Grades in formative workplace‐based assessment: a study of what works for whom and why
Open accessAbstract
Context: Grades are commonly used in formative workplace‐based assessment ( WBA ) in medical education and training, but may draw attention away from feedback about the task. A dilemma arises because the self‐regulatory focus of a trainee must include self‐awareness relative to agreed standards, which implies grading. Objectives: In this study we aimed to understand the meaning which medical students construct from WBA feedback with and without grades, and what influences this. Methods: Year 3 students were invited to take part in a randomised crossover study in which each student served as his or her own control. Each student undertook one WBA with and one without grades, and then chose whether or not to be given grades in a third WBA . These preferences were explored in semi‐structured interviews. A realist approach to analysis was used to gain understanding of student preferences and the impact of feedback with and without grades. Results: Of 83 students who were given feedback with and without grades, 65 (78%) then chose to have feedback with grades and 18 (22%) without grades in their third WBA . A total of 24 students were interviewed. Students described how grades locate their performance and calibrate their self‐assessment. For some, low grades focused attention and effort. Satisfactory and high grades enhanced self‐efficacy. Conclusions: Grades are concrete, powerful and blunt, can be harmful and need to be explained to help students create helpful meaning from them. Low grades risk reducing self‐efficacy in some and may encourage others to focus on proving their ability rather than on improvement. A metaphor of the semi‐permeable membrane is introduced to elucidate how students reduced potential negative effects and enhanced the positive effects of feedback with grades by selective filtering and pumping. This study illuminates the complexity of the processing of feedback by its recipients, and informs the use of grading in the provision of more effective, tailored feedback.
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Learners actively process some but not all of the information they get in feedback.
“Learners actively process some (but not all) of the information they get in feedback [25, 26].”
From Guidelines: The do’s, don’ts and don’t knows of feedback for clinical education. (2015) · cites this paper as [26]
Receiving grades in a frame of mind focused on knowing where one stands can enhance the seeking of strategies for improvement, especially if criteria for allocation of grades are understood.
“Receiving grades in this frame of mind was found to enhance the seeking of strategies for improvement, especially if criteria for allocation of grades are understood [26, 36].”
From Guidelines: The do’s, don’ts and don’t knows of feedback for clinical education. (2015) · cites this paper as [26]
Harmful effects of grades have been noted in some participants in school, higher education and medical education.
“Harmful effects of grades have also been noted in some participants in school, higher education and medical education [13, 26, 34]”
From Guidelines: The do’s, don’ts and don’t knows of feedback for clinical education. (2015) · cites this paper as [26]
Participants who reported that low grades motivated them to find strategies to improve needed an explanation of the grade for it to be useful to them.
“In studies of the impact of grades in formative assessment, participants who reported that low grades motivated them to find strategies to improve did however need an explanation of the grade in order for it to be useful to them [26, 57].”
From Guidelines: The do’s, don’ts and don’t knows of feedback for clinical education. (2015) · cites this paper as [26]
Recall of feedback is partial and selective.
“Recall of feedback is partial and selective [26].”
From Guidelines: The do’s, don’ts and don’t knows of feedback for clinical education. (2015) · cites this paper as [26]
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- Authors
- Lefroy, J., Hawarden, A., Gay, S. P., McKinley, R. K., & Cleland, J.
- Affiliations
- Keele University (GB)
- University of Aberdeen (GB)
- Corresponding author
- Lefroy, Janet
- Venue
- Medical Education
- Publisher
- Wiley
- Published
- 2015-02-18
- Volume
- 49
- Issue
- 3
- Pages
- 307-320
- ISSN
- 0308-0110 (ISSN-L)
- 1365-2923
- OpenAlex
- W2103762380
- Cited by
- 31
- References
- 40
- Citations by year
- 2026: 1 · 2024: 2 · 2023: 2 · 2022: 3 · 2021: 2 · 2020: 2 · 2019: 1 · 2018: 3 · 2017: 7 · 2016: 4 · 2015: 4
- FWCI
- 6.43
- Type
- journal article
- Language
- en
- Open access
- green
- eprints.keele.ac.uk
- Locations
- Medical Education (publishedVersion)
- PubMed (publishedVersion)
- Keele Research Repository (Keele University) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Social Sciences › Education › Student Assessment and Feedback
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Keywords
- GRADE, formative assessment, workplace-based assessment, feedback, medical students, self-efficacy, self-regulation, self-assessment, student preferences, realist approach
- MeSH terms
- Clinical Competence, Educational Measurement, Feedback, Female, United Kingdom, Humans, Learning, Male, Self-Assessment, Students, Medical, Workplace, Cross-Over Studies, Self Efficacy
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