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Cited by 349Innovations in Medical EducationClinical Reasoning and Diagnostic SkillsStudent Assessment and Feedback

Guidelines: The do’s, don’ts and don’t knows of feedback for clinical education.

Open access
Lefroy, Janet, Watling, Chris, Teunissen, Pim W., Brand, Paul·2015·Perspectives on Medical Education
DOI 10.1007/s40037-015-0231-7PMC PMC4673072
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Abstract

Introduction The guidelines offered in this paper aim to amalgamate the literature on formative feedback into practical Do’s, Don’ts and Don’t Knows for individual clinical supervisors and for the institutions that support clinical learning. Methods The authors built consensus by an iterative process. Do’s and Don’ts were proposed based on authors’ individual teaching experience and awareness of the literature, and the amalgamated set of guidelines were then refined by all authors and the evidence was summarized for each guideline. Don’t Knows were identified as being important questions to this international group of educators which if answered would change practice. The criteria for inclusion of evidence for these guidelines were not those of a systematic review, so indicators of strength of these recommendations were developed which combine the evidence with the authors’ consensus. Results A set of 32 Do and Don’t guidelines with the important Don’t Knows was compiled along with a summary of the evidence for each. These are divided into guidelines for the individual clinical supervisor giving feedback to their trainee (recommendations about both the process and the content of feedback) and guidelines for the learning culture (what elements of learning culture support the exchange of meaningful feedback, and what elements constrain it?) Conclusion Feedback is not easy to get right, but it is essential to learning in medicine, and there is a wealth of evidence supporting the Do’s and warning against the Don’ts. Further research into the critical Don’t Knows of feedback is required.

AI snapshot

Written from the paper’s full text.

TL;DR

This consensus guideline amalgamates literature and expert experience into 32 Do’s, Don’ts, and Don’t Knows for formative feedback in clinical education, divided between individual clinical supervisors and the learning culture. It offers a new definition of helpful feedback and highlights unresolved questions requiring further research.

Key findings

  • The authors compiled 32 guidelines from an initial list of 65, dropping only two as unimportant; the guidelines cover feedback process and content for individual supervisors and elements of learning culture that support or constrain meaningful feedback.
  • Each Do/Don’t is assigned a strength of recommendation: Strong (large and consistent body of evidence), Moderate (solid empiric evidence from one or more papers plus author consensus), or Tentative (limited empiric evidence plus author consensus).
  • No single feedback approach—sandwich, Pendleton, reflective feedback conversation, agenda-led outcome-based analysis, or feedforward—was established as most effective; the best approach likely varies by learner, teacher-learner relationship, and context.
  • Don’t Knows include what determines credibility, the right amount of feedback content, what makes an open and safe interaction, what influences trainee response, whether peer or standard comparisons help, whether written summaries enhance learning, group versus individual feedback, and whether using formative assessment for summative purposes corrupts the educational system.

Methods

  • The authors built consensus iteratively: after agreeing scope and criteria, each author independently listed Do’s, Don’ts, and Don’t Knows; these were amalgamated by JL, lead authors outlined evidence, all authors added evidence and comments, and the process was repeated once more for final agreement.
  • This was not a systematic review; inclusion of guidelines was based on the authors’ teaching experience and awareness of the literature, and strength of recommendation was determined by consensus using their own criteria rather than ABC indicators.
  • The guidelines concern formative feedback in clinical education for medical students and doctors learning in the workplace, and are also relevant to formative feedback associated with summative assessment.

Limitations

  • Stated: the authors identify an obvious weakness as the lack of a systematic search method, meaning they will have missed some usable evidence; they note they used known systematic reviews to ensure that evidence contributed to the guidelines.
  • Stated/evident: the recommendations rely on author consensus and a non-systematic evidence synthesis, with strength indicators that combine evidence and consensus rather than systematic review criteria.
  • Evident from the text: the guidelines are not empirically tested for implementation or outcomes, and many Don’t Knows remain unanswered, including whether feedback is more effective individually or in groups and how formative/summative role mixing affects feedback.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1007/s40037-015-0231-7

Cites

97 of 97 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 159 cited sources checked · 0 supported · 0 flagged

  • Findingnone given

    No single approach to feedback has been established to be the most effective.

    “Several approaches to feedback have been described in the literature (sandwich, Pendleton, reflective feedback conversation, agenda-led outcome-based analysis, feedforward), but no single approach has been established to be the most effective.”
    Quote in the paperSubstantial claim
  • Findingnone given

    Evidence of the effectiveness of the feedback sandwich is lacking.

    “Evidence of its effectiveness is lacking.”
    Quote in the paperNot a substantial claim
  • Findingnone given

    The evidence is conflicting on whether overt comparison with peers or with required performance standards is helpful to the trainee.

    “The evidence is rather conflicting on these two related questions, so although there is a lot of evidence we have decided that it may depend on the context and on what comparison is made.”
    Quote in the paperSubstantial claim
  • Findingown data

    The paper's review found that feedback approaches relating to the system approach to learning in the workplace are largely limited to individuals, despite health care increasingly demanding competent team function.

