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Sinclair, HK, Cleland, JA Undergraduate medical students: who
seeks formative feedback? Medical Education 2007: 41: 580-582.
Reviewed by Paola Palma Sisto, Medical College of Wisconsin
What is the problem so and what is known about it so far?
The positive effect of offering feedback on learner performance
has been well established. Formative feedback (offering advice to
improve) is distinctive and generally more useful for improvement
than summative feedback (final evaluation of performance). It is
unknown which type of learner is actively seeking formative feedback.
Why did the researchers do this particular study?
Year 3 medical students at the University of Aberdeen, UK must
complete a "journal style" review paper for a Community
Course before progression to Year 4. The papers are marked by course
tutors trained in essay marking. The students receive both formative
(written comments on each essay) and summative (final grade) on
each essay. The formative feedback has to be picked up by the student
or the student needs to give the course organizers a stamped, addressed
envelope. The summative evaluation can be accessed via a computerized
system. Since many students did not access their formative feedback,
researchers were interested in which type of student did and how
it correlated with performance on the essays.
Who was studied?
Study subjects were the 2004 and 2005 cohorts of Year 3 MBChB
students at the University of Aberdeen.
How was the study done?
This was an observational study of retrospective data. Data
on gender and final grade were routinely collected. Students were
required to sign for receipt of their formative feedback sheets
or office staff noted who had been sent the feedback via mail. Categorical
data were described as percentages and associations between 2 categorical
factors compared using chi-square tests.
What did the researchers find?
The study included a total of 360 students. 52.7% were female.
The overall final grades were distributed as follows: 9%-"outstanding",
50%-"very good", 30%-"good", 10%-"pass",
1%-"fail".
Less than half of the students (46.4%) sought their formative
feedback sheets in the 2 years.
Significantly more females collected the formative feedback
(53.6% vs. 38%, p=0.004) as compared to males. Those students that
achieved higher final grades also were more likely to collect the
formative feedback (56.7% of "outstanding" and "very
good" scores vs. 40.1% of the "good" and "pass
and fail" scores, P=0.02)
What were the limitations of the study?
This is a retrospective and observational study, which may not
be generalizable. The motivations of the students for accessing
the feedback were also not elicited. The researchers did not look
at overall performance on other courses using other methods of assessment
to determine if the "poorer" performing students were
actually performing poorly in other courses or in this specific
exercise, a type of exercise they had not performed previously up
until this point.
What are the implications of the study?
Students who tended to have poorer performance on the essay
type assessment, students who would have most benefited from feedback,
were less likely to access formative feedback in this particular
course. We are well aware that medical students often ask for more
feedback; however it is unclear whether the feedback is actually
valued and incorporated, unless the instructor specifically looks
for those attributes. The researchers conclude that the medical
students on this course may be more concerned about final grades
than about using assessments as a learning experience. The researchers
also consider that there may be an association between improved
performance and having a more positive attitude towards formative
feedback. Strategies need to be developed to teach all learners
the value of formative feedback.
Editorial Comment: While it is a little unclear that the
model used in this course really applies to feedback in general
(as the students could not use the feedback to improve their skills
in this particular course), it is disappointing that so few students
took advantage of their opportunities to view the faculty comments.
Alas, the old saw, "assessment wags the tail" rings true
after all these years. Bill Raszka.
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