Written feedback in workplace-based assessment

In considering the value of written feedback in general, a number of authors make important claims for its utility. Orsmond et al. (2005) and Carless (2006) have demonstrated that learners often review written feedback with the intention of making improvements to their work, and so the longevity of written feedback may thus support reflection, consolidation and repeated attempts to comprehend and apply the advice or

instruction of the tutor. Jolly and Boud (2013) highlight the potential for written feedback to be private, allowing learners to avoid the embarrassment of public criticism or even public praise: as Hattie and Timperly (2007) identify, even positive feedback can be perceived negatively if delivered in the presence of a social group whose collective values are not welcoming of individual praise. Whilst this is often the case in adolescent social groups, it may be also the case amongst groups of high performing professionals, such as groups of clinical radiology trainees.

Another advantage of written feedback over verbal feedback, as long as an immediate response is not required, is that it takes time to construct. This affords both teacher and learner with the opportunity to pause and reflect which, as Jolly and Boud (2013) observe, may be especially valuable if the learning or assessment episode has been intense or emotionally charged, as can often be the case in clinical settings. Furthermore, assessors can modify their original thoughts, rephrasing them if necessary to ensure that their comments are not as terse or critical as they might otherwise have been. Other linguistic amendments or revisions can also be made – Boud (1995) highlighted the paralysing nature of closed, judgemental statements which allow the learner no right of reply. Having time to redraft comments may afford assessors the opportunity to rephrase their feedback in order to ask open questions or make suggestions for further improvement instead.

The precise phrasing of assessors’ comments may not be the only barrier to genuine dialogue in written feedback. As Crisp (2007) and Bloxham and Campbell (2010) point out, the written format itself makes it challenging to conduct a genuinely dialogic feedback conversation. This is especially true if it is delivered at the end of a term or clinical placement. Bloxham and Campbell (2010) also allude to the particular difficulty posed in professional settings, in which learning involves not just achieving mastery over a particular set of skills or body of knowledge, but participating ever more fully in complex communities of practice. Learning in this sense, they argue, is unlikely to be supported effectively by formal written feedback. Instead, professional learning occurs by immersion in the community itself, with extensive opportunities for ‘observation, imitation, participation and dialogue’ (Bloxham and Campbell, 2010, p. 292).

None of this is to say that verbal feedback, by comparison, is necessarily valuable or genuinely dialogic. As revealed by Murdoch-Eaton & Sargeant (2012), verbal feedback

may be dismissed by learners, who may think it of little value, or fail even to identify it as feedback. In particular, these researchers found that early stage medical students did not identify verbal comments as feedback, preferring written comments instead:

Very little feedback is given; most of it is oral and general (ibid., p. 717).

Conversely, senior medical students in Murdoch-Eaton & Sargeant’s (2012) study did appear to value verbal feedback, especially when learning in the clinical environment. The authors viewed this as a maturational difference, but there may be other drivers for the persistence of these perceptions. In particular, the early stages of medical school often emphasise ‘traditional’ academic performance, such as lecture-based teaching and assessment via essays and written examinations. These features of the curriculum may well generate a reliance on, or expectation of, detailed written feedback. By comparison, the latter years of medical school tend to emphasise clinical experience through extended clinical placements. Students in that phase of the curriculum are more likely to be aware of the difficulty of providing written feedback in busy clinical environments, and more appreciative of verbal comments on their clinical performance. This likelihood is supported by the remarks of one study participant, a senior medical student, who commented:

Feedback is more focused now, it’s better i.e. towards clinical things and being a doctor rather than in previous years where it was more general and theoretical (ibid. p. 718).

In an echo of Murdoch-Eaton and Sargeant’s (2012) study, Jolly and Boud (2013) observe that there are marked differences between feedback practices in higher education compared with professional education. They perceive that in the former, feedback is much more likely to be written than verbal, whereas professional environments, and particularly clinical settings, are far more likely to feature verbal feedback. Paul et al. (2013) observe that clinical medicine has a strong oral tradition of teaching and learning, and Jolly and Boud (2013) observe that verbal feedback tends to predominate even when these professional learning situations are ‘staged’ – such as simulation-based training – with the feedback model in these cases often involving small-group discussion between the teacher, learner, peers and even (at times) patients. Consequently, the arrival of an approach to workplace assessment in clinical radiology that emphasises written rather than verbal feedback may have created

something of a culture clash, in which a clerical model of feedback that has been previously applied in classroom-based learning contexts has been adopted and applied in a professional, clinical context. Furthermore, this may have been done with insufficient regard for the feasibility of providing effective written feedback in the busy clinical setting, along with insufficient conceptualisation of the type of learning that occurs in this context and the extent to which it might be effectively supported by episodic written feedback comments.