Cited by 686Innovations in Medical EducationStudent Assessment and FeedbackClinical Reasoning and Diagnostic Skills

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What is feedback in clinical education?

Van De Ridder, J M Monica, Stokking, Karel M, McGaghie, William C, Ten Cate, Olle Th J·2008·Medical Education

DOI 10.1111/j.1365-2923.2007.02973.x

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Abstract

Objective Feedback is important in clinical education. However, the medical education literature provides no consensual definition of feedback. The aim of this study is to propose a consensual, research‐based, operational definition of feedback in clinical education. An operational definition is needed for educational practice and teacher training, and for research into the effectiveness of different types of feedback. Methods A literature search about definitions of feedback was performed in general sources, meta‐analyses and literature reviews in the social sciences and other fields. Feedback definitions given from 1995 to 2006 in the medical education literature are also reviewed. Results Three underlying concepts were found, defining feedback as ‘information’; as ‘reaction’, including information, and as a ‘cycle’, including both information and reaction. In most medical education and social science literature, feedback is usually conceptualised as information only. Comparison of feedback definitions in medical education reveals at least 9 different features. The following operational definition is proposed. Feedback is: ‘Specific information about the comparison between a trainee’s observed performance and a standard, given with the intent to improve the trainee’s performance.’ Conclusions Different conceptual representations and the use of different key features might be a cause for inconsistent definitions of feedback. The characteristics, strengths and weaknesses of this research‐based operational definition are discussed.

