Embedding Student Feedback Literacy within health professions education
Although feedback is viewed as instrumental in learning, it is universally reported as problematic. Learners state that they don’t get enough feedback, and when they do, they find it difficult to decode and apply in practice. Feedback is also reported to be an emotional process. Students react defensively to feedback as they interpret it as a critique ‘on person’ rather than ‘on work’ and teachers, in fearing this emotive response, painstakingly construct messages to minimise affective turbulence. Rather than continuing to attempt to improve feedback by upskilling teachers to better ‘send’ messages, there has been a shift to improving the way that learners actively engage in the feedback process - ‘feedback literacy’ - including seeking, using and generating feedback information for learning (Carless & Boud 2018, Molloy, Boud & Henderson, 2019).
This project aimed to develop the feedback literacy of learners across the health professions as they transitioned to their clinical placements. The qualitative interview study aimed to problematise student feedback literacy in the healthcare setting, from the learner’s perspective. Before commencing placements, 105 healthcare students across multiple professions at an Australian teaching hospital participated in a feedback literacy program, based on a learner-centred dialogic model Feedback Mark 2 (Boud & Molloy, 2013). After their placements, 27 students participated in semi-structured interviews to investigate their interactions with feedback. Informed by workplace learning theory, the interview transcripts were interrogated using framework analysis. Most students reported that after participating in the literacy program and trying new approaches they reframed feedback as a process they could initiate and engage in, rather one they were subjected to. When they took a proactive stance (as coached and ‘tried on’ through role play), students noted that in their placements, feedback conversations generated plans for improvement which they were enacting. However, students had to work hard against well-established rituals in feedback in healthcare which positioned students as recipients of busy clinicians’ advice. Students privileged intraprofessional supervisor feedback over information from interprofessional practitioners, patients, or peers. Findings suggest that student engagement with feedback can be augmented with focussed education but that there remain several systemic and cultural influences that constrain what students feel they can ask for, and do, when it comes to their learning in the health workplace. We also suggest that through careful design, learner feedback literacy should be developed as early as day one, year one, and scaffolded across health professional programs.
Dr Christy Noble
Professor Stephen Billett
This project was funded as part of a larger project by the Office of Learning and Teaching (Grant No. ID15-4902), led by Billet S (2015): 'Augmenting students' learning for employability through post-practicum educational processes'. Office of Learning and Teaching (OLT) $460,000.
Noble, C., Billett S., Sly, C., Collier, L., Armit, L., Hilder, J., & Molloy, E. (2019). “It’s yours to take”: Generating learner feedback literacy in the workplace. Advances in Health Sciences Education. doi 10.1007/s10459-019-09905-5
Noble, C., Sly, C., Collier, L., Armit, L., Hilder, J., & Molloy, E. (2019). Enhancing feedback literacy in the workplace: A learner-centred approach. In S. Billett, J. M. Newton, G. Rogers, & C. Noble (Eds.). Augmenting health and social care students’ clinical learning experiences: Outcomes and processes. Dordrecht, The Netherlands: Springer, pg. 1-22.
Ajjawi, R., Bearman, M., Molloy, E., Noble, C., & Tai, J. (2019). How to develop feedback literate students. Pre-Conference Workshop presented at the AMEE 2019 conference, August, Vienna, Austria.
Noble, C., Sly, C., Collier, L., Armit, L., Billet, S., & Molloy, E. (2018). Tried and Tested Model: Enhancing students' feedback literacy in the workplace. Paper presented at the AMEE 2018 conference, August, Basel, Switzerland.
Molloy, E., Noble, C., Sly, C., Collier, L., Armit, L., & Billett, S. (2017). Improving feedback literacy in the workplace: Students’ experiences of the benefits of learning to be vulnerable. Paper presented at the AMEE 2017 conference, 26-30 August, Helsinki, Finland.