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COMMENTARY
Year : 2017  |  Volume : 5  |  Issue : 1  |  Page : 45-48

The criteria of constructive feedback: The feedback that counts


Department of Surgery, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia

Date of Web Publication20-Jan-2017

Correspondence Address:
Ahmad AbdulAzeem Abdullah Omer
P.O. Box 3718, Tabuk 71481
Saudi Arabia
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DOI: 10.4103/2468-6360.198798

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How to cite this article:
Omer AA, Abdularhim ME. The criteria of constructive feedback: The feedback that counts. J Health Spec 2017;5:45-8

How to cite this URL:
Omer AA, Abdularhim ME. The criteria of constructive feedback: The feedback that counts. J Health Spec [serial online] 2017 [cited 2019 Nov 22];5:45-8. Available from: http://www.thejhs.org/text.asp?2017/5/1/45/198798


  Introduction Top


In the field of education, feedback is described as information regarding the students' performance that is provided with the intention to improve their learning.[1] The positive impact of feedback on learning stems from a large number of research studies in the medical education literature.[2] In the educational enterprise, feedback enhances learning, promotes acquisition of skills and drives professional growth and development.[3],[4] However, some evidence are currently showing that feedback can sometimes be 'done badly' resulting in unwanted consequences and leading to the failure of producing its expected outcomes.[4],[5],[6] Altmiller reported an increased frequency of uncivil behaviour in nursing education, which is attributed to lapses and gaps in the provision of constructive feedback. This escalating pattern of incivility is linked to some bad teachers' behaviours in the execution of feedback, which instead of being constructive may harm the teacher-student relationship and fuel retaliation by the students as a response to the uncivil behaviour.[7] It was identified that it is easy for teachers to provide their students with positive reinforcing feedback, but it is difficult to provide them with constructive feedback (positive criticism).[7] This difficulty has been referred to teachers' fear of insulting their relationship with their students, and sometimes due to their anticipation of poor evaluation by their learners when poor performance is criticised.[8] Poor feedback often results in a 'dismissive and defensive reaction' which means, at a glance, the learners would not accept the feedback and they would not work on it. However, on the long-term, this could also have some evident consequences such as reduced motivation and limited engagement with future feedback.[9]

  • Weak feedback has poor, and probably sometimes negative, impact on learning
  • Providing constructive criticism on performance is a challenging task but could be learnt
  • Constructive feedback motivates learners, improves their learning and enhances their professional growth.



  The Arena of Constructive Feedback Top


Providing the students with constructive criticism regarding their performance is crucial to reinforce their learning;[10] however, it is found to be a challenging task.[8] The proposed characteristics of constructive feedback appear in some of the definitions of the term. Hamid and Mahmood in their review of constructive feedback have recruited the following definition 'Where there are agreed standards of behaviour and performance, and two-way communication about what has gone right as well as what has gone wrong, there is feedback that we define as constructive feedback'.[11] The features of constructive feedback depicted here is that feedback should highlight and strengthen good performance, delineate poor performance, provide remedial action plans and involve two parties; preferably working as an ally.[11] Other criteria of constructive feedback include that it should be: Timely, specific, supportive, relevant, informative, accurate and understandable.[12] Constructive feedback has several advantages that are proposed to enhance learning in educational settings. It motivates learners and inspires and promotes them for learning.[13] It can be used as a tool for high-quality learning and to stimulate growth and professional development of learners. It has also a positive influence on the professional development of feedback providers as well.[11]

This article reviews and summarises some of the literature regarding feedback with the intention to identify the criteria of constructive feedback; the feedback that is desired and expected to improve students' learning and performance.


  Methods Top


A short review of some of the published literature on feedback in the context of medical education was conducted aiming to identify the essential features of constructive feedback in terms of its criteria as well as its recommended and beneficial practices. These will be discussed under two sections; general and conceptual characteristics, and criteria related to the quality of the feedback. The article hopes to shed light on the most important criteria of constructive feedback, however, the list of criteria described in [Table 1] is not meant to be comprehensive.
Table 1: Features of constructive feedback

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  Conceptual Characteristics of Constructive Feedback Top