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Background
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“(Van de Ridder et al. 2008).”
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“The TRI-O model was introduced at an appropriate moment when the students felt knowledge gap.(31,32) Limitations Limitations of this study include how the pre–posttest design was conducted in a single institution and used a cross-sectional design rather than quasi-experimental research with a control group.”
Method
The Quality of Operative Performance Narrative Feedback
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Background
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Background
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Background
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“Feedback is an important and valuable tool in interactive learning [4], and for our purposes, it may be defined as the provision of specific information on a student’s performance relative to a specific performance standard [5], with the intention of improving the student’s performance.”
Background
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“Why does this trend continue when so much has been written about techniques for giving feedback and more faculty development workshops are being organized on this very topic (van de Ridder et al. 2008; Krackov 2011; Krackov & Pohl 2011).”
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Background
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Background
Leadership-Specific Feedback Practices in Surgical Residency: A Qualitative Study
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“193).[54] Formative feedback in the clinical setting may take on a number of features that include being on-going, two-way, meaningful to the situation, be credible, be highly specific, include self-assessment, while providing direction for improvement for the supervisee.”
Background
The Educational Practices Construct of the NLN/Jeffries Simulation Framework: State of the Science
Hallmark, B. F., Thomas, C. M., & Gantt, L. T. (2013) · Clinical Simulation in Nursing · doi:10.1016/j.ecns.2013.04.006 · Cited by 30
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“Feedback within health professions education has been defined as ‘specific information about the comparison between a trainee's observed performance and a standard, given with the intent to improve the trainee's performance’.(69) As described above, WBA has enhanced feedback specificity and structure by defining those…”
Background
Challenges of providing timely feedback to residents: Faculty perspectives.
Zehra, T., Tariq, M., Ali, S. K., Motiwala, A., & Boulet, J. R. (2015) · PubMed · Cited by 27
Giving effective feedback in medical education
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“Research has shown that feedback in a clinical setting is more effective if the following requirements are met: the feedback is specific in content by focusing on observable competencies, compares student performance to a standard, corrects performance deficiencies, and contains a plan of action to improve performance…”
Background
Meeting international standards: A cultural approach in implementing the mini-CEX effectively in Indonesian clerkships
Suhoyo, Y., Schönrock-Adema, J., Rahayu, G. R., Kuks, J. B. M., & Cohen‐Schotanus, J. (2014) · Medical Teacher · doi:10.3109/0142159x.2014.917160 · Cited by 26
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BackgroundMethodInfluential
Barriers to feedback in undergraduate medical education. Male students' perspective in Central Saudi Arabia
AlHaqwi, A. I., Alwahbi, A., Abdulghani, H. M., & van der Molen, H. T. (2012) · Saudi Medical Journal · doi:10.15537/1658-3175.5553 · Cited by 26
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Background
Gender Differences in Emergency Medicine Attending Physician Comments to Residents: A Qualitative Analysis
Mamtani, M., Shofer, F. S., Scott, K. R., Kaminstein, D. S., Eriksen, W., Takacs, M. E., Hall, A. K., Weiss, A. K., Walter, L. A., Gallahue, F. E., et al. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.43134 · Cited by 25
“Site 1 had the fewest narrative comments (men and women faculty provided a median [IQR] of 5 [1-13] and 5 [2-10], respectively), while site 3 had the most narrative comments (men and women faculty provided a median [IQR] of 50 [13-97] and 57 [31-124], respectively).”
Background
Feedback in Clinical Education, Part II: Approved Clinical Instructor and Student Perceptions of and Influences on Feedback
Nottingham, S. L., & Henning, J. M. (2013) · Journal of Athletic Training · doi:10.4085/1062-6050-48.6.15 · Cited by 25
“These differences may stem from an inability of instructors to self-assess their behaviors or an inability of students to recognize feedback.(13,14) In addition to perceptions of feedback, several investigators in the areas of medical and athletic training(18,19) education have examined the factors that influence the…”
Background
Essentials of Debriefing and Feedback
Sawyer, T., Brett-Fleegler, M. B., & Eppich, W. (2016) · Comprehensive healthcare simulation · doi:10.1007/978-3-319-24187-6_3 · Cited by 28
The Use of Feedback in Improving the Knowledge, Attitudes and Skills of Medical Students: a Systematic Review and Meta-analysis of Randomized Controlled Trials
Castro, M. A. B. E., de Almeida, R. L. M., Lucchetti, A. L. G., Tibiriçá, S. H. C., Ezequiel, O. D. S., & Lucchetti, G. (2021) · Medical Science Educator · doi:10.1007/s40670-021-01443-3 · Cited by 24
Shaping the right conditions in programmatic assessment: how quality of narrative information affects the quality of high-stakes decision-making
de Jong, L. H., Bok, H. G. J., Schellekens, L. H., Kremer, W. D. J., Jonker, F. H., & van der Vleuten, C. P. M. (2022) · BMC Medical Education · doi:10.1186/s12909-022-03257-2 · Cited by 24
How well do faculty do in providing general surgery EPA feedback?
Layne, D., Jung, S. A., Varley, P. R., O’Rourke, A. P., & Minter, R. M. (2024) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2024.115902 · Cited by 24
Feedback That Helps Trainees Learn to Practice Without Supervision
Bearman, M., Brown, J. B., Kirby, C. N., & Ajjawi, R. (2020) · Academic Medicine · doi:10.1097/acm.0000000000003716 · Cited by 26
Difficult incidents and tutor interventions in problem‐based learning tutorials
Kindler, P. M., Grant, C., Kulla, S., Poole, G., & Godolphin, W. J. (2009) · Medical Education · doi:10.1111/j.1365-2923.2009.03423.x · Cited by 24
Faculty verbal evaluations reveal strategies used to promote medical student performance
Hauer, K. E., Mazotti, L. A., OʼBrien, B. C., Hemmer, P. A., & Tong, L. (2011) · Medical Education Online · doi:10.3402/meo.v16i0.6354 · Cited by 24
Emergency medical dispatchers’ experiences of managing emergency calls: a qualitative interview study
Torlén, K., Kurland, L., Olanders, K. J., Khoshegir, A., Kamil, H. A., Castrén, M. K., & Bohm, K. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-059803 · Cited by 23
Undergraduate Medical Students’ Perceptions on Feedback-Seeking Behaviour
