RESEARCH IN BRIEF
Critical factors about feedback: ‘They told me what I did wrong; but didn’t give me any feedback’ Michele Groves, Marion Mitchell, Amanda Henderson, Carol Jeffrey, Michelle Kelly and Duncan Nulty Accepted for publication: 26 November 2014
Aim This study reports nursing and midwifery undergraduate and postgraduate students’ perceptions of feedback during their participation in a performance-based learning activity, either an Objective Structured Clinical Examination (OSCE) for patient assessment or a simulation focussed on communication skills.
Background Providing feedback to students is critical to learning. The definition and process of giving feedback has significantly progressed since its initial concept of simply advising learners whether an answer to a test item was right or wrong (Kulhavy 1977). Feedback is now conceived more broadly and used throughout the learning process. By providing students with a snap-shot of their current ability and advice, feedback helps to define learning goals more clearly, increases achievement and influences learning style (Sadler 1989). Feedback cultivates reflective practice and develops expertise (Albanese 2006). This is especially so in work-based learning where the provision of immediate feedback on performance can particularly enhance applied learning. The nature of feedback varies widely and includes formative assessment by teachers and peers, and summative assessment required for academic progression. The most effective feedback is constructive. That is, it should focus Authors: Michele Groves, BSc, PhD, Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, Qld; Marion Mitchell, BN, PhD, Griffith Health Institute, Griffith University, Nathan, Qld; Amanda Henderson, BN, PhD, Griffith Health Institute, Griffith University, Nathan, Qld; Carol Jeffrey, BN, MHSc, Griffith Health Institute, Griffith University, Nathan, Qld; Michelle Kelly, BN, PhD, Faculty of Health, University of Technol-
© 2015 John Wiley & Sons Ltd Journal of Clinical Nursing, 24, 1737–1739, doi: 10.1111/jocn.12765
on the task being assessed, include strengths as well as weaknesses of performance and suggest strategies for performance improvement. However, its effectiveness is also dependent on factors such as format, timing and the perceived expertise of the provider (Hattie & Timperley 2007, Murdoch-Eaton & Sargeant 2012). Additionally, receptiveness to, and type of feedback preferred, varies with the maturity and life experience of the learner, for example, beginning medical students have indicated a preference for positive, re-assuring feedback whereas senior students preferred immediate verbal feedback (Murdoch-Eaton & Sargeant 2012).
Design Student perceptions of feedback were collected across four educational settings: two undergraduate nursing programmes, one undergraduate midwifery programme and a postgraduate course for rural and remote healthcare nurses where students’ learning was centred on a practice based activity, either an OSCE or simulation session. The OSCE consisted of one scenario that required students to undertake an integrated patient assessment while the simulation session focussed on communication skills with students alternately playing the roles of patient, carer, nurse, etc. In all settings, the activities were for formative assessment and students received feedback from teaching staff. Additionally, students were encouraged to organise informal practice sessions and obtain peer feedback. ogy, Sydney, NSW; Duncan Nulty, PhD, Griffith Institute of Higher Education, Griffith University, Nathan, Qld, Australia Correspondence: Michele Groves, PhD, Faculty of Health Sciences, The University of Queensland, Herston, Queensland 4006, Australia. Telephone: +61 401677476. E-mail: [email protected]
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Research in Brief
Method Data were collected via open-ended questions on student surveys (n = 557) and student participation in focus group discussions (n = 91) within one week of participation in the learning activity. Thematic analysis was conducted on text from surveys and transcripts of focus groups discussions.
Results Overall, students found the feedback they received to be beneficial to their learning regardless of their role in the practice based activity or whether they received individual or group feedback. However, three specific themes emerged from the data analysis. These related to the value of feedback for learning, students’ perception of the nature of feedback, and the need for consistency in giving feedback (see Table 1): 1 The value of feedback for learning. Students appreciated receiving detail regarding the positive aspects of their practice and areas in which they could improve. However, there was variable appreciation of peer feedback by students, some of whom felt that their colleagues’ lack of expertise limited the opportunity for effective learning.
2 Limited understanding of what constitutes feedback. There was evidence of limited understanding by some students about what actually constitutes feedback. This included the perception that feedback is always positive and different to simply correcting mistakes; another was that quantity was more important than quality. A small minority of the 557 students commented that they could only learn through ‘doing’ rather than ‘observing’ and that feedback given to others in a group setting was by definition, not applicable to them. Students in year one indicated that they were only informed about what they were doing wrong. They valued positive feedback in the form of reassurance rather than negative comments. 3 Issues to do with consistency in the quality and delivery of feedback. Some of the student comments indicated that there were differences in how staff gave feedback during teaching sessions. Sometimes this resulted in conflicts or contradictions in the performance of techniques. Students highlighted the need for a uniform approach to teaching and giving feedback.