  • A collaborative learning environment:That is nourished by confidence, trust and respect and admires the value of teamwork. A student-learner relationship nurtured by mutual trust and confidence will create a safe environment, in which learners can learn more effectively from their supervisors in clinical settings [14]
  • Use of dialogue: To enhance the active role of students in the process of feedback and strengthen their self-regulation capacity.[15] This coincides with the operational definition of feedback concluded by van de Ridder et al., in his comprehensive review of feedback definitions in the context of medical education. They viewed feedback as a cycle that includes information and reaction. They added that feedback could be referred to as a process of communication.[1] The ability to self-evaluate and self-regulate is an essential attribute of accomplished practitioners and it provides them with the capacity to learn for life, even beyond formal educational programmes. Novice learners, on the other hand and due to lack of expertise, are in particular need to instil these skills in them to produce imperative feedback results [13]
  • Curricular and teaching designs: That foster engagement and provide multiple feedback opportunities.[16] Modern medical curricula should embed feedback as a key component of their structure. Learners should be actively involved in teaching activities and should be given opportunities to observe their performance whenever possible. Attention to the importance of practicing self- and peer assessment exercises, and encouragement of the habit of reflection are essential and should remain on top of the mind of programmes' leaders and course instructors [17]
  • Effective communication: Early sharing of goals, expected outcomes and standards of quality performance.[18],[19],[20] Van den Bergh et al., highlighted the importance of the goal-directedness nature of feedback. They asserted the need to develop explicit and clear learning goals and communicated them to the students. The effectiveness of feedback here is that it should be related directly to the learning goals to yield a good outcome.[21] According to Ramani and Krackov, (2012) when instructional leaders and learners jointly develop and share the learning goals of a course or rotation, both of them can test and adjust their performance in relation to the achievement of those goals at any stage of the learning experience.[10]



  Specific Criteria Related to the Quality of Feedback Top


  • Immediate: Presented while the event is still fresh in the student's mind.[14] This also entails feedback to be provided with the person who attended the encounter, which further increases its credibility [8]
  • Specific: Addresses certain points of performance and not be based on generalisations.[5] Thus, feedback information such as, 'your physical examination skills of the patient's abdomen needs some revision', is rarely helpful to the student who performed the task because he will not know which part of his/her performance particularly requires attention. Instead, it would be more useful to the student if you said, 'the way in which you put your hand on the abdomen for superficial palpation requires improvement, your wrist should be straight? Try to kneel down' explaining why his/her performance is not correct and suggesting a method for correction; feedback should concentrate on behaviours that can be changed. Learners found feedback most effective when it focuses on specific performance, especially when it is accompanied by reasons of why performance was inadequate [22]
  • Non-judgemental: Phrased in non-evaluative language, which could hamper the defensive attitude of some students;[6] for example, information such as, 'your history of the patient's illness did not cover the possibilities of pancreatitis and peptic ulcer disease', non-judgemental sentence, is much better than when you say, 'your history was so deficient', judgemental sentence
  • Based on first-hand data: Provided by the same person who attended the event so that the learners are likely to believe in it.[14] Altmiller asserted that speaking in the first person using I instead of he/she would enhance a teacher credibility and shows the information provided as factual [7]
  • Accurate: Based on real observation and assessment of performance;[5] it should report events as they have occurred and avoid bias.[7] Kuvaas et al., have indicated that when feedback is not seen as accurate and acceptable, it would generate disagreement between the feedback provider and receiver, and in that occasion, it is less likely to be taken and acted upon to improve performance.[23] Ruscher et al., have pointed that feedback that is overly positive may be viewed by learners as a kind of pity and sympathy that could result in the feedback being disregarded [24]
  • Suggest plans for improvement: Not limited to one situation and advises actions for future improvement.[15],[25] A key feature of constructive feedback that is commonly mentioned is that it provides options for improvement in future tasks, which increases its effectiveness and allows the students to view it as an opportunity for learning [7],[23]
  • Seen as 'helpful': Not embarrassing, respectful, focuses on behaviour not personality and balances positive and negative comments. In this way, it is less likely to elicit negative emotional reaction in learners.[26],[27] Beginning with caring statements is a useful strategy that reflects teachers' motivation and his/her concern about his/her learners and allows the students to feel safe during the process; an example is, 'I am saying this because my ambition is to see you an excellent doctor in the future'. Beginning with caring statements encourages the students to accept and work on the feedback and should be assembled in every feedback message.[7] Moreover, Murdoch-Eaton in 2012 has indicated that negative feedback tends to generate responses of avoidance, prevention and obligation that would likely jeopardise the role of feedback in learning [13]
  • Solicited rather than imposed: Benefit from formal and informal occasions to arise and endorse the active role of students in seeking information regarding their performance.[17],[28] Fong et al., mentioned that feedback-seeking attitudes are encouraged in learning environments in which 'informational feedback' - the feedback that involves information on goal progress and how to accomplish it - is provided.[29] Delva et al., pointed to the interplay of other factors in shaping the feedback-seeking habit of learners. They recommended the establishment of a learning climate that encourages feedback and building comfortable relationship between teachers and learners to foster feedback-seeking behaviour [30]
  • Relevant: Targets specific learning performance tailored to the individual needs and interests of learners.[14] Ibrahim et al., elaborated on interns' dissatisfaction with performance appraisal in his study and reasoned that to the lack of perceived relevance of many of the appraisal domains. He recommended the involvement of immediate supervisors, who work with interns on a daily basis in the delivery of performance feedback and more emphasis on personal feedback addressing one's own strengths and weaknesses.[9] Hauer and Kogan have asserted the need to address provision of feedback in areas in which the students are most interested, for example, their bedside clinical skills, rather than commenting on their written assignments and verbal presentations [14]
  • Balanced: Amount of information delivered is neither scanty nor overwhelming.[28],[31] Ramani and Krackov have advocated that the amount of feedback presented in an encounter should be limited to what the learner can absorb [10]
  • Understandable: So that learners can act upon it, and the feedback loop could be closed.[15],[17] Feedback that is not understood and not followed by advice on how performance can be improved is unlikely to enhance learning [23]
  • Of multiple cycles: Provided sequentially over extended time, which could display what the students have really done with previous feedback messages.[32] This correlates with the concept of 'feed forward,' in which the students are enabled to show how they translate the feedback taken from one task into another subsequent task [33]
  • Tailored: Pitched at the appropriate level of learners and balance the amount of instruction versus the amount of feedback according to the learners' capabilities.[19] According to Hauer and Kogan, the credibility of feedback is augmented when the task being assessed is relevant, meaningful to patient care and appropriate to learners' ability [14]
  • Confidential: Provided without intermediary and privately in suitable situations.[34] Provision of feedback, particularly that one which highlights underperformance, to learners in front of patients and their peers may embarrass the learner and limit the usefulness of the feedback.[5]


