An exploration of types of feedback given to clinical dental students, and how best it can be used in support of their learning

The aim of this study was to investigate the types of feedback given to dental students during their clinical practice, and to explore how the students utilise this feedback. This was undertaken in order to gain an understanding of the best developmental support mechanisms for students, to be able to make suggestions as to how to enhance the quality of feedback given, and to improve the student use of feedback for their own reflection and goal setting. Written clinical feedback provided by staff over a period of a month was analysed and separate interviews of both staff and students were held to establish their views on the use and benefits of feedback, and how the process could be improved to enhance learning. The results from the study were used as the focus of staff training in giving and receiving feedback.

At the School of Dentistry, feedback is given by use of a custom built learning analytic dashboard known as LiftUpp® (Longitudinal Integrative Fully Transferable Undergraduate to Postgraduate Portfolio) which students access via the internet. During each clinical session, tutors give both verbal and written feedback to help the students develop the knowledge, skills and behaviours that are required of a practising clinician. In addition to the written feedback, which is entered into the LiftUpp® app via an ipad, the level of independence of each aspect of the tasks undertaken is also recorded (see Level of Independence table). This produces a huge amount of numerical data as there could be up to 10 data points per procedure.

Targeted written feedback is given to the students for those areas where further development is required. All written comments given by staff to undergraduate students during their clinical sessions in February 2017 were collected and analysed to explore variations in types of feedback. Individual semi-structured interviews also took place with 8 members of academic staff and 7 undergraduate students to discuss aspects of both the written and verbal feedback. This data was analysed using a thematic analysis approach to explore perceptions of both staff and students with regard to the feedback delivered.

From the study it was found that there was a considerable variation in the types of feedback that the staff were delivering, which could be divided into 3 groups: coaching, observational and judgemental. It was also noted that many staff felt that training in giving feedback would be beneficial, as students were often reluctant to accept their feedback.

There was a considerable variation in the way that students were utilising their feedback, and this generally fell into 2 camps: those who perceived it as assessment, viewing it infrequently and not engaging with the process in a reflective way, and as such showing fixed mindset traits, and those who perceived it in a more positive developmental manner.

The results of the study were presented at a whole school staff training day facilitated by colleagues from the Department of Psychology (A Forsythe & M Jellicoe) who highlighted the effect different types of feedback can have on learners, and showed the benefits of a coaching approach.

Following the staff training day, it was reported at a further focus group that staff felt they would change the way that they were giving feedback. At the very least, this case study has raised awareness amongst staff of the kinds of feedback which are most useful to students, and given them the opportunity to reflect on how they give feedback. With respect to students, in the forthcoming academic year, they will also be given training to help them make better use of their feedback via reflection and goal setting. In this way, both the processes of giving and of receiving feedback have been addressed.

Ethical approval was obtained for the study, and the staff and students kindly offered their time to take part in the interviews and focus groups. There was excellent attendance of the staff at the training day which was funded by the School of Dentistry, and the staff from the School of Psychology kindly agreed to facilitate.

This study relates to authentic formative assessment in that the students are provided with direct feedback in the clinical environment,  in order to help them develop and achieve their goals. This is truly authentic as the feedback is given to students following treatment of patients in the dental clinic.  This process prepares students for their professional life. Once qualified, all clinical practitioners must participate in CPD, including a reflective element (identifying areas for development/appropriate courses/reflection on their own learning).

This case study can be easily transferred to other disciplines. In order for any learning and development to take place, high quality feedback is a universal requirement. In addition, the key to students achieving their goals is their ability to receive and act upon their feedback.

A critical area in this study, before analysing the data, was defining the types of feedback and being very sure as to the difference between these. When undertaking focus groups, be very clear on the areas and questions that you wish to cover, as individuals can easily become sidetracked by other issues that they want to talk about.

Engagement of both staff and students with the process and the impetus to make change within the learning environment are key to the success of this case study.