    “Although we found several Do’s relating to the system approach to learning in the workplace, these feedback approaches are largely limited to individuals, despite ways of working in health care that increasingly demand competent team function.”
    Quote in the paperSubstantial claim
  • Interpretationnone given

    Feedback is essential to learning in medicine.

    “Feedback is not easy to get right, but it is essential to learning in medicine”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 52
  • May combine two claims. 45

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Findingnone given

    The specific constituents of a safe climate remain poorly understood, as are the ways in which individuals and organizations can promote it.

    “But the specific constituents of a safe climate remain poorly understood, as are the ways in which individuals and organizations can promote it.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingnone given

    The way trainees' desires and understandings are shaped is an area of study which is still producing conflicting results.

    “The way these desires and understandings are shaped is an area of study which is still producing conflicting results so deserves further careful study.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Trainees must perceive feedback as credible in order for it to be influential.

    “Do recognize that trainees must perceive feedback as credible in order for it to be influential.”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [7] Bing-You RG, Paterson J. Feedback falling on deaf ears: residents’ receptivity to feedback tempered by sender credibility. Med Teach. 1997;19:40. source

      Not checked in the free run.

    • cites [8] Sargeant J, Mann K, Ferrier S. Exploring family physicians’ reactions to multisource feedback: perceptions of credibility and usefulness. Med Educ. 2005;39:497–504. source

      Not checked in the free run.

    • cites [9] Sargeant J, Mann K, Sinclair D, Van Der Vleuten C, Metsemakers J. Challenges in multisource feedback: intended and unintended outcomes. Med Educ. 2007;41:583–91. source

      Not checked in the free run.

    • cites [10] Watling C, Driessen E, Vleuten CPM van der, Lingard L. Learning from clinical work: the roles of learning cues and credibility judgements. Med Educ. 2012;46:192–200. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The authors built consensus by an iterative process.

    “The authors built consensus by an iterative process.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Do's and Don'ts were proposed based on authors' individual teaching experience and awareness of the literature, and the amalgamated set of guidelines were refined by all authors and the evidence was summarized for each guideline.

    “Do’s and Don’ts were proposed based on authors’ individual teaching experience and awareness of the literature, and the amalgamated set of guidelines were then refined by all authors and the evidence was summarized for each guideline.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    There is a wealth of evidence supporting the Do's and warning against the Don'ts.

    “there is a wealth of evidence supporting the Do’s and warning against the Don’ts”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The criteria for inclusion of evidence for these guidelines were not those of a systematic review, and indicators of strength were developed combining evidence with authors' consensus.

    “The criteria for inclusion of evidence for these guidelines were not those of a systematic review, so indicators of strength of these recommendations were developed which combine the evidence with the authors’ consensus.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Feedback is part of a social interaction influenced by culture, values, expectations, personal histories, relationships, and power.

    “Feedback is part of a social interaction influenced by culture, values, expectations, personal histories, relationships, and power.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [3] Sargeant J, Mann K, Vleuten C van der, Metsemakers J. ‘Directed’ self-assessment: practice and feedback within a social context. J Contin Educ Health Prof. 2008;28:47–54. source

      Not checked in the free run.

    • cites [4] Watling C, Driessen E, Van der Vleuten CPM, Vanstone M, Lingard L. Beyond individualism: professional culture and its influence on feedback. Med Educ. 2013;47:585–94. source

      Not checked in the free run.

    • cites [6] Teunissen PW. Experience, trajectories, and reifications: an emerging framework of practice-based learning in healthcare workplaces. Adv Heal Sci Educ. 2015;20:843–56. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Feedback becomes less effective as attention shifts away from the task and toward the individual; feedback threatening to self-esteem is unlikely to be effective.

    “Kluger and DeNisi’s feedback intervention theory, derived from their meta-analysis of over 130 studies of feedback interventions in various settings, also posits that feedback becomes less effective as attention shifts away from the task and toward the individual; in short, feedback that is threatening to self-esteem is unlikely to be effective [28].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [28] Kluger A, DeNisi A. The effects of feedback interventions on performance: a historical review, a meta-analysis, and a preliminary feedback intervention theory. Psychol Bull. 1996;119:254. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In non-clinical higher education, learners ask for feedback more frequently and see more benefits than costs in it as it is perceived to contain more valuable information.

    “Research in non-clinical higher education shows that learners ask for feedback more frequently and see more benefits than costs in it as it is perceived to contain more valuable information.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [18] Morrison E, Cummings L. The impact of feedback diagnosticity and performance expectations on feedback-seeking behaviour. Hum Perform. 1992;5:251–64. source

      Not checked in the free run.

    • cites [19] Tsui AS, Ashford SJ. Adaptive self-regulation: a process view of managerial effectiveness. J Manage. 1994;20(1):93–121.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Although goal orientation is a fairly stable concept, a learning goal orientation can be fostered.

