|Year : 2021 | Volume
| Issue : 1 | Page : 62-67
Dental students' perception towards feedback during clinical training
Jayashri Tamanna Nerali1, Vinayak Kalyan Chakravarthy Pishipati2, Lahari Ajay Telang3, Ajay Telang4
1 Department of General Dentistry, Penang International Dental College, Butterworth, Malaysia
2 Department of Conservative Dentistry and Endodontics, Penang International Dental College, Butterworth, Malaysia
3 Department of Oral Medicine and Radiology, Penang International Dental College, Butterworth, Malaysia
4 Department of Oral Pathology, Penang International Dental College, Butterworth, Malaysia
|Date of Submission||14-Aug-2020|
|Date of Decision||10-Jan-2020|
|Date of Acceptance||13-Jan-2021|
|Date of Web Publication||26-Jun-2021|
Dr. Jayashri Tamanna Nerali
Department of General Dentistry, Penang International Dental College, Level 18-21, NB Tower, 5050 Jalan Bagan Luar, 12000 Butterworth, Penang
Source of Support: None, Conflict of Interest: None
Background and Aim: Feedback is an essential element in the clinical training of dental students which paves way for the achievement of learning outcomes and also to improve their future performance. The aim of this study was to analyze dental students' perceptions of importance, process, and content of feedback received during their clinical training. Materials and Methods: A cross-sectional, questionnaire was developed and validated and distributed to dental students (n = 178) of years 3, 4, and 5. Descriptive analysis and one-way ANOVA were used to compare the mean scores between the three groups. Open-ended responses were analyzed qualitatively. Results: The majority of students agreed that feedback on clinical performance is needed to improve learning and identify areas for improvements. Most of the students prefer one-to-one feedback, in a timely and regular manner and immediately after the clinical session. Eighty-six percent believed that feedback should be given with mutual respect. Most of the students disagree (80%) that marks/grades are an important part of the feedback. Students preferred feedback with positive and negative comments about their clinical work (93%), which would help them to engage in the process of learning and to make an action plan for future learning process. Conclusions: Students are aware of the purpose and importance of feedback and preferred timely, structured, and constructive feedback on their clinical performance. The dental clinical environment is stimulating and dynamic and the role of faculty feedback is crucial for students to reflect on their learning and improve future performance.
Keywords: Clinical training, constructive, dental students, feedback
|How to cite this article:|
Nerali JT, Chakravarthy Pishipati VK, Telang LA, Telang A. Dental students' perception towards feedback during clinical training. Arch Med Health Sci 2021;9:62-7
|How to cite this URL:|
Nerali JT, Chakravarthy Pishipati VK, Telang LA, Telang A. Dental students' perception towards feedback during clinical training. Arch Med Health Sci [serial online] 2021 [cited 2021 Aug 1];9:62-7. Available from: https://www.amhsjournal.org/text.asp?2021/9/1/62/319383
| Introduction|| |
Clinical training in dentistry demands the transfer of knowledge and skills acquired by learners in the classroom and simulation laboratories into effective patient care in a supervised clinical environment. Dental students, though relatively inexperienced, are expected to carry out difficult yet irreversible procedures as part of supervised patient care. A high level of supervision and teacher–student interaction is thus imperative to ensure safe and effective dental practice by students. Essential to this clinical training is providing feedback on students' performance in a given activity that is intended in more than one way to guide and enhance their future performance in that same or a related activity. Feedback which reinforces good performance not only enables learners to achieve the course or program goals but also provides the basis for remediation when needed.
Providing and receiving feedback is important for both the clinical instructor and learner to ensure effective learning. Feedback sessions that are constructive and promote a two-way conversation entrust the learner with an important role in assessing one's own performance., Some of the factors known to diminish the effectiveness of feedback are decreased motivation and performance, induced shame or collision with basic psychological needs, and competence of the supervisor to provide feedback.,,,,
The role of a clinical instructor is challenging as it involves providing feedback and guidance to dental students as well as the encouragement to reflect on their learning and gaps in knowledge about clinical practice. So much so that little or inconsistent feedback may limit students' learning process.,
Studies done in medical education context report students to be persistently dissatisfied with the feedback they receive claiming it to be infrequent and ineffective. On the other hand, teachers themselves believe that they provide frequent and sufficient feedback.,, Feedback as a topic in dental education remains a less researched area suggesting a need to improve the feedback process in clinical training for the effective development of future professionals. In our undergraduate clinical training, the students receive both verbal and written feedback on their clinical performance. Hence, this study was designed to analyze dental students' perceptions of importance, process, and content of feedback received during their clinical training.