Conclusion These findings provide important insights into perceptions of feedback, its effectiveness in promoting learning, student
Table 1 Results of student surveys and focus groups Value of feedback
Peer feedback
Limited understanding of what is feedback
Inconsistency in quality of feedback
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I learnt a lot from my fellow students in their performance and from my simulation assessor’s comment/feedback. (Student nurse) Found it very useful!! Pointed out areas where I need to improve to be able to make my consultation with clients more holistic. (Rural and remote health nurse) Having feedback from a broad range of professionals was extremely helpful in my current professional workplace and for the future. (Rural and remote health nurse) Good to be the patient- ‘reflect on practice’ and ‘how you would feel being the patient a different view’. When playing the patient even though not asking questions but answering the questions gives you a chance to learn and give others feedback on how they went. (Rural and remote health nurse) Feedback from teachers would have been better. (Student midwife) Practice and practiced with peers- a script to memory- peer didn’t pick up on some mistakes e.g. creases in palms (so kept learning the wrong thing). (Student midwife) Used each other – blind leading the blind. (Student nurse) Not so much feedback, if we did something wrong, more like a correction. (Student nurse) They told me what I did wrong but they didn’t give me any feedback. (Student nurse) Most people know that when the observer starts asking questions it’s bad but I found it helpful because it gave me an idea of what I had forgotten. (Student nurse) Being the non-communicative ‘Joseph’ (the patient) – [I] had to travel in a long way to do nothing. (Student nurse) [Feedback was . . .] different between assessors- some gave more feedback than others. If had something to look at (a feedback sheet) then better for us all. Everyone then has equal feedback. (Rural and remote health nurse) Some students felt it was “not consistent” that there were differences – causing uncertainty and confusion in regards to “what’s right”. (Student nurse) In both the lab sessions and the skill review sessions the students felt that their learning was negatively impacted by conflicting methods of doing each task causing them confusion and insecurity. (Student nurse)
© 2015 John Wiley & Sons Ltd Journal of Clinical Nursing, 24, 1737–1739
Research in brief
perceptions of what feedback is, and their receptiveness to different types of feedback, specifically in clinical practice situations. In particular, it supports other recent work that identifies that students at the beginning of their course of study understand feedback as positive affirmation. This is in contrast to more experienced and postgraduate students who value detailed statements about how they can improve (Murdoch-Eaton & Sargeant 2012).
Relevance to clinical practice
•
•
Both staff and students need to have a common understanding of the nature and various forms of feedback. In addition to the well-recognised features of quality feedback (timely, specific, constructive and the like), this study has highlighted the need to address two underpinning issues before embarking on the feedback process, namely: ○ That all teaching staff should be trained in giving give consistent and effective feedback in a way that will be most useful for students; and ○ That information should be provided to students about what constitutes feedback and how it can best be used to improve learning. The negative view of peer feedback by some students suggest that adequate preparation is important and should carefully consider: ○ The purpose of the feedback (e.g. to be used following expert feedback to check technique or as revision in the lead-up to summative assessment);
○
Where and how it is to be given.
Disclosure The authors have confirmed that all authors meet the ICMJE criteria for authorship credit (www.icmje.org/ ethical_1author.html), as follows: (1) substantial contributions to conception and design of, or acquisition of data or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, and (3) final approval of the version to be published.
Funding & Ethics This project was funded by Australian Government through the Office of Learning and Teaching, Department of Education, Employment and Workplace Relations. Ethical approval was obtained from the Ethics Review Committees of all participating institutions.
Key words clinical assessment, feedback, performance, student
Conflict of interest There are no conflicts of interest.
References Albanese MA (2006) Crafting the reflective lifelong learner: why, what and how. Medical Education 40, 288–290. Hattie J & Timperley H (2007) The power of feedback. Review of Educational Research 77, 81–112.
© 2015 John Wiley & Sons Ltd Journal of Clinical Nursing, 24, 1737–1739
Kulhavy RW (1977) Feedback in written instruction. Review of Educational Research 47, 211–232. Murdoch-Eaton D & Sargeant J (2012) Maturational differences in undergraduate medical students’ perceptions
about feedback. Medical Education 2012, 711–721. Sadler DR (1989) Formative assessment and the design of instructional systems. Instructional Science 18, 119–144.
