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| A study to explore the effects of anonymity on peer feedback in an integrated clinical anatomy presentation |
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It is widely recognised that to develop competency in professional skills it is necessary for a student to reflect on his/her behaviour. In order to facilitate such reflection, it is important to have constructive feedback on how others (including peers) view that behaviour.
Peer-assessment is widely used at Peninsula Medical School to help students develop a professional standard when giving or receiving feedback throughout their undergraduate medical studies, and which they can take forward into their medical careers. One such use of peer feedback has been an integrated clinical anatomy test where pairs of students in Year 2 are required to make a short presentation to a small peer group (~16) on a specific, pre-prepared anatomical scenario, using a life model, plastic models and projected anatomy diagrams as resources. The formative marking form used by the peer assessors has hitherto not been anonymized, and a staff perception has been that peers may have been generous in their marking in the conscious or unconscious hope of subsequent reciprocation, or for other social reasons (cf. Nowak & Sigmund, 2005). Moreover, it was felt that such attitudes might be modified if students were provided with some instruction on the subject of constructive criticism, regardless of whether or not they retained anonymity.
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Medical students in the Year 2 cohort (225 students across two sites – Exeter and Plymouth) were randomly allocated to one of four groups. Two groups were given tuition on how to provide constructive feedback. One of these groups subsequently gave named, the other anonymous, feedback to formatively assess peer presentations. The other two groups were given no tuition on feedback, and, similarly, one group subsequently gave named, the other anonymous, feedback.
Feedback forms included six Likert-style statements with a line (extending from 0 to 100%) on which to indicate the precision and accuracy of the information presented (Figures 1a and b).
Quantitative feedback data were categorized in one of four groups depending on whether it had been given anonymously or non-anonymously, and with or without extra instruction.
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Wilks' Lambda tests were applied to the data sets. Students who had been tutored in giving constructive feedback showed significantly lower (i.e. more critical) scoring, which was similar in effect to students giving anonymous feedback (Figure 2a and b).
Questions 1-3 gave rise to more generous scores (with high significance) when students had no tuition, with question 4 also showing a marginally significant difference (Figure 2a). Anonymity showed highly significant differences between scores given in response to questions 3 and 5, with marked but non-significant differences in questions 2 and 6. Overall, it appeared that the decrease in scoring was more marked in students who were given tuition, although there was no significant interaction between groups that had been given tuition and those that provided feedback anonymously.
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As expected, anonymity allowed students to be more critical of their peers in a formative assessment setting. A similar effect was seen after students had been provided with tuition regarding critical feedback. A trend towards the effect of extra tuition ameliorating the effect usually enjoyed by anonymity, suggests that further, longitudinal study would be worthwhile.
It also came to our attention that students who had given a presentation were able to positively engage with the providers of feedback (when identified) and this gave an improved opportunity for enhancement of learning and presentation skills.
Providing appropriate tuition to students on how to give constructive feedback improves the value of the feedback given, while also providing an opportunity for collaborative learning. The effect seen is similar to that seen when students provide anonymous feedback.
The authors would like to acknowledge the input of Mr James Oldham for the original idea of the anatomy presentation, Dr Tudor Chinnah (Exeter Medical School), for his input into the study, and Ms Yvonne Harris, Ms Julie Belka and Mrs Deborah Kirvell for collecting and inputting the data. We would also like to thank Ms Eithne Heffernan for discussion into how best to set up the trial for statistical analysis.
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