    “There are experimental studies showing that although goal orientation is a fairly stable concept, a learning goal orientation can be fostered [21].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [21] Molloy E, Boud D. Seeking a different angle on feedback in clinical education: the learner as seeker, judge and user of performance information. Med Educ. 2013;47:227–9. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Increasing the specificity of feedback benefits initial performance but discourages exploration, potentially undermining deeper learning required for independent performance.

    “Goodman et al. [30], for example, showed that increasing the specificity of feedback benefits initial performance, but discourages exploration, potentially undermining the deeper learning required for independent performance.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] Goodman JS, Wood RE, Hendrickx M. Feedback specificity, exploration, and learning. J Appl Psychol. 2004;89:248–62. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Credible feedback is well-informed, typically by direct observation of the task or event, and comes from a trustworthy source.

    “Credible feedback is well-informed, typically by direct observation of the task or event, and it comes from a trustworthy source.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [9] Sargeant J, Mann K, Sinclair D, Van Der Vleuten C, Metsemakers J. Challenges in multisource feedback: intended and unintended outcomes. Med Educ. 2007;41:583–91. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Feedback is most effective when directed at the task level and may assist in deep processing and mastery of tasks when it is about processing of tasks or self-regulation.

    “feedback is most effective when directed at the task level and may assist in ‘deep processing and mastery of tasks’ when it is about processing of tasks or self-regulation.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [13] Hattie J, Timperley H. The power of feedback. Rev Educ Res. 2007;77:81–112. source

      Not checked in the free run.

    • cites [28] Kluger A, DeNisi A. The effects of feedback interventions on performance: a historical review, a meta-analysis, and a preliminary feedback intervention theory. Psychol Bull. 1996;119:254. source

      Not checked in the free run.

    • cites [32] Archer JC. State of the science in health professional education: effective feedback. Med Educ. 2010;44:101–8. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Sargeant invoked feedback intervention theory to explain the difficulty practising physicians experienced in accepting and using negative or critical multisource feedback.

    “Sargeant invoked this theory to explain the difficulty practising physicians experienced in accepting and using negative or critical multisource feedback [31].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Sargeant J, Mann K, Sinclair D, Vleuten C van der, Metsemakers J. Understanding the influence of emotions and reflection upon multi-source feedback acceptance and use. Adv Heal Sci Educ Theory Pr. 2008;13:275–88. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Immediate error correction during task acquisition is more effective than delayed, whereas immediate correction when trying to build fluency detracts from learning automaticity.

    “Thus immediate error correction during task acquisition is more effective than delayed, whereas immediate correction when trying to build fluency will detract from the learning of automaticity which is a process and therefore better discussed after the event.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [13] Hattie J, Timperley H. The power of feedback. Rev Educ Res. 2007;77:81–112. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Feedback is most effective if directed at unsatisfactory elements of performance and linked to specific learning aims.

    “It is most effective if directed at unsatisfactory elements of performance and linked to specific learning aims [23].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] Van de Ridder JMM, McGaghie WC, Stokking KM, ten Cate OTJ. Variables that affect the process and outcome of feedback, relevant for medical training: a meta-review. Med Educ. 2015;49:658–73. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Feedback needs to be tailored to the trainee's perceptions.

    “Feedback needs to be tailored to the trainee’s perceptions [2].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2] Eva KW, Armson H, Holmboe E, et al. Factors influencing responsiveness to feedback: on the interplay between fear, confidence, and reasoning processes. Adv Health Sci Educ Theory Pract. 2012;17:15–26. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The prevention self-regulatory system may encourage learning for fear of failure but this feels like necessity and achievement causes relaxation rather than desire for further learning.

    “The prevention self-regulatory system may encourage learning for fear of failure but this will feel like a necessity and achievement will cause relaxation rather than a desire for further learning [34].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] Kluger A, Van Dijk A. Feedback, the various tasks of the doctor, and the feedforward alternative. Med Educ. 2010;44:1166. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Items thought clear Do's or Don'ts but after examining conflicting evidence were moved into the Don't Know section were: Is comparison with peers helpful? Is comparison with required performance standards helpful? Can the same people give summative and formative feedback?

    “Items which had been thought clear Do’s or Don’ts but after examining the conflicting evidence were moved into the Don’t Know section were: Is comparison with peers helpful? Is comparison with required performance standards helpful? Can the same people give summative and formative feedback? (item no.32).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Overcoming barriers to meaningful feedback demands both individual and institutional efforts.

    “Overcoming barriers to meaningful feedback demands both individual and institutional efforts.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The initial list of Do's, Don'ts, and Don't Knows numbered 65 and was reduced to 32 largely by amalgamation with only two dropped as unimportant on group reflection.

    “Our initial list of Do’s, Don’ts, and Don’t Knows numbered 65. We reduced this to the 32 listed largely by amalgamation with only two being dropped as unimportant on group reflection.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationnone given

    The impact of guidance to individual clinical supervisors would be limited if they were working within a system that did not actively promote feedback as a way of improving.

    “the impact of that guidance would be limited if they were working within a system that didn’t actively promote feedback as a way of improving.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The Don't Knows were identified as important questions to this international group of educators which if answered would change practice.

