Feedback

Feedback is information communicated to the learner that is intended to modify his or her thinking or behaviour in order to improve learning. Feedback provided by the teacher to the student:

Knowledge of the extent to which the expected learning outcomes have been achieved will lead the student to more effective and efficient learning. It will provide for learners an insight into their performance that they might not otherwise have. Feedback is part of a two-way communication between a teacher or trainer and the learner. Feedback should be regarded as an essential teaching activity.

It has been demonstrated that academic achievement in classes where effective feedback is provided for students is considerably higher than in classes where this is not so. As Hattie and Timperley (2007) reported, the most powerful single thing that teachers can do to enhance achievement of their students is to provide them with feedback.

Satisfaction studies carried out both with undergraduate students and postgraduate trainees have revealed that one of the commonest complaints students have is that they do not receive meaningful feedback. Too often feedback is omitted or, if provided, is not seen to be helpful.

How to give constructive feedback has been identified by teachers as one of the core competencies thought to be important in their work as a teacher. Much is known about how effective feedback can be provided. It is a skill that can be learned. Here we provide eight evidence-based practical guidelines:

Activity

A second strategy that has been shown to enhance achievement is active engagement of the learner. Good teachers incorporate active learning into their teaching and learning programme. The principle of active learning is implicit in many of the changes that have taken place in the medical curriculum. These include student-centred approaches, the use of small group work and problem-based learning.

The traditional lecture has been criticised in that the learning is all too often passive with information passed from the lecturer’s notes to the student’s notes without going through the brain of either.

Evidence demonstrates that where a learner is actively involved in the learning process, the achievements will be significantly enhanced. Learners should be challenged to think and review what they are studying and how new information and skills can be incorporated into their existing knowledge base and skills repertoire. The active learning results in a deeper and more meaningful processing of the learning material with information being stored in the long-term memory. What we need to guard against is ‘inert knowledge’ – information transmitted to the student that is not used and usually forgotten.

Some learning methods such as simulation and portfolio learning, by their very nature, actively engage the student while others such as the lecture or printed text are frequently associated with passive learning. Almost all learning situations can be transformed from a passive to an active one. Here are some examples:

Whatever the context – whether in the lecture theatre, small group situation, practical laboratory clinical setting or independent learning – scheduled activities should be designed to be meaningful. Clicking to turn a page in an e-learning programme is an activity but it does not contribute to the student’s learning. It is important that the teacher and students grasp the purpose or function of an activity and how it contributes to a mastery of the learning outcomes.

The development of student activities can be time consuming but at the same time it is rewarding. The associated cost and resource implications can be justified more easily where the object of the learning is a complex task or a difficult concept, such as gaining an understanding of acid–base balance.

Individualisation

In the present consumer culture, the needs of the individual are being increasingly recognised whether it is in relation to planning a holiday or purchasing a computer. The same should be true of education. We all have different learning needs and learn in different ways.

Teachers have had to cope in medical schools with large classes of students and have had to design the learning experiences and programmes accordingly. As illustrated in Figure 2.2, students, like the raw material entering a factory, pass through a standard process emerging as a product with a uniform specification. There has been little opportunity to cater for the needs of the individual student. Students have different requirements in terms of:

Fig 2.2 A factory approach with a standard product.

Students are now less willing to accept teaching and learning opportunities that do not match their needs and help them to achieve their personal learning goals. With the availability of new learning technologies, we need to work towards an ‘adaptive learning’ programme where the experience offered to students adapts to their personal needs as they work through the programme. Of the four principles mentioned in this chapter, individualisation is probably the most difficult to apply. It is the one where we are likely to see the most change in the next decade.

Today, faced with the challenge of individualising learning, the teacher has a number of options:

Relevance

A major criticism of much of medical education in the past has been a lack of relevance of the subjects taught, particularly in the early years of the medical course. This was highlighted in numerous reports on medical education published throughout the twentieth century. Particular concern was expressed about how the basic sciences were taught with a common criticism that the subjects as taught lacked relevance to the training of a doctor.

Pressures to constantly examine the relevance of what is covered in the curriculum include:

Relevance is an important consideration in curriculum planning, in the preparation of a teaching programme, and in the creation of assessment tools for a number of reasons:

The engagement of medical students in more authentic learning experiences offers many advantages, but there may be associated difficulties. Teachers in the early years of the curriculum may be equipped to tackle the subjects from the perspective of a basic scientist. They may not have practised as a doctor and may have difficulty in putting the topic into a clinical context.

The curriculum can be designed so that the students’ attention is focused on the application of what they are learning to their future practice as a doctor. The following are examples of how relevant and meaningful learning contexts can be created: