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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2012  |  Volume : 23  |  Issue : 5  |  Page : 1051-1055
Importance and process of feedback in undergraduate medical education in Saudi Arabia


Family Medicine, King Saud Bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia

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Date of Web Publication13-Sep-2012
 

   Abstract 

Feedback is an essential element in the process of students' learning and develop­ment. This study aimed to explore the views of medical students regarding the importance and process of feedback in their medical education. A cross-sectional questionnaire-based study was conducted in our college of medicine. The questionnaire included questions to assess the students' views about the importance and the need of feedback in the learning process and whether feed­back should follow certain or all forms of assessment. In addition, the questionnaire contained questions that aimed to explore students' views about the contents and process of feedback. One hundred and eighty-six male medical students participated in this study. While the majority of students (85%) indicated that feedback was important for their learning and expressed their need for regular feedback during their study, only about 20% of them indicated receiving regular feed­back. Senior students perceived that they received feedback less frequently than their junior colleagues' (P <0.05). The majority of the participants expressed their interest into receiving an immediate feedback after their summative and formative assessment. Students think that feedback should be balanced and include a suggested plan for their future learning process. Senior students showed a higher preference to have feedback that also contained points related to their strengths more than juniors. Students also indicated their preference to have one-to-one and written feed­back more than feedback that was conveyed in groups and verbally. These issues are of high im­portance and should be considered for planning and implementing an effective feedback system.

How to cite this article:
AlHaqwi AI. Importance and process of feedback in undergraduate medical education in Saudi Arabia. Saudi J Kidney Dis Transpl 2012;23:1051-5

How to cite this URL:
AlHaqwi AI. Importance and process of feedback in undergraduate medical education in Saudi Arabia. Saudi J Kidney Dis Transpl [serial online] 2012 [cited 2020 Oct 29];23:1051-5. Available from: https://www.sjkdt.org/text.asp?2012/23/5/1051/100949

   Introduction Top


Feedback is crucial in clinical learning situa­tions. The positive effect of offering feedback has long been recognized. [1],[2] Feedback could be defined in clinical education as: "specific information about the comparison between a trainee's observed performance and a standard, given with the intent to improve the trainee's performance". [3]

Medical educators frequently believe that they convey feedback to medical trainees, whereas trainees reporting that feedback is rare. [4] Stu­dents express their interest in receiving feed­back on their performance [5] and consider pro­vision of feedback as a major factor that could facilitate their learning. [6] Studies have shown that feedback has the ability to enhance stu­dent's performance and render them to feel confident and competent in their role, espe­cially if the feedback is immediate. It allows for reflection in practice and offers the stu­dents opportunity to meet standards. [7]

Numerous factors have been shown to be associated with the provision of feedback, which include assessor's perception and training. [8] Students vary in their utilization of feedback, when offered. Females and better students are keener to seek out feedback that might be expected to help them continue to do better. [9]

The aim of this study was to explore the views of medical students regarding the impor­tance and process of feedback. Moreover, we attempted to determine a suitable approach for feedback from students' perspectives.


   Materials and Methods Top


This cross-sectional questionnaire-based study was conducted at College of Medicine, King Saud Bin Abdul-Aziz University for Health Sciences (KSAU-HS), during the period of February-May 2011. This college was esta­blished in 2004 and adopted a problem-based learning, system-based and community-oriented curriculum.

All male medical students of the College of Medicine, KSAU-HS, were invited to partici­pate in this study.

The questionnaire was developed in the light of the stated objectives of the study. Methodo­logies of some relevant published researches were reviewed and relevant questions and points were selected for utilization in the ques­tionnaire of this study. The questionnaire in­cluded questions to assess the student's views about the importance and the need for feed­back in the learning process and whether feedback should follow certain or all forms of assess­ments. In addition, the questionnaire contained questions that aimed to explore students' views about the contents and process of feedback. A pilot study of the questionnaire was carried out to ensure students' understanding and clarity of the questionnaire; it was self-administered and anonymous. The proposal of the study was discussed and approved by the ethics com­mittee, research center, KSAU-HS.


