CHAPTER 6. Giving Feedback
Chapter Aims
The purpose of this chapter is to assist you with understanding the role of feedback in relation to the assessment process and the student learning experience. After reading this chapter you will be able to:
• Identify the key aspects of verbal and written feedback.
• Understand the relevance of the feedback sandwich in facilitating learning.
• Consider the professional accountability and responsibility in delivering feedback.
• Develop your competence and confidence for feedback experiences.
Feedback
For many mentors, giving feedback to students is one of the biggest challenges and probably the most difficult aspects of their role. It is not uncommon for even experienced mentors to be nervous about giving a student feedback regarding their performance, particularly when the feedback is not positive. In fact, some mentors are so reluctant to give feedback to students that they avoid doing it at all. It can be very tempting to delay or avoid evaluation meetings with students for fear of a negative response or over-reaction to criticism. In addition, the pressure of the clinical environment, for example staffing levels or very busy shifts can also impact on the delivery of feedback. This is highly problematic, as providing time for reflection, giving feedback, monitoring and documenting a student’s progress are all vital if the assessment process is to be followed and the student is to be given every opportunity to improve. If feedback has not been consistent throughout the placement, students may be confused regarding the decisions you are making related to their learning outcomes, and you may find you lack the evidence to support your decisions. It is also important to realize that if you don’t provide your student with feedback you will not be meeting the standards expected by the NMC in relation to mentorship, which has serious professional implications.
Previous experience of feedback
If you have already had experience of giving feedback to a student it is likely that you will have had a mix of experiences; some of these may have been positive, while others may have been less than satisfactory. There will always be reasons for these different experiences; however they can only be properly analysed by taking a step back and reflecting objectively on each experience. Understanding the circumstances surrounding each of the different types of feedback events you have experienced can provide a useful guide in understanding where improvements are needed (Activity 6.1).
Activity 6.1
Reflecting on previous experiences of giving feedback
Reflect on one feedback situation that you feel went particularly well. Now make some brief notes about why you feel the situation went well. For example, you might like to comment about the environment, the stage of the assessment, what you discussed with the student.
Now reflect on a feedback experience that was unsatisfactory and use the same process to make some brief notes about what took place. Try to focus on the factors that you feel contributed to the negative feedback experience.
Feedback requires a number of factors to be in place to be effective. It takes both confidence and skill to deliver feedback in a way that is helpful to the student. Feedback also needs to take place in the right environment with sufficient time to discuss any issues of concern or areas for further development. If any of these elements are lacking then it is quite possible that your feedback experience will be unsatisfactory. Take a look at the key areas of each feedback situation that you reflected on in Activity 6.1. In terms of your negative experience, did you have sufficient knowledge or skill in relation to giving feedback? Was the environment right and did you have sufficient time? If the answer is no to any of these questions then this probably explains why the event was unsatisfactory. Now look at the positive event. What particular knowledge, skills or resources made the difference here? Hopefully you can start to see that the difference in each event is not you personally; it is the combination of circumstances, skills and knowledge that together can separate positive and negative feedback experiences.
Preparation for feedback
Without any doubt the preparation of mentors for delivering effective feedback to students is vital and if you have not been well prepared for this event it is likely to become either chaotic or very uncomfortable. If you are lacking the confidence and skill to give fair and accurate feedback, then you are certainly not alone. While feedback is a vital component of fair and accurate assessment, you must also ensure that vulnerable students are protected and their self-esteem is not damaged as a result of your feedback. As a result feedback often becomes a delicate balancing act between protecting a student’s feelings and being honest. If you are not prepared or not confident in how to do this a feedback situation can be very daunting indeed. In order to address these issues we must take a fresh look at feedback; what it is, what it isn’t; and most importantly, how to get it right.
Assessment and feedback
The assessment of pre-registration students can best be described as a ‘process’, with regular feedback to students being an integral aspect of this process. You cannot decide to ‘opt out’ of providing feedback as the process then falters. If you fail to provide a student with feedback then you are not only failing to fulfil your professional role as a mentor but you are also failing in your obligation to the student. Students value feedback and define this as an attribute of a ‘good’ mentor (see Case study 6.1), whereas a mentor who gives no feedback or delivers it in a way that is unhelpful to the student will be poorly evaluated by a student. So let’s look at feedback in more detail.
