Why is feedback important?
Feedback is central to developing learners' competence and confidence at all stages of their professional careers. Many clinical situations involve the integration of knowledge, skills and behaviours in complex and often stressful environments, with time and service pressures on both teacher and learner. Feedback doesn’t have to be formal, it can be a quick nod, smile or word of encouragement as a learner is doing something (such as washing a patient with you) so that learners can see they are doing well.
However, the more formal purpose of giving feedback to learners is so that they think about the gap between actual and desired performance and identify how they can narrow the gap and improve. Learners value feedback that helps them develop, facilitates self-reflection and motivates them to learn more and improve. However, students across all subject disciplines routinely say that they don’t get enough helpful feedback (see for example, UK National Student Survey results) so it is important both for organisations and individual learners that feedback is improved and clearly signposted as such.
In the wake of formal inquiries into patient care and safety in the UK such as the Francis Report (2013), much more emphasis is now being placed on the assessment and development of caring and compassionate clinical practice; professional behaviours and attitudes are regularly and routinely assessed using a raft of workplace-based assessments. Such tools may include multi-source feedback (360 appraisals), observations of clinical performance and case-based discussions. Feedback is a critical element of all these assessments and should ideally involve health professionals across the board (and patients if possible) in their delivery, on multiple occasions and throughout training programmes.
One of the main purposes of feedback is to encourage reflection. Gordon notes that:
Just as many learning opportunities are wasted if they are not accompanied by feedback from an observer, so too are they wasted if the learner cannot reflect honestly on his or her performance. One to one teaching is ideally suited to encouraging reflective practice, because you can model the way a reflective practitioner behaves. Two key skills are (a) ‘unpacking’ your clinical reasoning and decision making processes and (b) describing and discussing the ethical values and beliefs that guide you in patient care. (2003, p. 544)
Grounding feedback within an overall approach that emphasises ongoing reflective practice helps learners to develop the capacity to critically evaluate their own and others’ performance, to self-monitor and move towards professional autonomy.
How do you and colleagues embed reflection within learning and clinical activities? What challenges are there in doing so in busy clinical or academic environments?