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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

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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