An understanding of feedback

Sam Quill reflects critically on his understanding of feedback and how it has developed through engaging with 3rd year students in dermatology and otorhinolaryngology and with academic peers, working together in a Communities of Practice model. 

Undertaking Trinity’s Special Purpose Certificate in Academic Practice has encouraged me to design student-centred learning activities around social constructivist techniques (e.g. Carlisle & Jordan 2005, Ramsden 1996). In clinical education contexts where minimum standards of care are required for every patient, it concerns me that not all students are equally likely to benefit from peer learning activities: integrating constructivism into my practice has highlighted to me that not all students are equally prepared to learn from their peers. Some of the issues my students encounter with peer feedback might well be related to Biggs’ theory of ‘academic learners’. Biggs (1999) suggests that students who thrive in higher-level education without much teacher direction, where student-led learning activities like peer feedback pervade, already possess the skills to reflect on their learning.

When I asked my students what they thought about feedback, I was interested to discover that learners who found student-led approaches more difficult tended to focus their criticisms on peerfeedback to patient case presentations. They indicated that they preferred instruction on the “correct” answer from subject experts, rather than learning through peer dialogue and shared understanding.They felt that peer feedback often pointed to what they had done ‘wrong’ rather than offering ‘feed-forward’ action points. They also expressed negative emotions towards what they perceived to be critical feedback. I believe this has dissuaded the studentsfrom providing honest evaluation of others’ work in an attempt to not hurt each other’s feelings.

The point of feedback?

From discussions with students it seemed likely that some students were unclear on the purpose of feedback and therefore unsure of what to expect and how to ‘do’ feedback appropriately. Price et. Al (2012) acknowledge the lack of clear consensus on the definition of feedback but suggests that it can serve different roles in learning. For example, on the behaviourist side of the spectrum lie the corrective and reinforcement roles of feedback; on the constructivist side, feedback has a more dialogic, future-focused function. A common mistake in higher education practice involves asking students to reflect “without necessary scaffolding or clear expectation”. Sharing my experiences with colleagues and peers undertaking the Reflecting and Evaluating your Teaching in Higher Education module revealed that this was a common misstep and for me, peer presentations and ‘formally’ structured discussion with colleagues reinforced the benefits of combining individual and collective reflection to work on common challenges.

Peer-driven reflection has prompted me to acknowledge the need for a shared understanding of feedback between me and my students – an insight that has helped my students to embrace the introduction of metacognitive skills into their curriculum.

In both teaching and in clinical practice, I recognize that reflective skills and pedagogical literacy are particularly important in a paradigm where peer learning underpins postgraduate clinical professional development. Ryan & Ryan remind us that “deep reflective skills can be taught, however they require development and practice over time.” By reflecting actively on the process of ‘unfurling’ the concept of scholarship of teaching, as outlined by Kreber & Cranton (2000), I can see how my social-constructivist learning activities could be adapted to support better learning for more students. I believe our senior faculty need to plan for the integration of reflective learning skills at all levels of medical education, especially in the earlier, pre-clinical years – but this approach needs to be adopted into daily educational practice, not discussed solely at high level curriculum committees.

Next steps?

Looking ahead, I want to build on my areas of improvement identified in the Johari window below, encouraging me to articulate these in response to peer commentary. Specifically, I want to take more of a scholarly approach to evidencing the value of change in my teaching activities at TCD. I would love to see these new reflective feedback skills resulting in a generation of doctors who intuitively “reflect-in-action”, providing responsive care to patients in need, who also have the ability to “reflect-on-action” and improve medical practice and medical education in the future.  Both self-reflection and peer feedback have been essential in developing my Johari window. Would you consider doing a similar exercise for your own context? The links below offer some sample resources below to try for yourself!

Reflective learning resources:

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