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 pam.harvey@monash.edu

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)