    “The Don’t Knows were identified as being important questions to this international group of educators which if answered would change practice.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Influential feedback thrives in the context of trusting relationships.

    “influential feedback thrives in the context of trusting relationships”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    For information to become feedback, it must enable the learner to take action to remedy the gap between actual and desired performance.

    “Sadler suggests that for information to become feedback, it must enable the learner to take action to remedy the gap between actual and desired performance [37].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37] Sadler DR. Beyond feedback: developing student capability in complex appraisal. Assess Eval High Educ. 2010;35:535–50. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Providing feedback that is poorly informed or based on hearsay diminishes the value that trainees assign to feedback in general.

    “Don’t provide feedback that is poorly informed (or is based on hearsay); doing so diminishes the value that trainees assign to feedback in general”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    As the players and contexts change, so too does the most useful approach to feedback.

    “As the players and the contexts change, so too does the most useful approach to feedback.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Positive feedback is more effective in motivating performance improvement for learners in promotion focus, while negative feedback is more useful in motivating performance improvement for learners in prevention focus.

    “positive feedback is more effective in motivating performance improvement for learners in promotion focus, while negative feedback is more useful in motivating performance improvement for learners in prevention focus [28].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [28] Kluger A, DeNisi A. The effects of feedback interventions on performance: a historical review, a meta-analysis, and a preliminary feedback intervention theory. Psychol Bull. 1996;119:254. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Conflicts of individual authors' Do's and Don'ts arose over whether trainees benefit from receiving grades with formative feedback; consensus was that this may be useful to some trainees and a tentative recommendation was included.

    “Conflicts of individual authors’ Do’s and Don’ts arose over whether trainees benefit from receiving grades with formative feedback. The consensus was that this may be useful to some trainees and a tentative recommendation was included.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The authors' range of undergraduate to postgraduate education teaching and research experience across three countries' health systems led them to believe they could compile useful guidelines.

    “The range of undergraduate to postgraduate education teaching and research experience we had across three countries’ health systems led us to believe that we could compile useful guidelines.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    Several approaches to feedback have been described in the literature, but no single approach has been established to be the most effective; the likely best approach varies according to the learner, the teacher-learner relationship, and the context.

    “Several approaches have been described in the literature (sandwich, Pendleton, reflective feedback conversation, agenda-led outcome-based analysis, feedforward), but no single approach has been established to be the most effective. Rather, the likely best approach varies according to the learner, the teacher-learner relationship, and the context”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Grades are a clear and non-nuanced form of feedback which can trigger both promotion and prevention responses in trainees.

    “Grades are a clear and non-nuanced form of feedback which can trigger both promotion and prevention responses in trainees [28].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [28] Kluger A, DeNisi A. The effects of feedback interventions on performance: a historical review, a meta-analysis, and a preliminary feedback intervention theory. Psychol Bull. 1996;119:254. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The trainee's desire to improve and confidence in ability are to some extent personality traits but can change with the trainee's situation.

    “To some extent these are personality traits (innate or learned earlier in life) but they can change with the trainee’s situation and we need to know how to promote both.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    For trainees with a low level of competence, scaffolding involves giving directive feedback or specific instructions; for trainees with a high level of competence, scaffolding can be less directive (facilitative feedback).

    “For trainees with a low level of competence, scaffolding involves giving directive feedback or specific instructions; for trainees with a high level of competence scaffolding can be less directive i.e. suggestions, hints and tips for (further) improvement (facilitative feedback) [27].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [27] Shute VJ. Focus on formative feedback. Rev Educ Res. 2008;78:153–89. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The feedforward interview aims to avoid creating a discrepancy between a preferred standard and the actual state of affairs by focusing learners on their best performances.

    “It aims to avoid creating a discrepancy between a preferred standard and the actual state of affairs (seen as a key element of feedback, but also recognized as problematic for trainees who have low self-esteem) by focusing learners on their best performances.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Kluger A, Van Dijk A. Feedback, the various tasks of the doctor, and the feedforward alternative. Med Educ. 2010;44:1166. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Regulatory focus theory might explain some of the observed variability in feedback responses.

    “Kluger and van Dijk [34] proposed that regulatory focus theory might explain some of the observed variability in feedback responses, and Watling et al.’s naturalistic exploration of the usefulness of this theory showed it offered some insights into feedback responses in clinical learning situations [25].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [25] Watling C, Driessen E, Vleuten CPM van der, Vanstone M, Lingard L. Understanding responses to feedback: the potential and limitations of regulatory focus theory. Med Educ. 2012;46:593–603. source

      Not checked in the free run.

    • cites [34] Kluger A, Van Dijk A. Feedback, the various tasks of the doctor, and the feedforward alternative. Med Educ. 2010;44:1166. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Trainee response to feedback depends on perceptions of whether the advice challenges their way of doing things and whether the emotional impact of feedback is positive.

    “Trainee response depends on perceptions of the advice—does it challenge their way of doing things? (I need to change) and is the emotional impact of feedback positive? (I want to change and believe I can change).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Kluger and van Dijk recommend periodical feedforward interviews with trainees about their peak experiences.