Oktaria, D., & Soemantri, D. (2018) · Malaysian Journal of Medical Sciences · doi:10.21315/mjms2018.25.1.9 · Cited by 23
Competency-based teacher training: A systematic revision of a proven programme in medical didactics
Griewatz, J., Simon, M., & Lammerding‐Koeppel, M. (2017) · PubMed Central · doi:10.3205/zma001121 · Cited by 23
The Practice of Feedback in Health Professions Education in the Hierarchical and Collectivistic Culture: a Scoping Review
Soemantri, D., Nurokhmanti, H., Qomariyah, N. U., & Claramita, M. (2022) · Medical Science Educator · doi:10.1007/s40670-022-01597-8 · Cited by 25
“Feedback is defined as ‘specific information about the comparison between trainees’ observed performance and a standard, given with the intent to improve the trainees’ performance’ [5].”
Background
Personalized Video Feedback and Repeated Task Practice Improve Laparoscopic Knot-Tying Skills: Two Controlled Trials
Abbott, E., Thompson, W. S., Pandian, T. K., Zendejas, B., Farley, D. R., & Cook, D. A. (2017) · Academic Medicine · doi:10.1097/acm.0000000000001924 · Cited by 24
Residents' narrative feedback on teaching performance of clinical teachers: analysis of the content and phrasing of suggestions for improvement
van der Leeuw, R. M., Schipper, M. P., Heineman, M. J., & Lombarts, K. M. J. M. H. (2016) · Postgraduate Medical Journal · doi:10.1136/postgradmedj-2014-133214 · Cited by 22
Does what we write matter? Determining the features of high- and low-quality summative written comments of students on the internal medicine clerkship using pile-sort and consensus analysis: a mixed-methods study
Gulbas, L. E., Guerin, W., & Ryder, H. F. (2016) · BMC Medical Education · doi:10.1186/s12909-016-0660-y · Cited by 21
“Feedback is defined as “specific information about the comparison between a trainee’s observed performance and a standard, given with the intent to improve trainee’s performance” [31] – it follows that a supervisor must know, and demonstrate knowledge, of both the trainee and a standard, to provide quality feedback su…”
Background
Debriefing: The state of the art and science in healthcare simulation
Cheng, A., Eppich, W., Sawyer, T., & Grant, V. J. (2017) · doi:10.1002/9781119061656.ch21 · Cited by 22
Student reactions to AI versus human feedback in teamwork skills assessment
Kotlyar, I., & Krasman, J. (2025) · International Journal of Educational Technology in Higher Education · doi:10.1186/s41239-025-00555-9 · Cited by 21
Resident Perspective on Feedback and Barriers for Use as an Educational Tool
Albano, S., Quadri, S. A., Farooqui, M., Arangua, L., Clark, T., Fischberg, G. M., Tayag, E. C., & Siddiqi, J. (2019) · Cureus · doi:10.7759/cureus.4633 · Cited by 21
Delivery and use of individualised feedback in large class medical teaching
Burr, S. A., Brodier, E., & Wilkinson, S. (2013) · BMC Medical Education · doi:10.1186/1472-6920-13-63 · Cited by 21
Task‐ versus ego‐oriented feedback delivered as numbers or comments during intubation training
Manzone, J. C., Tremblay, L., You-Ten, K. E., Desai, D., & Brydges, R. (2014) · Medical Education · doi:10.1111/medu.12397 · Cited by 21
Feedback during active learning: elementary school teachers’ beliefs and perceived problems
van den Bergh, L., Ros, A., & Beijaard, D. (2013) · Educational Studies · doi:10.1080/03055698.2013.767188 · Cited by 21
Feedback using an ePortfolio for medicine long cases: quality not quantity
Bleasel, J. F., Burgess, A. W., Weeks, R., & Haq, I. (2016) · BMC Medical Education · doi:10.1186/s12909-016-0801-3 · Cited by 23
“Feedback is critical for learning in clinical medicine [10].”
Background
Medical Student Perceptions of Learner-Initiated Feedback Using a Mobile Web Application
Robertson, A. C., & Fowler, L. C. (2017) · Journal of Medical Education and Curricular Development · doi:10.1177/2382120517746384 · Cited by 21
Innovative use of simulated patients for educational purposes
Bokken, L. (2009) · Research Publications (Maastricht University) · doi:10.26481/dis.20090304lb · Cited by 21
Feedback mapping—The curricular cornerstone of an “educational alliance.”
Murdoch-Eaton, D., & Bowen, L. (2017) · Medical Teacher · doi:10.1080/0142159x.2017.1297892 · Cited by 20
“These contrary perceptions illustrate differing recollections of not only whether feedback has actually happened, but also whether the learner has recognized the feedback and how they may use it to construct meaning (Irby 1994; Van de Ridder et al. 2008; Murdoch-Eaton & Sargeant 2012).”
Background
Séance de simulation: du briefing au débriefing
Savoldelli, G. L., & Boet, S. (2013) · Springer eBooks · doi:10.1007/978-2-8178-0469-9_32 · Cited by 20
Calibrated Peer Review for Interpreting Linear Regression Parameters: Results from a Graduate Course
Enders, F. B., Jenkins, S. M., & Hoverman, V. R. (2010) · Journal of Statistics Education · doi:10.1080/10691898.2010.11889489 · Cited by 20
“For each student, we were able to qualitatively identify a time during their CPR assignment in which they demonstrated this understanding.”
BackgroundMethodInfluential
Written feedback on supervised learning events
Nesbitt, A., Pitcher, A., James, L., Sturrock, A. M., & Griffin, A. (2014) · The Clinical Teacher · doi:10.1111/tct.12145 · Cited by 20
Accounting Students' Feedback on Feedback in Australian Universities: They're Less Than Impressed
Watty, K., Lange, P. D., Carr, R. A., O’Connell, B., Howieson, B. A., & Jacobsen, B. (2013) · Accounting Education · doi:10.1080/09639284.2013.823746 · Cited by 20
“Yet, there is some evidence that there are different conceptions of what constitutes feedback (see, for example, Black and William, 1998; Van de Ridder et al., 2008).”
BackgroundInfluential
Development and Validation of a Large Language Model–Based System for Medical History-Taking Training: Prospective Multicase Study on Evaluation Stability, Human-AI Consistency, and Transparency
Liu, Y., Shi, C., Wu, L., Lin, X., Chen, X., Zhu, Y., Tan, H., & Zhang, W. (2025) · JMIR Medical Education · doi:10.2196/73419 · Cited by 23
Twelve tips for institutional approach to outcome-based education in health professions programmes
Er, H. M., Nadarajah, V. D., Chen, Y. S., Misra, S., Perera, J., Ravindranath, S., & Yee, H. Y. (2019) · Medical Teacher · doi:10.1080/0142159x.2019.1659942 · Cited by 20
myTIPreport and Training for Independent Practice: A Tool for Real-Time Workplace Feedback for Milestones and Procedural Skills
Connolly, A., Goepfert, A. R., Blanchard, A. K., Buys, E. A., Donnellan, N. M., Amundsen, C. L., Galvin, S. L., & Kenton, K. S. (2018) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-17-00137.1 · Cited by 19
The Clinician-Educator's Handbook
Turner, T. L., Palazzi, D. L., Ward, M., & Lorin, M. I. (2010) · MedEdPORTAL · doi:10.15766/mep_2374-8265.7749 · Cited by 18
Development of a laparoscopic surgical skills simulation curriculum: Enhancing resident training through directed coaching and closed-loop feedback
Lovasik, B. P., Fay, K. T., Patel, A. D., Stetler, J. L., Papandria, D., Santore, M. T., Davis, S. S., Lin, E., & Srinivasan, J. K. (2021) · Surgery · doi:10.1016/j.surg.2021.08.020 · Cited by 20

