2014, 1–2, Early Online

PERSONAL VIEW

Offering effective feedback to trainees

MORKOS ISKANDER

Department of Urology, Royal Liverpool and Broadgreen Hospitals, Liverpool, UK

Abstract

Effective feedback on performance is an integral part of clinical training. It allows the trainee to critically reflect on their

development, as well as enable the teacher to chart progress and detect areas for development. In order to provide effective

feedback, we need to take into account the performance itself, but also the setting where feedback is offered, and the expected

outcomes of the encounter. As ever, negative feedback remains more difficult to give and receive, and as such requires a greater

degree of delicacy to produce a positive result.

Part of being a clinical tutor is offering feedback, which serves

to give each trainee a reference to their past performance and

a guide for future activity. A recent example where I gave

feedback to a trainee was in preparation for a final assessment

on a trauma course. On this course, the trainee is required to

manage a simulated patient scenario in real time, with results

and case development being fed to them as the case develops.

On average, each scenario lasts between twenty and thirty

pressure-filled and fast paced minutes. During this simulation it

became clear that the trainee was not performing as expected,

and by the ten minute mark had triggered two separate

automatic failures. The trainee became aware of these errors

and attempted to correct them, but due to the extra stress and

pressure at this point, became further flustered. At this point I

intervened, with the second examiner, to stop the simulation.

I asked the trainee what her experience of the scenario at

this point was, and where she felt it had progressed. The reply

reflected the volume of adrenaline and she specifically stated

that there had been no issues so far. I proceeded to evaluate

her progress in a stepwise, detailed fashion, with her and

highlighted where she performed well and the pitfalls that had

tripped her up, as well as offering guidance on how they may

best be avoided and referred her back to the set course text.

At this point she requested we stop the practice session and

return to a more didactic teaching style. The feedback

concluded with a video demonstration of how such a scenario

maybe managed. The trainee found receiving this critical

feedback quite difficult, and I personally found it challenging

to phrase.

As a separate example, in my role as an undergraduate

tutor, I regularly give written feedback to students regarding

their performance at specific activities. The feedback consists

of a grade, as well as two to three sentences describing and

justifying the grade. A teaching session I facilitated recently

was an outpatient clinic attended by two medical students. The

performance of both these students varied, with the main

reason for this disparity being the degree of preparation

by each one prior to attending clinic. This disparity was also

evident in the grades awarded, although the written feedback

was in my view more invaluable for their continued

development. I congratulated the student that had prepared

for the clinic adequately and stated that this is appreciated

by me as well as encouraging this student to continue their

self-directed learning. For the other student I highlighted that

adequate preparation for each session will lead to a greater

degree of enjoyment and learning. I then highlighted a variety

of possible learning resources.

In both these occasions, and indeed prior to them, I found

positive feedback much easier to give, with negative feedback

requiring far more deployment of communication skills to

ensure that areas of improvement are highlighted, without

diminishing the student’s sense of self-esteem or their ability.

Drawing students’ attention back to the required curriculum

can be a good focus point for highlighting the expectations

and demands placed on them. This reference point acts as a

reflection of what has already been taught and emphasises the

standard set for the students. In medical education, as well as

presumably in other avenues of educating professionals,

feedback forms a foundation for future progress and under-

scores the areas for improvement (Sachdeva 1996).

From a future practice point of view, my opinion is that

prompt feedback is intrinsically more valuable. The trade-off

being that supplying a great deal of information in the heat of

the moment may be overwhelming, and the information may

or may not be retained at the end of the session (Thomas &

Arnold 2011). Furthermore, close attention to the setting of

feedback, as with the first example I described here I may have

offered the feedback in less than ideal setting. The trainee may

have benefited from being allowed to complete the scenario,

as it would have provided her with opportunity to either

Correspondence: Morkos Iskander, Department of Urology, Leighton Hospital, Middlewich Road, Crewe, CW1 4QJ, UK. Tel: +44 7737591858; E-

mail: morkos.iskander@doctors.org.uk

ISSN 0142-159X print/ISSN 1466-187X online/14/000001–2 � 2014 Informa UK Ltd. 1DOI: 10.3109/0142159X.2014.916786

Med

Tea

ch D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y M

ichi

gan

Uni

vers

ity o

n 11

/02/

14Fo

r pe

rson

al u

se o

nly.

produce a better overall performance, or afforded her insight

into the earlier part. The setting where feedback is delivered

can have a profound effect on the utilisation of information,

with trainees typically appreciating opportunities to solve their

mistakes independently (Moorhead et al. 2004).

As a tutor, there is a constant and persistent duty of care

towards students, and the need to provide both negative and

positive constructive feedback is ever present (Schartel 2012).

Furthermore, current evidence states that well placed feedback

has an excellent potential to positively influence future

outcomes (Saedon et al. 2012), which is after all, the central

point of education and assessment.

Notes on Contributor

MORKOS ISKANDER is a urological surgeon in training, currently in Mersey

Deanery, England.

Declaration of interest: The authors report no conflicts of

interest. The authors alone are responsible for the content and

writing of the article.

References

Moorhead R, Maguire P, Thoo SL. 2004. Giving feedback to learners in the

practice. Aust Fam Physician 33:691–695.

Sachdeva AK. 1996. Use of effective feedback to facilitate adult learning.

J Cancer Educ 11:106–118.

Saedon H, Salleh S, Balakrishnan A, Imray CH, Saedon M. 2012. The role of

feedback in improving the effectiveness of workplace based assess-

ments: A systematic review. BMC Med Educ 12:25.

Schartel SA. 2012. Giving feedback – An integral part of education. Best

Pract Res Clin Anaesthesiol 26:77–87.

Thomas JD, Arnold RM. 2011. Giving feedback. J Palliat Med 14:

233–239.

M. Iskander

2

Med

Tea

ch D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y M

ichi

gan

Uni

vers

ity o

n 11

/02/

14Fo

r pe

rson

al u

se o

nly.