| Materials and Methods|| |
A cross-sectional study was conducted to evaluate dental student's perception of feedback during their clinical training. Ethical approval was obtained from the Internal Review Board of the Institution. All participants were provided with an information sheet outlining the purpose of the investigation and the role they would be expected to play and informed consent was obtained. A self-administered questionnaire was developed by reviewing the literature in the light of the stated objectives and purpose of the study, which was then validated by three content experts. Cronbach's alpha was used to measure the reliability of the questionnaire. The value of α was 0.74, which showed that the questionnaire has good reliability.
The self-administered questionnaire was distributed to a total of 178 dental students belonging to the clinical years 3, 4, and 5. The questionnaire consisted of demographic details such as gender and year of study and 16 closed-ended questions and 1 open-ended question. The closed-ended questions were based on a 5-point Likert's scale (1 = strongly disagree to 5 = strongly agree) grouped under three domains which were the importance of feedback (items 1–3), the process of feedback (items 4–10), and content of feedback (items 11–16). The open-ended question was regarding overall opinion on the feedback process.
Data obtained was analyzed using the software Statistical Package for the Social Sciences (SPSS for windows version 20) IBM Corp, Armonk, NY, USA. Negative items 10 and 14 were reverse coded for the purpose of the analysis. For ease of analysis, the 5-point Likert scale responses were combined into three: “agree” (strongly agree plus agree), “neutral,” and “disagree” (strongly disagree plus disagree). Descriptive analysis was done by calculating frequency, percentages, mean, and standard deviation. One-way ANOVA was used to compare the mean scores between the three groups and P < 0.05 was used to determine statistical significance. Responses for the open-ended question were analyzed qualitatively.
| Results|| |
A total of 178 students participated in this study (year 3 = 38, year 4 = 73, and year 5 = 67). [Table 1] presents the frequency, percentage, mean scores, and standard deviation (SD) of the participant's perception of “Importance of feedback.” Majority of students (≥97.4%) of all 3 years agreed that feedback about clinical performance is needed to improve learning/performance and identify areas for improvement. Students (≥82.2%) agreed to the statement that “feedback is a two-way process in which I and faculty are involved” with a statistically significant difference between the mean scores of the three groups (P < 0.05).
|Table 1: Frequency, percentage, mean scores, and standard deviation of the participant's perception of the importance of feedback|
Click here to view
[Table 2] presents the frequency, percentage, mean scores, and SD of the participants regarding “Process of Feedback” for items 4–10. Most of the students (≥81.5%) preferred one-to-one feedback. With regard to items 5, 6, and 7 which had questions related to the method of feedback, students of all 3-year groups preferred “combination of verbal and oral” instead of “written only” or “verbal only” feedback. Most students (≥86%) believed that “feedback should be with mutual respect.”
|Table 2: Frequency, percentage, mean scores, and standard deviation of the participant's perception of process of feedback|
Click here to view
For item 9 which states “Feedback should be given in a timely and regular manner,” more than 80% of participants agree to receive feedback immediately after the clinical session rather than weekly or at the end of the term. Year 3 and 4 students' response was neutral (47.4% and 47.9%, respectively) for the item 10 which states “I received feedback late and could not connect feedback with action,” whereas 49.2% of year 5 students disagreed. There was no statistically significant difference between students of years 3, 4, and 5 for all the items of “Process of feedback”.
[Table 3] presents the frequency, percentage, mean scores, and SD of the participants regarding “Content of feedback” for items 11–16. The majority of the students (≥93.2%) indicated that “feedback given by instructor should include positive and negative points about clinical performance”. Most of the students disagreed (≥ 80%) that “marks/grades are an important part of feedback”. More than 95% of students agreed that “feedback helps them to engage in the process of learning and making an action plan”. However, the students' response was neutral to the statement “feedback given by the instructor gives specific information about my performance.”
|Table 3: Frequency, percentage, mean scores, and standard deviation of the participant's perception of content of feedback|
Click here to view
For items 15 and 16, although more than 95% of the students across all 3 years reviewed the feedback given for their clinical performance yet, less than 28% jot down the verbal feedback in their notebooks for future reference. There was no statistically significant difference found between students of years 3, 4, and 5 for all the items of “Content of feedback.”
