Anastasiya Lipnevich, PhD, Professor of Educational Psychology, CUNY and NBME Visiting Scholar, provides insights on effective feedback strategies in medical education and key considerations for guiding learners toward clinical competence and professional growth.
Imagine a third-year medical student on their first clinical rotation, explaining a new diabetes diagnosis to an anxious patient. The attending physician observes silently, then notes: “I noticed you provided a lot of information quickly. How do you think the patient felt about the amount of information they received? What might you do differently next time to reduce jargon and check their understanding?”
This moment of guided reflection, evoked by thoughtful feedback, could be critical in transforming a knowledgeable student into an effective, empathetic communicator, and subsequently, into a compassionate, skilled health care professional.
In medical education, mastering a vast array of knowledge and skills is only part of the journey. Equally important is the process of self-improvement and adaptation, which requires continuous reflection. But here’s the catch: to effectively reflect on your performance, you need to know how. That’s where feedback comes in. It’s not just about pointing out what went right or wrong; it’s about teaching the very skill of reflection itself. Good feedback serves as a model, demonstrating how to analyze a situation, consider alternative approaches and plan for improvement. It is also a key component of formative assessment – or assessment for learning
However, not all feedback is created equal. Its effectiveness depends on how it is delivered, interpreted and acted upon.
Formative feedback is a core component of any educational system, but in medical education, it holds special significance. The complexity and immediacy of clinical practice demand that students receive ongoing, targeted feedback that enables them to make timely adjustments. Here, we examine three interconnected dimensions of feedback that can significantly enhance clinical competence and decision-making skills.
Process-Focused Feedback addresses the methodological aspects of clinical practice, emphasizing the ‘how’ rather than just the ‘what.’
Imagine a medical student, Alex, struggling to gather a thorough patient history. Their attending physician might say, “Alex, I noticed you’re asking a lot of closed-ended questions. Try opening with ‘Tell me more about…’ and see how that changes the conversation.” This real-time guidance helps Alex adjust their approach on the spot.
Product-Focused Feedback evaluates the outcome or end result of a clinical encounter or decision-making process.
After the patient interview, the physician might add, “Your history missed some key details about the patient’s medication regimen. Always remember to cross-check their current medications with their past medical history.” This feedback may help Alex to do better during their next interview.
Progress-Focused Feedback takes a longitudinal view, tracking development over time and reinforcing positive changes. It’s essential for maintaining motivation and guiding long-term professional growth.
A month later, the same physician notes, “Alex, your patient interviews have come a long way. You’re asking more open-ended questions and getting a much more comprehensive history now. Keep it up!” This type of feedback acknowledges growth, boosting confidence and motivation.
The true power of feedback in medical education lies in the synergistic application of these three dimensions. Process-focused feedback drives transferable improvement in clinical skills. Product-focused feedback enhances specific objectives. Progress-focused feedback sustains motivation and guides long-term professional development.
Context
The environment where feedback is provided significantly impacts its reception and effectiveness. Whether during clinical rotations, simulation labs or case discussions, the context shapes how students interpret and apply feedback.
In clinical settings, where stakes are higher and the pace is faster, feedback needs to be more direct and closely tied to immediate patient care responsibilities. For example, a student performing a procedure incorrectly in the operating room requires urgent guidance to correct the issue before compromising patient safety. Here, the focus is on educating while safeguarding outcomes in real time.
In contrast, feedback in simulated environments or case discussions can be more exploratory and reflective, allowing students to experiment and learn from mistakes in a low-stakes setting. In these scenarios, feedback should encourage critical thinking about decision-making processes and improvements.
Source
The source of the feedback is equally important. Feedback can come from instructors, attending physicians, peers, or it can be AI generated. Instructor feedback is typically seen as the most authoritative, especially when it comes from experienced clinicians. However, feedback from peers can also offer valuable insights, especially in collaborative environments where students work in teams, mirroring the collaborative nature of health care delivery.
