, B. (2007).Effective educational and clinical supervision. MedTeach. 20079;29:2-19.16. Pendleton D, Schofield T, Tate P & Havelock P; TheConsultation: An Approach to Learning and Teaching:Oxford: OUP. 1984.17. Sadler, D.R. Beyond feedback: Developing studentcapability in complex appraisal.Assessment & Evaluationin Higher Education.2010; 35: 535-550.18. Orsmond, P., S. Merry, and K. Reiling. Biologystudents 'utilization of tutors'formative feedback: Aqualitative interview study. Assessment & Evaluation inHigher Education.2005; 30: 369-386.

Feedback in Pakistan’s Medical & Dental Education SystemHafeez K / Wahaj A