Questions about feedback

Answer to "How can feedback be exchanged effectively in formative and summative settings?"

Feedback exchanges can be formal or informal, scheduled or on-the-fly. The timing of feedback in clinical settings can be ongoing with short exchanges based on specific task performance or more structured at mid-points or end of rotations. It is easy to think that assessment and feedback are synonymous, but they are not. Assessment relates to performance calibration at various points during training and involves judgement of performance. Feedback is about learning; while it often includes discussion of data gathered during assessment, the discussion focuses on how the learner can use that data for development and to improve.  In-person feedback conversations can also include a discussion of performance in challenging domains such as communication skills, professionalism etc.


 In contrast to assessment, feedback requires the following to promte learning:

  • Direct observation of performance

  • An in-person conversation about performance data

  • Discussion of learning goals and  and how the feedback relates to those goals

  • Facilitated self-reflection on performance; e.g., by asking open questions of the learner

  • Non-judgemental language that involves a description of performance

  • Not grading of performance or comparing to peers

  • Comparison of performance against expected performance standards or outocmes for a given level of training

  • A shared agreement between teachers and learners on current performance and performance goals

  • Formulation of action plans to achieve performance goals


Both formative and summative feedback conversations ideally include the above strategies and require attention to learner self-efficacy as well.


Formative feedback should happen frequently, at least daily, and involves the following feedback-performance loop, ideally co-constructed by teachers and learners:

  • Conversations about specifc aspects of perfromnce at multiple points during a rotation or experience

  • Focussed action plans to implement for improvement until the next conversation

  • Creation of learning opportunities to implement action plans

  • Debriefing on effectiveness of action plans and new behaviours


Summative feedback generally occurs at the end of a learning experience/ clinical rotation and hence provide less opportunity for the feedback provider to follow up with the learner. However, t formulation of future action plans are still important. Again, ideally it should be co-constructed by teachers and learners, to promote self-direction and lifelong learning.  However, if the learner lacks insight, this may not be possible.  It involves:

  • Feedback exchange at the end of a rotation or experience

  • Summarising performance in key domains specific to the rotation or experience

  • Reflection on whether and how the gap between learner performance and target performance has narrowed

  • Validation of successes and behaviour change

  • Discussion of new goals

  • Potential action plans to achieve new goals



Cilliers, F. J., Schuwirth, L. W., Adendorff, H. J., Herman, N., et al. (2010) ‘The mechanism of impact of summative assessment on medical students’ learning’, Advances in Health Sciences Education, 15(5), pp. 695–715.

Harrison, C. J., Könings, K. D., Schuwirth, L., Wass, V., et al. (2015) ‘Barriers to the uptake and use of feedback in the context of summative assessment’, Advances in Health Sciences Education, 20(1), pp. 229–245.

Ramani, S., Könings, K. D., Ginsburg, S. and Vleuten, C. P. M. van der (2018) ‘Twelve tips to promote a feedback culture with a growth mind-set: Swinging the feedback pendulum from recipes to relationships’, Medical Teacher.

Shute, V. J. (2008) ‘Focus on Formative Feedback’, Review of Educational Research, 78(1), pp. 153–189.

Sinclair, H. K. and Cleland, J. A. (2007) ‘Undergraduate medical students: who seeks formative feedback?’, Medical Education, 41(6), pp. 580–582.