Case study 6.1
A student’s experience of feedback
‘My current mentor gives me great feedback. I say great because I trust her opinion and she’s not trying to get anything out of it. She is always keeping me up-to-date on my progress and making sure I know which areas to focus on and develop. I’m not afraid to have a go at new experiences when I’m working with her, not because she lets me get away with anything but because if I do make a mistake she talks me through it and encourages me on how to improve the next time. I always know where I stand and am always encouraged to learn as much as I can.’
What is feedback?
Feedback is the main way that you will provide a student with a review of their performance during a practice placement. It is both opinion based and a judgement. It is for this reason that many mentors do not like giving feedback. They either feel uncomfortable providing an opinion or in making a judgement about a student’s performance. However, your primary role as a mentor is to assess students, and to do this you must form both an opinion and make a judgement regarding your student’s competence. Remember though that although feedback is based on a judgement of student competence, this competence should always be related to the learning outcomes the student is trying to achieve. Your role is not to set the competence the student is to achieve; this has already been predetermined for you by the NMC. Your role is simply to match the evidence of competence against these standards. This is where your opinion and judgement are required, not based on your personal thoughts and feelings, but on factual evidence against NMC standards.
The main purpose of feedback is for you to provide your student with guidance on their understanding and performance. All feedback you give should therefore be directly related to student learning. If feedback is not related to their learning, students may become easily disillusioned and it can also become personal. Likewise, if feedback is given too late or fails to concentrate on skill it will not be of benefit to the student and can lead to conflict. In fact, any feedback that fails to concentrate on skill development and enhanced clinical performance will encourage a negative response. Feedback must always be an evaluation of performance, not an evaluation of character.
Students want feedback
Feedback is important to students because they want to know your opinion regarding their performance on clinical placement. No student wants to fail their placement and for this reason they can become preoccupied with receiving feedback about their performance. It is easy to understand why feedback is so important to a student as not only can it provide reassurance on current achievements, it also provides an opportunity to improve if there are any problems. Students rely on you to tell them of any concerns so they can make improvements if required. If a student hears nothing from you then they will assume that they have no problems. Unless you indicate otherwise, students will conclude that they are doing well and should have no cause for concern.
Why do mentors fail to give feedback?
There are a multitude of reasons as to why mentors fail to deliver feedback. One of the most common issues are the time constraints and competing clinical pressures that can impact on the time that mentors can spend with students. Of course, the irony is that the really busy shifts tend to be the times that students require maximum support and feedback. In addition, sick leave, night duty and annual leave can all impact on the feedback opportunities between students and mentors. You may also find it difficult to give feedback in terms of staying objective and not letting your personal opinion influence what you are saying.
On the whole, students will have very little comprehension that giving feedback may be difficult for you, and as a result, assume that if you have any concerns about their progress then you will let them know. If you do not raise any concerns with a student then they will assume that you have no concerns as in Case study 6.2. While students are encouraged during their education programme to reflect upon their own performance, it is unrealistic to expect that students will be able to identify and rectify their own practice without your input at all.
Case study 6.2
A mentor’s experience of feedback
‘When I was a very newly qualified mentor I lacked a lot of confidence in discussing the placement with my student so I guess I used to avoid feedback. On one occasion my student asked how they had performed during a handover and to be honest, there were lots of problems, but I just didn’t have the heart to say anything. I think I was afraid for some reason of being honest. I realize that this was a huge mistake because the next thing I knew this student was telling everyone that they had passed all their learning outcomes for the placement. It just became so awkward because I didn’t know how to say there were any problems after that and had to call the university link lecturer for advice. When we did meet with the student she said she didn’t trust me anymore and I don’t blame her. If only I’d been honest when she asked me I could have given some clear feedback and we could have worked on the problems together.’
You should not expect that students will recognize their mistakes and take appropriate action without some feedback from you. No matter how obvious it may seem to you, a student will rarely take action to rectify a problem unless you have discussed this with them and explored how to improve their performance. So, feedback must be clear, and feedback must be timely.
When should i give feedback?
We’ve already established that students expect feedback. They want to hear from you how they are performing. Keeping this in mind you will need to provide your student with feedback from the very beginning of their placement. While it is up to you as to how often and when you provide feedback to a student during their placement, it is worth remembering that the NMC expects that you will provide feedback to a student as often as it is needed to guide performance.
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