Authors: Van De Ridder, J. M. M., Stokking, K. M., McGaghie, W. C., & Ten Cate, O. T. J.
Affiliations: Utrecht University (NL)
Northwestern University (US)
ORCID: McGaghie, William C
Venue: Medical Education
Publisher: Wiley
Published: 2008-01-22
Volume: 42
Issue: 2
Pages: 189-197
ISSN: 0308-0110 (ISSN-L)
1365-2923
DOI: 10.1111/j.1365-2923.2007.02973.x
OpenAlex: W1807214239
Semantic Scholar: e411b553fd3fa2a57ef58d5fd2f19a8d83f555a4
Cited by: 686
References: 66
Citations by year: 2026: 30 · 2025: 39 · 2024: 46 · 2023: 41 · 2022: 46 · 2021: 72 · 2020: 45 · 2019: 44 · 2018: 37 · 2017: 39 · 2016: 54 · 2015: 29 · 2014: 42 · 2013: 44 · 2012: 27
FWCI: 2.38
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Medical Education (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Education › Innovations in Medical Education
Social Sciences › Education › Student Assessment and Feedback
Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
Keywords: feedback, clinical teaching, operational definitions, trainee performance, performance standards, teacher professional development, feedback loops
MeSH terms: Education, Medical, Feedback, Social Sciences, Teaching, Clinical Medicine, Observation

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