   Statistical Analysis Top


Data were coded, entered and analyzed using the Statistical Package for Social Sciences (SPSS), version 17. Descriptive analysis was done to summarize information by calculating the number and percent for categorical varia­bles, whereas the mean and standard deviation (SD) were calculated for continuous variables. Chi-squared test was used to measure the difference. A P-value less than 0.05 was used to determine statistical significance.


   Results Top


One hundred and eighty-six out of 291 male medical students participated in this study (64% response rate). Their mean age was 22.7 (±3.6 SD) years. For comparison purposes, students were grouped into two study levels; juniors and seniors as illustrated in [Table 1].
Table 1: Study level.

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Ninety-six students (52%) indicated receiving some sort of feedback. The remaining groups of students indicated either not receiving feed­back at all (26%) or could not decide whether they had received any kind of feedback (13%).

While, the majority of students (85%) indi­cated that feedback was important for their learning and expressed their need for regular feedback during their study; only about 20% of them indicated receiving regular feedback.

Senior students perceived that they received feedback less frequently than their junior col­leagues'. The difference between the two groups was statistically significant (P <0.05).

The majority of the participating students expressed their interest in receiving immediate feedback after their summative and formative assessments as shown in [Table 2].
Table 2: Students' views about the importance of feedback.

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In relation to the content of the feedback, about 90% of the students thought that the feedback should have points about their good performance as well as about their weaknes­ses. This approach was supported by the junior students more often than the senior students, with a significant statistical difference (P <0.02).

Interestingly, senior students showed a higher preference to have a feedback that contains points related to their strengths more than the junior students. This difference was associated with a borderline statistical significance (P <0.088).

The majority of the students also indicated their wish to include in the feedback a guide of how to improve their future performance. The detailed students' responses are shown in [Table 3].
Table 3: Students' views on the content of the feedback.

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In relation to the process of feedback, the students generally preferred receiving one-to-one and written feedback more than the feed­back that was conveyed in groups and ver­bally. However, there was no statistical diffe­rence between the opinions of both groups, as shown in [Table 4].
Table 4: Students' views on the process of the feedback.

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   Discussion Top


The results of our study illustrate that medi­cal students recognized the importance of the feedback in their learning and professional development, as they expressed their interest in receiving a regular feedback. This is compa­rable with students' views in other settings. [10],[11],[12]

Almost half of our sample indicated either not receiving feedback or could not remember if they received one. This identifies an impor­tant issue related to the clarity of the concept and process of feedback, both to students as well as the faculty.

Only a minority of students (20%) indicated receiving regular feedback. This view highlights the reported difference in the perception bet­ween faculty and students regarding frequency of feedback in clinical training. [5],[6] To ensure the provision of regular feedback activities requires establishing an inbuilt system and procedures that monitor the frequency and uti­lization of the offered feedback. Senior students reported receiving feedback less frequently than juniors. This may reflect the increasing insight into the importance and need of feedback associated with advancing study levels of students.

The majority of the students in our study indicated their preference to have immediate feedback after their formative and summative assessments. The timing of feedback is impor­tant in clinical settings. Feedback, to be effec­tive, should be given immediately after stu­dents' observed behavior or performance. [7],[13]

Our students indicated their need to receive balanced feedback that includes their strengths and weaknesses and a guide for how to deve­lop their competencies. Such an approach is essential to get the optional benefit of feedback. [14],[15]

Interestingly, the senior students in our study expressed a special need to focus the feedback more often on their strengths. This reflects the educational importance of the modifications of the different components of the feedback accor­ding to the needs of the students. In addition, senior students may need more reassurance and insight about their competencies than their junior colleagues. [16],[17]

The students in our study preferred the one-to-one and written form of feedback. This form may be associated with less tension when compared with the verbal and group feedback. However, in order to give effective feedback, different forms should be used and tailored to the needs and acceptability of the learners. This should be done repeatedly and incorpo­rated within the curriculum. [18]

In conclusion, this study showed that under­graduate medical students have a positive atti­tude toward the value and the importance of feedback. They perceived that feedback was not offered to them regularly. The students preferred a balanced one-to-one and written form of feedback. Their suggestions were worth serious consideration while planning and implementing an effective feedback system.