Tips for provision of constructive feedback

  • Establish a safe learning environment enriched with trust and respect
  • Develop and share clear learning goals
  • Embed self- and peer-assessment exercises in teaching activities
  • Observe students' performance and provide feedback whenever possible
  • Acknowledge good performance and suggest plans to correct mistakes
  • Ensure understanding of the feedback and check its application in future tasks.



  Conclusion Top


Constructive feedback is an essential adjunct of effective learning. Application of constructive feedback on the ground requires some enabling factors, which involve a safe learning environment, effective communication, clear learning goals and suitable curricular and pedagogic strategies. In addition, the feedback message should be immediate, specific, accurate, confidential, relevant, tailored, understandable, voiced in non-judgemental language and provides suggestions for improvement. Such feedback could be assigned as an effective feedback that would likely enhance students' learning. Provision of constructive feedback is a skill and competency that can be learnt, thus faculty development programmes and deliberate practice of high-quality feedback is strongly encouraged.[9],[13]

 
  References Top

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van de Ridder JM, Stokking KM, McGaghie WC, ten Cate OT. What is feedback in clinical education? Med Educ 2008;42:189-97.  Back to cited text no. 1
    
2.
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Kruglikova I, Grantcharov TP, Drewes AM, Funch-JensenP. The impact of constructive feedback on training in gastrointestinal endoscopy using high-fidelity virtual-reality simulation: A randomised controlled trial. Gut 2010;59:181-5.  Back to cited text no. 3
    
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Ibrahim J, MacPhail A, Chadwick L, Jeffcott S. Interns' perceptions of performance feedback. Med Educ 2014;48:417-29.  Back to cited text no. 9
    
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Ramani S, Krackov SK. Twelve tips for giving feedback effectively in the clinical environment. Med Teach 2012;34:787-91.  Back to cited text no. 10
    
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22.
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Fong C, Warner J, Williams K, Schalert D, Chen L, Williamson Z, et al. Deconstructing constructive criticism; the nature of academic emotions associated with constructive, positive, and negative feedback. Learn Individ Differ 2016;49:393-9.  Back to cited text no. 29
    
30.
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31.
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33.
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34.
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    Tables

  [Table 1]


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BMC Medical Education. 2019; 19(1)
[Pubmed] | [DOI]



 

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