    “Kluger and van Dijk recommend periodical feedforward interviews with trainees about their peak experiences, partly in order to prepare the ground for necessary feedback to be received with a ‘promotion’ approach.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Kluger A, Van Dijk A. Feedback, the various tasks of the doctor, and the feedforward alternative. Med Educ. 2010;44:1166. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationnone given

    The conversation in reflective feedback should be viewed as a process rather than an event; revisiting and follow-up are often required.

    “Importantly, the conversation should be viewed as a process rather than an event; revisiting and follow-up are often required.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    There are many factors which influence the effect of feedback, and the choice of how to deliver feedback depends on the task, the recipient and the feedback relationship.

    “There are many factors which influence the effect of feedback, and the choice of how to deliver the feedback will depend on the task, the recipient and the feedback relationship [23].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Van de Ridder JMM, McGaghie WC, Stokking KM, ten Cate OTJ. Variables that affect the process and outcome of feedback, relevant for medical training: a meta-review. Med Educ. 2015;49:658–73. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Grades have the potential to demotivate or to reduce effort.

    “Because of the potential for grades to demotivate or to reduce effort, it has been suggested that it might be wisest to avoid giving grades except when formally assessing the learner (in infrequent ‘high stakes’ assessments) [58].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [58] Driessen E, Scheele F. What is wrong with assessment in postgraduate training? Lessons from clinical practice and educational research. Med Teach. 2013;35:569–74. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Evidence from higher education studies suggests that more feedback is less, and that increasing complexity can even reduce the effect of feedback.

    “We do have some evidence from higher education studies which suggests that more is less, and that increasing complexity can even reduce the effect of feedback [27].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Shute VJ. Focus on formative feedback. Rev Educ Res. 2008;78:153–89. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Reflection influences the assessment and assimilation of feedback and the processing of emotional responses to feedback.

    “Reflection was found to influence not only the assessment and assimilation of feedback, but also the processing of their emotional responses to feedback.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [52] Sargeant JM, Mann KV, Vleuten CP van der, Metsemakers JF. Reflection: a link between receiving and using assessment feedback. Adv Heal Sci Educ. 2008;14:399–410. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Credibility is a fundamental determinant of the ultimate impact of feedback on a learner.

    “Credibility is a fundamental determinant of the ultimate impact of feedback on a learner.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Trainees value feedback in principle, and value the provision of feedback as a desired quality of clinical teachers.

    “Surveys have demonstrated that trainees value feedback in principle, and value the provision of feedback as a desired quality of clinical teachers [53].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [53] Schultz KW, Kirby J, Delva D, et al. Medical students’ and residents’ preferred site characteristics and preceptor behaviours for learning in the ambulatory setting: a cross-sectional survey. BMC Med Educ. 2004;4:12. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    A learning environment offers a range of affordances, or opportunities to learn, but an individual learner must exercise agency to engage with those affordances.

    “Billett emphasizes the notions of affordances and agency; a learning environment offers a range of affordances, or opportunities to learn, but an individual learner must exercise agency to engage with those affordances.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [61] Eraut M. Learning from other people in the workplace. Oxford Rev Educ. 2007;33:403–22. source

      Not checked in the free run.

    • cites [62] Billett S. Toward a workplace pedagogy: guidance, participation, and engagement. Adult Educ Q. 2002;53:27–43. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Some feedback recipients feel content to be 'good enough' or become helpless when told they are not making the grade, to the detriment of their performance.

    “According to Kluger and de Nisi’s meta-analysis, some feedback recipients feel content to be ‘good enough’ or become helpless when told they are not making the grade, to the detriment of their performance [28].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [28] Kluger A, DeNisi A. The effects of feedback interventions on performance: a historical review, a meta-analysis, and a preliminary feedback intervention theory. Psychol Bull. 1996;119:254. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Trainees are anxious to know whether they are 'making the grade'.

    “Trainees are anxious to know whether they are ‘making the grade’.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Undergraduate medical students can be motivated by and can learn from self-comparison with peers.

    “But despite these concerns, some research has suggested value in comparisons: one group showed that undergraduate medical students can be motivated by and can learn from self-comparison with peers [65].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [65] Raat J, Kuks J, Cohen-Schotanus J. Learning in clinical practice: stimulating and discouraging response to social comparison. Med Teach. 2010;32:899–904. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Responses to feedback are driven by individual traits and preferences and by values embedded within the learning culture.

    “Responses to feedback are driven by individual traits and preferences and by values embedded within the learning culture.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Unfavourable comparisons with others may threaten self-esteem and promote a performance goal orientation, potentially hindering learning.

    “Unfavourable comparisons with others may threaten self-esteem and promote a performance goal orientation, potentially hindering learning [17].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Teunissen PW, Bok HGJ. Believing is seeing: how people’s beliefs influence goals, emotions and behaviour. Med Educ. 2013;47:1064–72. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Feedback challenges may lie with either affordance or agency, or both.

