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Why is feedback so important in healthcare education and training?

Feedback is important to the ongoing development of learners in healthcare settings. 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 is central to developing learners' competence and confidence at all stages of their medical careers.

Over the past few years, new assessment procedures have been introduced for junior doctors. Clinical practice and professional behaviours and attitudes are regularly and routinely assessed using a raft of workplace-based assessments. Such tools may include multi-source feedback, observations of clinical performance and case-based discussions. Feedback is a critical element of all these assessments and will involve health professionals across the board in their delivery, on multiple occasions and throughout the training programme.

Jill Gordon (writing in 2003 about the importance and influence of one-to-one teaching situations in clinical medicine) reinforces this, noting that feedback is vital and that the most effective and helpful feedback is based on observable behaviours:

Learners value feedback highly, and valid feedback is based on observation. Deal with observable behaviours and be practical, timely, and concrete. The one to one relationship enables you to give feedback with sensitivity and in private. Begin by asking the learner to tell you what he or she feels confident of having done well and what he or she would like to improve. Follow up with your own observations of what was done well (be specific), and then outline one or two points that could help the student to improve. (p. 544)

She goes on to note that one of the main purposes of feedback is to encourage reflection:

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. (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.

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