Abstract Title | Do Students Receive Effective Written Feedback on Supervised Learning Events?


  1. Alex Nesbitt
  2. Lyndon James
  3. Andrew Pitcher
  4. Ann Griffin
  5. Alison Sturrock


Assessment: Written and Feedback


University College London Medical School



Feedback is integral to learning and development. It has been identified as one of the top five factors in learner achievement and promotes learning by informing trainees of their progress, their learning needs and by motivating them to improve. 1,2



Medical students value constructive feedback as it helps them to improve their performance. Supervised Learning Events (SLEs) were developed as performance assessments and to create opportunities for students to receive feedback. While many would argue the strengths of SLEs, there is a lack of literature assessing the quality of written feedback for medical students.


Summary of Work


A random 10% sample (n=36) of year four students in the academic year 2010-2011 (n=367) were contacted and asked to provide their 16 SLE forms for evaluation in exchange for a £20 gift voucher. Two hundred and fifty forms were received (121 mini-CEX, 122 CBD and 7 Case Note Review (CNR)), which were anonymised.


 Six students, with guidance from two faculty staff, devised a coding framework for the forms, to grade the quality and domain of feedback according to the gold standard as defined by Van de Ridder et al.3 The coding framework used can be seen in table 1.


Domain covered by feedback

Clinical Skill


Communication Skills


Global judgement of feedback quality


Neither strong, nor weak



Reasons for poor quality feedback





Relevance of feedback

Relevant to learning objectives

Relevant to end of year assessment



Type of feedback

Point of good performance

Area for improvement





Summary of Results

 Overall, 63.1% of feedback entries were graded weak (Figure 2). A greater proportion of the “areas for improvement” comments were graded weak (73.6%) compared to the points of good performance (52.8%). Examples of comments in each category are shown.





“Keep practising”

”Points of good performance: 9/10”

Neither strong, nor weak:

“Significant improvements needed in upper limb neurological exam”

“Very good history taking and record keeping.”



“To practice a systematic approach to CVS examination to make sure relevant aspects are not forgotten eg. measuring BP, collapsing pulse and radio-radial delay.”

“To continue to enquire about the impact medical illness has on a patient’s ADL as this is an aspect that often gets missed in the hospital setting.”




Box 1: Examples of feedback graded weak, neither strong or weak and strong

Reasons for Classification of Feedback as Weak

 Weak feedback was classified as being non-specific, unclear, illegible, irrelevant or “blank” . Additionally, a large proportion of forms carried the comment “keep practising” (or similar). This was assigned an additional code. See Table 2 for full results.



Proportion of ‘weak’ units of feedback coded with listed codes (%)





Keep practising







Table 2 Primary reasons for coding of units of feedback as weak



The quality of written feedback is clearly an area for development.  Factors that impede this include a lack of time and the fact that some assessors may be uncomfortable providing negative feedback. In order to improve, it is important that both students and assessors are trained more thoroughly in giving effective written feedback.

Take-home Messages


To improve the feedback being given to students, it is important that both students and assessors are aware of the purpose and benefits of SLEs and the delivery of feedback. Assessors should be trained more thoroughly in giving effective written feedback.



We would like to thank Freya Baird for her help in the initial data collection.


[1] Hattie J, Timperley H. The Power of Feedback.Rev Educ Res 2007;77:81-112

[2] Norcini J, Burch V. Workplace-based assessment as an educational tool: AMEE Guide No. 31. Med Teach 2007;29:855-871


[3] Van De Ridder JM, Stokking KM, Mcgaghie WC, Ten Cate OT. What is feedback in clinical education? MedEduc 2008;42:189-197

Summary of Work
Summary of Results
Take-home Messages
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