Regardless of the source, the credibility and relatability of the feedback provider influences how the feedback is received. Students are more likely to engage with feedback from sources they trust and respect. Crucially, feedback should always be paired with opportunities for improvement. It’s not enough to tell a student what went wrong; they must be given the chance to apply the feedback and refine their skills.
For instance, after receiving feedback on their patient interaction skills, a student should be provided with subsequent opportunities to practice and improve, whether through simulations or real clinical encounters. This cycle of feedback and practice creates a dynamic learning environment where students can actively work toward meeting the learning objectives and gradually develop mastery.
Message
The message is the core of any feedback interaction. In medical education, feedback messages need to be specific, constructive and aligned with learning objectives. Generic comments such as “good job” or “needs improvement” don’t offer students the direction they need to make meaningful changes. Instead, feedback should highlight particular aspects of performance and provide clear, actionable steps for improvement.
For example, if a student struggles with diagnostic reasoning, the feedback message should focus on specific weaknesses, such as, “Your differential diagnosis was too narrow—next time, consider a broader range of possibilities and use more diagnostic tests to rule out alternative diagnoses.” This type of feedback not only pinpoints the issue but also provides a pathway for improvement.
Learner
Each learner is unique, entering training with a distinctive constellation of individual characteristics that influence how they receive and process feedback. Some students are highly receptive and eager to act on feedback, while others may feel defensive or discouraged by critical comments.
Customizing feedback to fit the individual needs of each learner is ideal. Tailored feedback that considers a student’s strengths and areas for growth can significantly enhance its effectiveness. However, what truly matters is fostering an environment where students view feedback as an opportunity for improvement.
Regardless of how well-crafted the feedback is, its impact diminishes if students perceive it as mere criticism or a final judgment on their performance. By shifting their perspective to see feedback as a constructive tool, students can unlock the potential for growth and development.
For instance, when a student receives feedback on their diagnostic reasoning, viewing it as an opportunity to refine their skills and enhance their understanding can lead to meaningful change. Instead of focusing on what went wrong, they can concentrate on how to improve, transforming feedback into a vital part of their learning journey.
Processing
Processing refers to how students interpret and act upon the feedback they receive. This is the final step in the feedback loop, and arguably the most important, as it determines whether feedback leads to actual improvement. Feedback that is too vague, overwhelming or disconnected from the student’s experiences can hinder meaningful processing.
To maximize the effectiveness of feedback, educators should encourage students to engage in reflective practices. This might involve asking students to write reflections on the feedback they received, discuss it with peers, or develop action plans based on the feedback. These activities help students internalize the feedback and translate it into concrete steps for improvement.
In medical education, formative feedback is a powerful tool for guiding students toward clinical competence and professional growth. By understanding and applying these principles of effective feedback, educators can optimize the feedback process.
Feedback should be carefully aligned with learning objectives, ensuring that students understand how it relates to their overall educational goals. Importantly, students should be provided with opportunities for revision based on the feedback received, allowing them to apply new insights and improve their performance.
Additionally, educators should offer tools and strategies that encourage self-reflection, enabling students to generate their own internal feedback. This approach not only enhances the immediate impact of feedback but also cultivates the critical skills important for lifelong learning in the medical profession.
Suggested reading:
Cantillon, P., & Sargeant, J. (2008). Giving feedback in clinical settings. BMJ, 337, a1961.
Kluger, A. N., & DeNisi, A. (1996). The effects of feedback interventions on performance: a historical review, a meta-analysis, and a preliminary feedback intervention theory. Psychological bulletin, 119(2), 254.
Watling, C., & Ginsburg, S. (2019). Feedback in the clinical environment: How critical is the learner-teacher relationship? Medical Education, 53(1), 10-20.
Wisniewski, B., Zierer, K., & Hattie, J. (2020). The power of feedback revisited: A meta-analysis of educational feedback research. Frontiers in psychology, 10, 487662.