Giving feedback in clinical settings.

Feedback is the cornerstone of effective clinical teaching. Without feedback, good practice is not reinforced, poor performance is not corrected, and the path to improvement not identified. Though teachers believe that they give regular and sufficient feedback, often this is not how it is perceived by learners. Feedback is about providing information to studentswith the intentionof narrowing the gapbetween actual and desired performance. 6 The purpose of giving feedback is to encourage learners to think about their performance and how they might improve. 2 Surveys of learners’ preferences show that theywant feedback that stimulates them to reflect on what they are doing. 8 Feedback is a concept that is strongly theory based. From a behaviourist perspective, feedback has been shown to reinforce or modify behaviour. However, feedback can also cause harm; negative feedback, if not carefully managed, can result in demotivation and deterioration in performance. Cognitive theorists have shown that feedback helps learners to reconstruct knowledge, change their performance, and feel motivated for future learning. 12 Empirical evidence also shows that feedback enhances clinical performance. For example, in a recent systematic review, regular feedback significantly improved the clinical performance of consultant clinicians. Feedback and assessment are closely related educational activities. They overlap considerably in terms of purpose and methodology (box 1).