Theme
Assessment: Written and Feedback
INSTITUTION
University College London Medical School
Feedback is integral to learning and development. It has been identified as one of the top five factors in learner achievement and promotes learning by informing trainees of their progress, their learning needs and by motivating them to improve. 1,2
Medical students value constructive feedback as it helps them to improve their performance. Supervised Learning Events (SLEs) were developed as performance assessments and to create opportunities for students to receive feedback. While many would argue the strengths of SLEs, there is a lack of literature assessing the quality of written feedback for medical students.
A random 10% sample (n=36) of year four students in the academic year 2010-2011 (n=367) were contacted and asked to provide their 16 SLE forms for evaluation in exchange for a £20 gift voucher. Two hundred and fifty forms were received (121 mini-CEX, 122 CBD and 7 Case Note Review (CNR)), which were anonymised.
Six students, with guidance from two faculty staff, devised a coding framework for the forms, to grade the quality and domain of feedback according to the gold standard as defined by Van de Ridder et al.3 The coding framework used can be seen in table 1.
Domain covered by feedback |
Clinical Skill |
Professionalism |
Communication Skills |
|
Global judgement of feedback quality |
Strong |
Neither strong, nor weak |
Weak |
|
Reasons for poor quality feedback |
Blank |
Irrelevant |
Illegible |
Non-specific |
Relevance of feedback |
Relevant to learning objectives |
Relevant to end of year assessment |
|
|
Type of feedback |
Point of good performance |
Area for improvement |
|
|
Overall, 63.1% of feedback entries were graded weak (Figure 2). A greater proportion of the “areas for improvement” comments were graded weak (73.6%) compared to the points of good performance (52.8%). Examples of comments in each category are shown.
Weak:
“Keep practising”
”Points of good performance: 9/10”
Neither strong, nor weak:
“Significant improvements needed in upper limb neurological exam”
“Very good history taking and record keeping.”
Strong:
“To practice a systematic approach to CVS examination to make sure relevant aspects are not for “To continue to enquire about the impact medical illness has on a patient’s ADL as this is an aspect that often gets missed in the hospital setting.”
|
Reasons for Classification of Feedback as Weak |
Weak feedback was classified as being non-specific, unclear, illegible, irrelevant or “blank” . Additionally, a large proportion of forms carried the comment “keep practising” (or similar). This was assigned an additional code. See Table 2 for full results.
|
Proportion of ‘weak’ units of feedback coded with listed codes (%) |
Blank |
40.6 |
Non-specific |
34.1 |
Keep practising |
19.5 |
Irrelevant |
4.6 |
Illegible |
1.2 |
Table 2 Primary reasons for coding of units of feedback as weak
The quality of written feedback is clearly an area for development. Factors that impede this include a lack of time and the fact that some assessors may be uncomfortable providing negative feedback. In order to improve, it is important that both students and assessors are trained more thoroughly in giving effective written feedback.
To improve the feedback being given to students, it is important that both students and assessors are aware of the purpose and benefits of SLEs and the delivery of feedback. Assessors should be trained more thoroughly in giving effective written feedback.
We would like to thank Freya Baird for her help in the initial data collection.
[1] Hattie J, Timperley H. The Power of Feedback.Rev Educ Res 2007;77:81-112