    “Feedback challenges may lie with either affordance (is good feedback made available to learners?) or agency (do learners choose to engage with feedback?), or both”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Institutions can create opportunities for longitudinal teacher-learner relationships to flourish, such as extended placements.

    “Institutions can create opportunities for longitudinal teacher-learner relationships to flourish, such as extended placements [68–70].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [68] Veloski J, Boex JR, Grasberger J, Evans A, Wolfson DB. Systematic review of the literature on assessment, feedback and physicians’ clinical performance: BEME Guide No. 7. Med Teach. 2006;28(2):117. source

      Not checked in the free run.

    • cites [69] Bok HG, Teunissen PW, Favier RP. Programmatic assessment of competency-based workplace learning: when theory meets practice. BMC Med Educ. 2013;13:123. source

      Not checked in the free run.

    • cites [70] Hägg-Martinell A, Hult H, Henriksson P, Kiessling A. Students perceive healthcare as a valuable learning environment when accepted as a part of the workplace community. Educ Heal Chang Learn Pract. 2014;27:15–23.

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Feedback works best soon after the event, especially for a complex task such as consulting with a patient.

    “One explanation is that feedback works best soon after the event, especially for a complex task such as consulting with a patient [11, 13].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [11] Watling C, Kenyon C, Zibrowski E, et al. Rules of engagement: residents’ perceptions of the in-training evaluation process. Acad Med. 2008;83(10 Suppl):S97–100. source

      Not checked in the free run.

    • cites [13] Hattie J, Timperley H. The power of feedback. Rev Educ Res. 2007;77:81–112. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    Enabling support of learners to self-monitor in relation to competency requirements is an important goal.

    “Enabling support of learners to self-monitor in relation to competency requirements is an important goal [63, 64]”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [63] GMC. Tomorrow’s doctors the duties of a doctor registered with the General Medical Council. 2009.

      Not checked in the free run.

    • cites [64] Eva K, Regehr G. Self-assessment in the health professions: a reformulation and research agenda. Acad Med. 2005;80:46. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Programmatic assessment emphasizes progress and learning from feedback and builds it into the system.

    “In the new movement towards programmatic assessment, progress and learning from feedback is emphasized and built into the system [74, 75].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [74] Van der Vleuten CPM, Schuwirth LWT. Assessing professional competence: from methods to programmes. Med Educ. 2005;39:309–17. source

      Not checked in the free run.

    • cites [75] Schuwirth LWT, Van der Vleuten CPM. Programmatic assessment: from assessment of learning to assessment for learning. Med Teach. 2011;33:478–85. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A safe and supportive climate is important for the exchange of feedback.

    “Many, including Pendleton [47], have highlighted the importance of a safe and supportive climate for the exchange of feedback.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [47] Pendleton D, Schofield T, Tate P, Havelock P. The new consultation developing doctor-patient communication. Oxford: Oxford University Press; 2003. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Potential disadvantages of video review include the relative complexity of arranging filming and viewing and that trainees may choose their best performances if videos are selectively proffered for feedback.

    “Potential disadvantages include the relative complexity of arranging filming and viewing and that if videos are being selectively proffered for feedback the trainee may choose their best performances.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The main advantage of video is that the trainee can review what they did as well as getting feedback.

    “The main advantage of video is that the trainee can review what they did and as well as getting feedback.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Faculty development is important but not sufficient to improve the effectiveness of feedback.

    “Faculty development is important but not sufficient; attention must also be paid to learners’ receptivity to feedback and to the elements of the learning culture that support or constrain the feedback exchange.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Tutor training is needed for tutors to accurately diagnose academic and social needs, understand and empathize with the learner's perspective, and have skills to employ appropriate scaffolding tools.

    “The feedback landscape described by Evans [1] indicates the need for tutor training: the tutor must accurately diagnose academic and social needs; understand and empathize with the learner’s perspective, and have skills to employ appropriate scaffolding tools.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] Evans C. Making sense of assessment feedback in higher education. Rev Educ Res. 2013;83:70–120. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There are few studies on the impact of the provision of feedback to teams of individuals and the outcomes are variable.

    “There are few studies on the impact of the provision of feedback to teams of individuals and the outcomes are variable, as described in a review by Gabelica et al. [89].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [89] Gabelica C, Bossche P Van Den, Segers M, Gijselaers W. Feedback, a powerful lever in teams: a review. Educ Res Rev. 2012;7:123–44. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Part of becoming 'routine' is that feedback, including critique, is exchanged very frequently.

    “And part of becoming ‘routine’ is that feedback, including critique, is exchanged very frequently.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Promoting communities of practice can be a helpful approach in turning the workplace into a powerful learning environment.

    “This can be a helpful approach in turning the workplace into a powerful learning environment when it can otherwise be a frustratingly hard place to change [6].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6] Teunissen PW. Experience, trajectories, and reifications: an emerging framework of practice-based learning in healthcare workplaces. Adv Heal Sci Educ. 2015;20:843–56. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The concept of the 'educational alliance' has been proposed as a framework for understanding the links between the teacher-learner relationship and the impact of the feedback generated within it.