 
   References Top

1.Ende J. Feedback in Clinical Medical Student. JAMA 1983;250:777-81.  Back to cited text no. 1
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2.Hattie J, Timperley H. The Power of Feedback. Rev Educ Res 2007;77:81-112.  Back to cited text no. 2
    
3.Ridder JM, Stokking KM, McGaghie WC, Cate OT. What is Feedback in Clinical Education? Med Educ 2008;42:189-97.  Back to cited text no. 3
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4.Shenan TJ. Feedback: Giving and Receiving. J Med Educ 1984;59-913.  Back to cited text no. 4
    
5.Duffield KE, Spencer JA. Survey of Medical Student views about Perception and Fairness of Assessment. Med Educ 2002;36:879-86.  Back to cited text no. 5
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6.Lofmark RN. Facilitating and Obstructing Factors in Learning. J Advanced Learning 2001;34:43-50.  Back to cited text no. 6
    
7.Glover PA. Feedback:"I listened, reflected and utilized". Third year nursing students' perception and use of feedback in the clinical setting. Int J Nurs Pract 2000;6:247-52.  Back to cited text no. 7
    
8.Fernando N, Cleland J, McKenzie H, Cassar K. Identifying the Factors that determine Feedback given to Undergraduate Medical Students. Med Educ 2008;42:89-95.  Back to cited text no. 8
[PUBMED]    
9.Sinclair HK, Cleland JA. Undergraduate medical students: Who seeks formative feedback? Med Educ 2007;41:580-2.  Back to cited text no. 9
[PUBMED]    
10.Torre DM, Sebastian JL, Simpson DE. Learning activities and high-quality teaching: Perception of third-year IM clerkship students. Acad Med 2003;78:812-4.  Back to cited text no. 10
[PUBMED]    
11.Torre DM, Simpson D, Sebastial JL, Elnicki DM. Learning/feedback activities and high-quality teaching: Perception of third year medical students during an inpatient rotation. Acad Med 2005;80:950-4.  Back to cited text no. 11
    
12.AlHaqwi AI, Molen HT, Magzoub ME, Schmidt HG. Determinants of Effective Clinical Learning; A students and Teacher Perspectives in Saudi Arabia. Educ Health 2010;23:1-14.  Back to cited text no. 12
    
13.Clynes MP, Raftery SE. Feedback: An essential element of student learning in clinical practice. Nurse Educ Pract 2008;8:405-11.  Back to cited text no. 13
[PUBMED]    
14.Gigante J, Dell M, Sharkey A. Getting beyond "Good Job": How to give effective feedback. Pediatrics 2011;127:205-7.  Back to cited text no. 14
[PUBMED]    
15.Moorhead R, Maguire P, Thoo SL. Giving feed­back to learners in the practice. Aust Fam Physician 2004;33:691-5.  Back to cited text no. 15
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16.Sargeant J. Toward a common understanding of self-assessment. J Contin Educ Health Prof 2008; 28:1-4.  Back to cited text no. 16
[PUBMED]    
17.Eva KW, Armson H, Holmboe E, et al. Factors influencing responsiveness to feedback: On the interplay between fear, confidence, and reasoning process. Adv Health Sci Educ Theory Pract 2012;17(1):15-26.  Back to cited text no. 17
    
18.Henderson P, Ferguson-Smith AC, Johnson MH. Developing essential professional skills: A framework for teaching and learning about feedback. BMC Med Educ 2005;5:11.  Back to cited text no. 18
[PUBMED]    

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Correspondence Address:
Ali I AlHaqwi
Associate Professor, Family Medicine, King Saud Bin Abdul-Aziz University for Health Sciences, P.O. Box 69416, Riyadh 11547
Saudi Arabia
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DOI: 10.4103/1319-2442.100949

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]

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   Statistical Analysis
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