Creating an Effective Feedback Environment to Enhance Students’ Field Experiences

by Clare Olin, PharmD, PGY1 Pharmacy Practice Resident, University of Mississippi Medical Center

Many students in higher education learn through field experiences, like internships or clinical “rotations.” During these experiences, an assigned preceptor helps the student to gain “on the job” experience to better understand their chosen profession. Experimental education is important because it provides students with an opportunity to use skills they initially learning about during didactic instruction. The preceptor reinforces the knowledge the student initially gained in the classroom.  Students also receive feedback from the preceptor who evaluates their performance.  Ultimately, these experiences and the feedback from their preceptors prepare them for their career. 

Feedback given by preceptors is meaningful in guiding a student’s growth. It’s important to create what Steelman and colleagues an effective “feedback environment.”¹ This is how feedback is delivered in both words and actions. Learners are more likely to accept and act on feedback when it is given well. There are seven variables that contribute to the feedback environment and influence whether the recipient will perceive the feedback as useful:¹

• Source credibility
• Feedback quality
• Feedback delivery
• Frequency of favorable feedback
• Frequency of unfavorable feedback
• Source availability  

Source credibility refers to how students perceive their preceptors. Students are more likely to acknowledge and implement the comments provided by people they highly respect.  Thus, a preceptor should be, first and foremost, a good professional role model.  Feedback is considered high quality when it is consistent, relevant, specific, and useful to the learner. Feedback delivery refers to both verbal and non-verbal communication. The reception of both positive and negative comments can be influenced by the tone, volume, word inflection, eye contact, and even body language of the deliverer. The frequency of favorable feedback can influence a student’s behavior and keep them motivated. Thus, positive reinforcement techniques can help engage students throughout their practice experiences and build positive attitudes and relationships. Positive feedback also builds students confidence and helps them develop independence. The frequency of unfavorable feedback is also important.  Constructive feedback is intended to help students improve and, when delivered effectively, can also keep students motivated. When unfavorable feedback is given, it is more likely to be taken positively if preceptors describe specific ways that the students’ performance can improve. Source availability refers to the how accessible the preceptor is – both physically and psychologically. Students are more likely to approach an accessible preceptor with questions and concerns. This can then help build a relationship between the two, and in turn, it may allow the feedback received to be more meaningful. While these seven principles were determined by observing employee relationships with their direct supervisors, the concepts are equally applicable to clinical instruction. In clinical teaching environments, students are preparing for a job and feedback strategies should be similar.² 

One study looked at the feedback strategies of preceptors in relation to student’s perceived feedback value.³ Students (n=132) from multiple states and with a variety of clinical experiences were asked to complete a survey. The survey consisted of three sections: demographic data, feedback environment scale (FES), and the feedback orientation scale (FOS).  The students were asked to rank statements about FES and FOS using a 5-point scale.  The FES section of the survey examined the following aspects of the environment:

• Source credibility
• Feedback quality
• Feedback delivery
• Favorable feedback
• Unfavorable feedback
• Source availability
• Promotes feedback-seeking behaviors

The FES represented how well students respond to the feedback “environment” that the preceptor created. The FOS included the student’s self-reflection on how they best use feedback and included:

• Utility
• Accountability
• Social awareness
• Feedback self-efficacy

The results demonstrated a significant positive correlation between the FOS and FES scores (p = 0.01), meaning that as the student’s perception of the feedback environment improved so did the perceived usefulness of the feedback given. When focusing on each element of the feedback environment, feedback utility was most affected by feedback quality and delivery. There was a significant relationship between accountability and the frequency of favorable feedback (p = 0.05), suggesting that consistency of feedback promotes the application of the preceptor’s assessments to the student’s daily work. Although utility, social awareness, and self-efficacy did not achieve statistical significance, there were positive relationships between each and the FES scores.

In order to implement these principles in practice, preceptors should start by being accessible and available to students. This should include providing phone number(s), email address, and reliable office hours or meeting times.  In addition, it is important to create a psychologically safe environment so that students feel comfortable reaching out. Regularly scheduled times for feedback can help the preceptor and the student stay on track. Preceptors should plan what to say in advance of these meetings and be prepared to give specific examples of both positive and negative observations.⁴ Preceptors should also encourage students to engage in self-reflection by using open-ended questions.  Finally, preceptors should give feedback promptly after a practice experience while the student can recall specific details.⁴

Keeping the seven dimensions of an effective feedback environment in mind can help new preceptors create positive field experiences. Constructive feedback should be specific and provide actionable strategies the student can use to improve their performance. Positive reinforcement should be given whenever a student has shown improvement. Effective feedback enhances students’ confidence and will enhance their ability to their professional responsibilities in the future.

References

1. Steelman LA, Levy PE, Snell AF. The feedback environment scale: construct definition, measurement, and validation. Educ Psychol Meas. 2004;64(1):165-184. doi:10.1177/0013164403258440.
2. Jonsson A. Facilitating productive use of feedback in higher education. Active Learn High Educ. 2013;14(1):63-76. doi:10.1177/1469787412467125.
3. Nolan T, Loubier C. Relating Instructor Feedback and Student Reception in the Clinical Environment. Radiol Technol. 2018 Jan;89(3):238-256.
4. Hardavella G, Aamli-Gaagnat A, Saad N, et al. How to give and receive feedback effectively. Breathe 2017; 13: 327–333.