    “Recognizing the centrality of relationship in the feedback process, the concept of the ‘educational alliance’ has been proposed as a framework for understanding the links between the teacher-learner relationship and the impact of the feedback generated within it [51, 79].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [51] Telio S, Ajjawi R, Regehr G. The “Educational Alliance” as a framework for reconceptualizing feedback in medical education. Acad Med. 2015;90:609–14. source

      Not checked in the free run.

    • cites [79] Wearne S, Dornan T, Teunissen PW, Skinner T. General practitioners as supervisors in postgraduate clinical education: an integrative review. Med Educ. 2012;46:1161–73. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    We did, however, use the systematic reviews we know of to ensure that the evidence therein has contributed to these guidelines.

    “We did, however, use the systematic reviews we know of to ensure that the evidence therein has contributed to these guidelines.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    An obvious weakness is the lack of a systematic search method; as a consequence, we will have missed some useable evidence.

    “An obvious weakness is the lack of a systematic search method; as a consequence, we will have missed some useable evidence.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    These processes and outcomes will flourish in the supportive learning culture of systematic dialogic feedback.

    “These processes and outcomes will flourish in the supportive learning culture of systematic dialogic feedback.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Programmatic assessment is designed to optimize learning and reduce exam stress.

    “Programmatic assessment (a system of frequent formative assessments also used for end-of-year summative judgements) is designed to optimize learning and reduce exam stress [86].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [86] Van der Vleuten CPM, Schuwirth LWT, Driessen EW, et al. A model for programmatic assessment fit for purpose. Med Teach. 2012;34:205–14. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Feedback about and during the process of teamwork was more reliably effective than feedback about performance given to the team or to individuals within the team.

    “Feedback about and during the process of teamwork was more reliably effective than feedback about performance given to the team or to individuals within the team.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [89] Gabelica C, Bossche P Van Den, Segers M, Gijselaers W. Feedback, a powerful lever in teams: a review. Educ Res Rev. 2012;7:123–44. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Interpretationnone given

    The wealth of research on feedback paints a picture of a nuanced process, with a great potential to help learners in all sorts of circumstances, but also a process that is fraught with variability and unpredictability, and influenced by individuals, contexts, and culture.

    “The wealth of research on feedback paints a picture of a nuanced process, with a great potential to help learners in all sorts of circumstances, but also a process that is fraught with variability and unpredictability, and influenced by individuals, contexts, and culture.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    The best feedback process loops back into a subsequent assessment with feedback about whether this has resulted in improved clinical performance.

    “And the best feedback process loops back into a subsequent assessment with feedback about whether this has resulted in improved clinical performance.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Trainees are looking for information about their performance and motivation to be/aim to be exemplary clinicians.

  • May combine two claims.

    Interpretationreasoning

    The advantages of group feedback are that a range of feedback perspectives are gained, feedback-giving is role-modelled, and observers learn vicariously.

    “The advantages to this approach are that a range of feedback perspectives are gained, feedback-giving is role-modelled, and observers learn vicariously.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: In group learning of clinical skills, feedback to the trainee(s) who have experimented with a task is generally given by and in front of the group.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Feedback is both an opportunity and a threat for teachers and learners.

    “In short, feedback is both an opportunity and a threat for teachers and learners.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Recent literature suggests that the quality and impact of feedback may be compromised when the teacher is assigned the dual role of coach and assessor.

    “Recent literature has begun to challenge this approach, suggesting that the quality and impact of feedback may be compromised when the teacher is assigned this dual role [38, 91, 92].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [38] Watling C, Driessen E, Vleuten CPM van der, Lingard L. Learning culture and feedback: an international study of medical athletes and musicians. Med Educ. 2014;48:713–23. source

      Not checked in the free run.

    • cites [91] Cavalcanti RB, Detsky AS. The education and training of future physicianswhy coaches can’t be judges. JAMA. 2011;306:993–4.

      Not checked in the free run.

    • cites [92] Kogan JR, Conforti LN, Bernabeo EC, Durning SJ, Hauer KE, Holmboe ES. Faculty staff perceptions of feedback to residents after direct observation of clinical skills. Med Educ. 2012;46:201–15. source

      Not checked in the free run.

    • Rests on an assumption: The same teacher is routinely expected to play both the coach and assessor roles simultaneously and for the same learner.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Feedback resists one-size-fits-all guidelines.

    “Feedback resists one-size-fits-all guidelines.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    The feedback process is incomplete if it does not result in the generation of strategies for improvement-either recommendations, or self-generated as a result of feedback.

    “The feedback process is incomplete if it does not result in the generation of strategies for improvement—either recommendations, or self-generated as a result of feedback.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Trainees are looking for information about their performance and motivation to be/aim to be exemplary clinicians.

  • May combine two claims.

    Interpretationnone given

    The disadvantages of group feedback are reduced control over content and volume of feedback, plus the risk of a negative emotional impact.

    “The disadvantages are reduced control over content and volume of feedback, plus the risk of a negative emotional impact.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: In group learning of clinical skills, feedback to the trainee(s) who have experimented with a task is generally given by and in front of the group.
79 of 79

  • The paper relies on this without support.

