Funded Competition Entry
Constructively describe your experience of receiving feedback, with suggestions for ways in which feedback might be improved
Students value feedback. In fact, feedback is the most often cited criticism by students when it is not provided. Ultimately, constructive criticism is an essential element in any organisational setting. Businesses use feedback to maintain and recruit talented staff, engage customers and of course to improve performance. In the US alone, providing coaching for managers on how to give constructive feedback costs organisations billions of dollars. This, in itself, illustrates the difficulty of developing the skill of constructive feedback in a way that it encourages one to learn and enhances their existing abilities. Below, I have attempted to describe my perception of both the positives and negatives of providing feedback in a medical school setting.
From my experience in medical school, I applaud the level of feedback provided on written knowledge. Universities have become more and more innovative in providing students with detailed information on their performance in written, summative and formative assessments. Technology has paved the way in providing personalised areas for improvement and enhancement. One university I visited had adopted a “traffic light” online feedback resource. This technology monitored students’ level of knowledge on every online assessment taken and was able to provide students with immediate feedback on all questions answered. The system presented the student with a list of red, amber and green areas for improvement. The red areas demonstrated weaker topics with the strongest subjects in green. The student could then click on each red “traffic light” and the system highlighted where in the curriculum the question referred to and provided a link to the lecture notes and reading lists for that topic. Such an individualised response is, indeed, an innovative method of ensuring that feedback in written aspects of medicine are thoroughly analysed and perfected.
Unfortunately, feedback in clinical and practical skills is much more complex and whilst technology can ease the delivery of feedback it cannot be relied on solely to improve students’ skills. Clinical skills exams are an opportunity to highlight proficiency which may not have been previously detected as a weakness; however by the time a student gets to an assessment level the “pass/fail” blow is too powerful to truly allow a student to correct their performance. In addition, clinical exams focus on checklists of procedures that need to be done, as opposed to the techniques and approaches used in these procedures. For example, many students will percuss a chest and receive the “tick” on a checklist, but only a small minority adopt the correct technique required in percussing that chest. Ultimately, any clinical feedback provided must be implemented appropriately; in an attachment setting. Here, clinicians can provide students with constructive criticism in a non-judgemental manner; a fine window of opportunity to improve clinical practice. Often, however, this opportunity is lost or inefficiently utilised and creates a sad state of affairs for students who would undoubtedly appreciate such feedback.
There are, of course, a number of pressures on clinical staff in terms of time and the continuously larger cohorts of students entering medical school who are allocated to various placements. This can often make it difficult for students and staff to develop core competencies and improve their performance. In fact, in my experience, very few clinicians have the time and capacity to observe a complete consultation and examination carried out by a student. A number of hospitals employ Clinical Teaching Fellows who are dedicated to teaching and improving students’ performance. They are of immense value. Whilst I was on an attachment for Obstetrics and Gynaecology; the Clinical Teaching Fellow spent a considerable amount of time noting each student’s history, taking skills in a simulated environment and thereafter providing constructive areas for improvement which many clinicians would not be able to manage alongside their own clinical commitments.
Another issue is the content of feedback; a concern that should not be taken lightly. There are a number of instances which come to mind where feedback received was of no use or even worse- so discouraging- that any optimism of improving was lost on me. Vague comments on performance such as “that was a good effort” guised as helping to improve one's performance, cannot truly be classified as feedback. Such feedback needs to be supplemented by specific examples. Similarly, a torrent of improvements which need to be made can be overwhelming and detrimental. Thus, my advice to staff is to concentrate on one or two key areas of development which should then be enhanced before moving to other areas.
Students, by definition, are learners and a skill which is of great use is the ability to reflect on individual feedback by engaging in a dialogue with staff. Constructive criticism is an art, and does not have to be a one-way dialogue. Some of the most useful feedback I have received is from staff that thoroughly assess my own insight into my clinical capabilities. Reflective feedback is a powerful and essential tool and therefore by primarily outlining my own strengths and weaknesses’, I have eased the role of the assessor to focus on what my aims are in a particular setting. This also has the double advantage of removing the common misperception by students of what constitutes feedback from staff.
In summary, powerful feedback is an essential and important ingredient in creating talent. In order to create 'Tomorrow’s Doctors', staff must ensure that the windows of opportunity for constructive criticism are maximised encouraging students to develop an insight into their individual abilities and strengths.
Submitted by
Raisha Nurani, Medicine, St Georges, University of London
This proposal was funded under the Student essay competition - 2010 call
