Practice Teaching Rounds

Giving feedback in clinical settings

BMJ 2008; 337 doi: http://dx.doi.org/10.1136/bmj.a1961 (Published 10 November 2008) Cite this as: BMJ 2008;337:a1961
  1. Peter Cantillon, senior lecturer in general practice1,
  2. Joan Sargeant, associate professor and director2
  1. 1Department of General Practice, National University of Ireland, Galway, Ireland
  2. 2Program Development and Evaluation, Continuing Medical Education, Division of Medical Education, Dalhousie University, Halifax, NS, Canada
  1. Correspondence to: P Cantillon peter.cantillon{at}nuigalway.ie

    Think about a clinical teaching session that you supervised recently. How much feedback did you provide? How useful do you think your feedback was?

    Feedback is the cornerstone of effective clinical teaching.1 Without feedback, good practice is not reinforced, poor performance is not corrected, and the path to improvement not identified. Though teachers believe that they give regular and sufficient feedback, often this is not how it is perceived by learners.2 3 4

    Feedback is about providing information to students with the intention of narrowing the gap between actual and desired performance.5 6 The purpose of giving feedback is to encourage learners to think about their performance and how they might improve.1 2 Surveys of learners’ preferences show that they want feedback that stimulates them to reflect on what they are doing.7 8

    Feedback is a concept that is strongly theory based. From a behaviourist perspective, feedback has been shown to reinforce or modify behaviour.9 However, feedback can also cause harm; negative feedback, if not carefully managed, can result in demotivation and deterioration in performance.10 Cognitive theorists have shown that feedback helps learners to reconstruct knowledge, change their performance, and feel motivated for future learning.11 12 Empirical evidence also shows that feedback enhances clinical performance. For example, in a recent systematic review, regular feedback significantly improved the clinical performance of consultant clinicians.13

    Feedback and assessment are closely related educational activities. They overlap considerably in terms of purpose and methodology (box 1).

    Box 1 The relation between feedback and assessment

    Assessment is often described in terms of being a continuum between “formative” and “summative” assessment. At one end of the continuum, formative assessment is essentially about providing feedback to students in order to support and enhance learning; at the other end, summative assessment is about measuring students’ achievement with the …

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