    Effective feedback remains difficult to achieve within the context of clinical education.

    “Despite the importance of feedback and the attention it has received in scholarly literature, effective feedback remains difficult to achieve within the context of clinical education.”

  • The paper relies on this without support.

    The authors’ combined experience and study in this area is sufficient to offer recommendations.

    “we offer recommendations based on published evidence from scientific exploration of the feedback process, and on our combined experience and study in this area.”

  • The paper relies on this without support.

    The Don’t Knows are important questions which if answered would change practice.

    “The Don’t Knows were identified as being important questions to this international group of educators which if answered would change practice.”

  • The paper relies on this without support.

    The authors’ range of experience across three countries’ health systems enabled them to compile useful guidelines.

    “The range of undergraduate to postgraduate education teaching and research experience we had across three countries’ health systems led us to believe that we could compile useful guidelines.”

  • The paper relies on this without support.

    The authors’ consensus is a valid basis for determining the strength of recommendations.

    “indicators of strength of these recommendations were developed which combine the evidence with the authors’ consensus.”

  • The paper relies on this without support.

    Feedback is a powerful way of learning.

    “feedback is a powerful way of learning”

  • The paper relies on this without support.

    In group learning of clinical skills, feedback to the trainee(s) who have experimented with a task is generally given by and in front of the group.

    “In group learning of clinical skills, feedback to the trainee(s) who have experimented with a task is generally given by and in front of the group.”

  • The paper relies on this without support.

    Medical education blurs the line, at times, between summative and formative assessment.

    “Medical education not only blurs the line, at times, between summative and formative assessment, but also blurs the line for its teachers between the roles of coach and assessor.”

  • The paper relies on this without support.

    Medical education blurs the line for its teachers between the roles of coach and assessor.

    “Medical education not only blurs the line, at times, between summative and formative assessment, but also blurs the line for its teachers between the roles of coach and assessor.”

  • The paper relies on this without support.

    The same teacher is routinely expected to play both the coach and assessor roles simultaneously and for the same learner.

    “Although these roles are distinct—coaches provide formative feedback while assessors make summative judgements—the same teacher is routinely expected to play both roles simultaneously and for the same learner.”

  • The paper relies on this without support.

    Trainees are looking for information about their performance and motivation to be/aim to be exemplary clinicians.

    “Trainees are looking for information about their performance and motivation to be/aim to be exemplary clinicians.”

  • The paper relies on this without support.

    Feedback is essential to learning in medicine.

    “Feedback may be complex, but it is essential to learning in medicine.”
12 of 12

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Invested, credible supervisors and a supportive, open culture are integral to positive learning and coaching in medicine and education.

    “Invested, credible supervisors 2,4-7 and a supportive, open culture [33][34][35][36] are integral to positive learning and coaching in medicine 8 and education.16,19”

    From The R2C2 Model in Residency Education: How Does It Foster Coaching and Promote Feedback Use? (2018) · cites this paper as [2]

  • Features important to the provision of feedback include actively engaging providers and recipients in the feedback interaction and addressing factors that influence feedback credibility and use, such as relationships, context, and culture.

    “Features seen to be especially important to the provision of feedback include actively engaging providers and recipients in the feedback interaction and addressing factors that influence feedback credibility and use, such as relationships, context, and culture.[2][3][4][5][6][7][8]”

    From The R2C2 Model in Residency Education: How Does It Foster Coaching and Promote Feedback Use? (2018) · cites this paper as [2]

Cites

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Related

Authors
Lefroy, J., Watling, C., Teunissen, P. W., & Brand, P.
Affiliations
  • Keele University (GB)
  • Maastricht University Medical Centre (NL)
  • Isala (NL)
Corresponding author
Lefroy, Janet
ORCID
Venue
Perspectives on Medical Education
Publisher
Ubiquity Press, Ltd.
Published
2015-11-30
Volume
4
Issue
6
Pages
284-299
ISSN
  • 2212-2761 (ISSN-L)
  • 2212-277X
DOI
10.1007/s40037-015-0231-7
PMC
PMC4673072
OpenAlex
W2184804741
Semantic Scholar
a247cc3bded28c9d1b09ad1d54b30c73454a56a6
Cited by
347
References
99
Citations by year
2026: 26 · 2025: 26 · 2024: 31 · 2023: 44 · 2022: 44 · 2021: 54 · 2020: 29 · 2019: 39 · 2018: 26 · 2017: 19 · 2016: 8 · 2015: 1
FWCI
19.30
Type
journal article
Language
en
Open access
Licence
Locations
  • Perspectives on Medical Education (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (publishedVersion, cc-by)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
  • Keele Research Repository (Keele University) (submittedVersion, cc-by)
  • Pure Amsterdam UMC (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
  • Social Sciences › Education › Student Assessment and Feedback
Keywords
formative feedback, clinical supervision, clinical teaching, trainee feedback, learning culture, competence development, self-efficacy, medical education

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

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