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

The DOI matches its Crossref record; 97 of the 99 references it cites were found in a registry or an index; 1 of the 159 sources its claims cite were checked for support.

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

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.

Overview

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.

Figures

Fig. 1 Feedback processes and outcomes—what the trainee wants from the feedback relationship
Fig. 1 Feedback processes and outcomes—what the trainee wants from the feedback relationshipCC BY · PubMed Central

Verification

Claims the paper makes

116 Not checked yet · 35 Own interpretation · 10 Own method · 10 No basis given · 1 Supported · 1 Own result

Verify all 158 references — free account

Show all 94 claims

  • Probably not a substantial claim. 52
  • It may state two separate claims as one. 45
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?

Citations

Cites

Show all 99 references

Cited by

Sorted by citations

See all 349

Metadata

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
Venue
Perspectives on Medical Education
Published
2015-11-30
Volume
4
Issue
6
Pages
284-299
ISSN
  • 2212-2761 (ISSN-L)
  • 2212-277X
OpenAlex
W2184804741
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
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
  • Social Sciences › Education › 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.

A language model drew the claims from the paper on 2026-10-10, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-10-10 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

Cited sources are checked with a language model’s help (gpt-6-sol).

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review