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Critical factors about feedback: ‘They told me what I did wrong; but didn’t give me any feedback’ Michele Groves, Marion Mitchell, Amanda Henderson, Carol Jeffrey, Michelle Kelly and Duncan Nulty Accepted for publication: 26 November 2014
Aim This study reports nursing and midwifery undergraduate and postgraduate students’ perceptions of feedback during their participation in a performance-based learning activity, either an Objective Structured Clinical Examination (OSCE) for patient assessment or a simulation focussed on communication skills.
Background Providing feedback to students is critical to learning. The definition and process of giving feedback has significantly progressed since its initial concept of simply advising learners whether an answer to a test item was right or wrong (Kulhavy 1977). Feedback is now conceived more broadly and used throughout the learning process. By providing students with a snap-shot of their current ability and advice, feedback helps to define learning goals more clearly, increases achievement and influences learning style (Sadler 1989). Feedback cultivates reflective practice and develops expertise (Albanese 2006). This is especially so in work-based learning where the provision of immediate feedback on performance can particularly enhance applied learning. The nature of feedback varies widely and includes formative assessment by teachers and peers, and summative assessment required for academic progression. The most effective feedback is constructive. That is, it should focus Authors: Michele Groves, BSc, PhD, Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, Qld; Marion Mitchell, BN, PhD, Griffith Health Institute, Griffith University, Nathan, Qld; Amanda Henderson, BN, PhD, Griffith Health Institute, Griffith University, Nathan, Qld; Carol Jeffrey, BN, MHSc, Griffith Health Institute, Griffith University, Nathan, Qld; Michelle Kelly, BN, PhD, Faculty of Health, University of Technol-
© 2015 John Wiley & Sons Ltd Journal of Clinical Nursing, 24, 1737–1739, doi: 10.1111/jocn.12765
on the task being assessed, include strengths as well as weaknesses of performance and suggest strategies for performance improvement. However, its effectiveness is also dependent on factors such as format, timing and the perceived expertise of the provider (Hattie & Timperley 2007, Murdoch-Eaton & Sargeant 2012). Additionally, receptiveness to, and type of feedback preferred, varies with the maturity and life experience of the learner, for example, beginning medical students have indicated a preference for positive, re-assuring feedback whereas senior students preferred immediate verbal feedback (Murdoch-Eaton & Sargeant 2012).
Design Student perceptions of feedback were collected across four educational settings: two undergraduate nursing programmes, one undergraduate midwifery programme and a postgraduate course for rural and remote healthcare nurses where students’ learning was centred on a practice based activity, either an OSCE or simulation session. The OSCE consisted of one scenario that required students to undertake an integrated patient assessment while the simulation session focussed on communication skills with students alternately playing the roles of patient, carer, nurse, etc. In all settings, the activities were for formative assessment and students received feedback from teaching staff. Additionally, students were encouraged to organise informal practice sessions and obtain peer feedback. ogy, Sydney, NSW; Duncan Nulty, PhD, Griffith Institute of Higher Education, Griffith University, Nathan, Qld, Australia Correspondence: Michele Groves, PhD, Faculty of Health Sciences, The University of Queensland, Herston, Queensland 4006, Australia. Telephone: +61 401677476. E-mail: [email protected]
1737
Research in Brief
Method Data were collected via open-ended questions on student surveys (n = 557) and student participation in focus group discussions (n = 91) within one week of participation in the learning activity. Thematic analysis was conducted on text from surveys and transcripts of focus groups discussions.
Results Overall, students found the feedback they received to be beneficial to their learning regardless of their role in the practice based activity or whether they received individual or group feedback. However, three specific themes emerged from the data analysis. These related to the value of feedback for learning, students’ perception of the nature of feedback, and the need for consistency in giving feedback (see Table 1): 1 The value of feedback for learning. Students appreciated receiving detail regarding the positive aspects of their practice and areas in which they could improve. However, there was variable appreciation of peer feedback by students, some of whom felt that their colleagues’ lack of expertise limited the opportunity for effective learning.
2 Limited understanding of what constitutes feedback. There was evidence of limited understanding by some students about what actually constitutes feedback. This included the perception that feedback is always positive and different to simply correcting mistakes; another was that quantity was more important than quality. A small minority of the 557 students commented that they could only learn through ‘doing’ rather than ‘observing’ and that feedback given to others in a group setting was by definition, not applicable to them. Students in year one indicated that they were only informed about what they were doing wrong. They valued positive feedback in the form of reassurance rather than negative comments. 3 Issues to do with consistency in the quality and delivery of feedback. Some of the student comments indicated that there were differences in how staff gave feedback during teaching sessions. Sometimes this resulted in conflicts or contradictions in the performance of techniques. Students highlighted the need for a uniform approach to teaching and giving feedback.
Conclusion These findings provide important insights into perceptions of feedback, its effectiveness in promoting learning, student
Table 1 Results of student surveys and focus groups Value of feedback
Peer feedback
Limited understanding of what is feedback
Inconsistency in quality of feedback
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I learnt a lot from my fellow students in their performance and from my simulation assessor’s comment/feedback. (Student nurse) Found it very useful!! Pointed out areas where I need to improve to be able to make my consultation with clients more holistic. (Rural and remote health nurse) Having feedback from a broad range of professionals was extremely helpful in my current professional workplace and for the future. (Rural and remote health nurse) Good to be the patient- ‘reflect on practice’ and ‘how you would feel being the patient a different view’. When playing the patient even though not asking questions but answering the questions gives you a chance to learn and give others feedback on how they went. (Rural and remote health nurse) Feedback from teachers would have been better. (Student midwife) Practice and practiced with peers- a script to memory- peer didn’t pick up on some mistakes e.g. creases in palms (so kept learning the wrong thing). (Student midwife) Used each other – blind leading the blind. (Student nurse) Not so much feedback, if we did something wrong, more like a correction. (Student nurse) They told me what I did wrong but they didn’t give me any feedback. (Student nurse) Most people know that when the observer starts asking questions it’s bad but I found it helpful because it gave me an idea of what I had forgotten. (Student nurse) Being the non-communicative ‘Joseph’ (the patient) – [I] had to travel in a long way to do nothing. (Student nurse) [Feedback was . . .] different between assessors- some gave more feedback than others. If had something to look at (a feedback sheet) then better for us all. Everyone then has equal feedback. (Rural and remote health nurse) Some students felt it was “not consistent” that there were differences – causing uncertainty and confusion in regards to “what’s right”. (Student nurse) In both the lab sessions and the skill review sessions the students felt that their learning was negatively impacted by conflicting methods of doing each task causing them confusion and insecurity. (Student nurse)
© 2015 John Wiley & Sons Ltd Journal of Clinical Nursing, 24, 1737–1739
Research in brief
perceptions of what feedback is, and their receptiveness to different types of feedback, specifically in clinical practice situations. In particular, it supports other recent work that identifies that students at the beginning of their course of study understand feedback as positive affirmation. This is in contrast to more experienced and postgraduate students who value detailed statements about how they can improve (Murdoch-Eaton & Sargeant 2012).
Relevance to clinical practice
•
•
Both staff and students need to have a common understanding of the nature and various forms of feedback. In addition to the well-recognised features of quality feedback (timely, specific, constructive and the like), this study has highlighted the need to address two underpinning issues before embarking on the feedback process, namely: ○ That all teaching staff should be trained in giving give consistent and effective feedback in a way that will be most useful for students; and ○ That information should be provided to students about what constitutes feedback and how it can best be used to improve learning. The negative view of peer feedback by some students suggest that adequate preparation is important and should carefully consider: ○ The purpose of the feedback (e.g. to be used following expert feedback to check technique or as revision in the lead-up to summative assessment);
○
Where and how it is to be given.
Disclosure The authors have confirmed that all authors meet the ICMJE criteria for authorship credit (www.icmje.org/ ethical_1author.html), as follows: (1) substantial contributions to conception and design of, or acquisition of data or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, and (3) final approval of the version to be published.
Funding & Ethics This project was funded by Australian Government through the Office of Learning and Teaching, Department of Education, Employment and Workplace Relations. Ethical approval was obtained from the Ethics Review Committees of all participating institutions.
Key words clinical assessment, feedback, performance, student
Conflict of interest There are no conflicts of interest.
References Albanese MA (2006) Crafting the reflective lifelong learner: why, what and how. Medical Education 40, 288–290. Hattie J & Timperley H (2007) The power of feedback. Review of Educational Research 77, 81–112.
© 2015 John Wiley & Sons Ltd Journal of Clinical Nursing, 24, 1737–1739
Kulhavy RW (1977) Feedback in written instruction. Review of Educational Research 47, 211–232. Murdoch-Eaton D & Sargeant J (2012) Maturational differences in undergraduate medical students’ perceptions
about feedback. Medical Education 2012, 711–721. Sadler DR (1989) Formative assessment and the design of instructional systems. Instructional Science 18, 119–144.
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