The open-ended question responses were analyzed by thematic analysis and the following three themes were identified: (1) constructive feedback, (2) attitude of a teacher, and (3) preferred method of feedback
- Constructive feedback: Most of the students had written that feedback should be constructive with positive comments of encouragement and also negative comments to improve the learning and future performance. Students also mentioned that feedback should be given clearly and with proper guidance to avoid confusion
Y4 – “I believe feedback, either positive or negative is very important to be given to students after clinical practice or assessment.” “Positive comments are important to allow students to know what they have done right”
Y3 – “Negative feedback should be given appropriately and in an appropriate manner”
Y5 – “I love to get constructive feedback which will help me improve my clinical work.”
- Attitude of a teacher: While giving feedback, the teacher's attitude is very vital and it effects the student's motivation and self-confidence.
Y3 – “Lecturers can be more patient while guiding students for better performance.” “Scolding is not going to help; it might lower the self-confidence”
Y4 – “Feedback should be given in a neutral tone”
Y5 – “Don't scold the student in the presence of the patient or give irritated facial expressions, because it would make the patient lose confidence in me and may not cooperate during the treatment course.”
- Preferred method of feedback: Students suggested different methods of feedback which they would like to receive during clinical learning to improve their knowledge and skills.
Y3 – “I would prefer handwritten feedback to look back again while studying or before performing a procedure on a patient”
Y4 – “” Sometimes it is better to discuss feedback in a designated room, so that I am not embarrassed and I prefer verbal feedback”
Y5 – “I think feedback can be given through WhatsApp or other media so that it can be well recorded and read more regularly.”
| Discussion|| |
Feedback involving student–faculty with one-to one effective communication is an essential part of clinical teaching and learning in dentistry. This helps in the refinement of psychomotor and diagnostic skills of students., Constructive feedback from the teacher gives the learner insight into his or her actions and their consequences. The current study has explored student's perception in three different domains of feedback: the importance of feedback, the process of feedback, and the content of the feedback.
Importance of feedback
The results of our study demonstrate that dental students recognized the importance of the feedback given about their clinical performance that enables them to identify areas of improvement. In the absence of feedback from teachers, students will have to rely on self-assessment to determine what has gone well and what needs improvement. Students in our study identify feedback as a two-way process in which both student and teacher are involved. Just as the role of a teacher is important in providing meaningful feedback, equally important is the role of the learner in expecting and seeking feedback. Feedback links a teacher to his/her role of teaching and assessing and also demonstrates his/her commitment to the learners. Learners should be encouraged to make efforts to elicit feedback by asking for verbal or written feedback. The hierarchical culture of medical education is known to promote a one-way flow of information from teacher to learner instead of a two-way conversation. As a result, the learner may view feedback as a negative experience in which performance would be criticized. Feedback sessions should be a two-way process in which the learner should be a partner in the feedback process who initiates and responds to questions rather than a one-way process in which he/she feels ridiculed.
Process of feedback
Students in our study preferred one-to-one feedback, which was also noticed in another study where students expressed that feedback to be given privately to help them to improve their clinical performance. Feedback delivered in groups in a manner associated with shame and embarrassment to the learner can make it more difficult for them to participate in feedback. One-to-one feedback may be associated with less tension when compared with group feedback.
Students in this study preferred a combination of verbal and written forms of feedback instead of only verbal or only written feedback. When delivered in different forms, feedback that is tailored to the needs and ability of the learner is considered effective. This method should be followed repeatedly and incorporated within the curriculum.
Data in our study suggest that students across the groups agreed that feedback should be with mutual respect for the learner and instructor. Working in a mutually respectful partnership is the key to enhance the effectiveness and outcome of constructive feedback., A positive learning environment with effective feedback can enhance teacher–learner relationship and in turn lead to beneficial changes in the learner's behavior while achieving expected learning outcomes.,
In the present study, students preferred feedback to be provided in a timely and regular manner, immediately at the end of the clinical session rather than at weekly or end of the term sessions. Similar results have been reported in other studies.,, Feedback is considered constructive for learning if it is delivered immediately and sensitive to different learning styles.
For the question “I received feedback late and could not connect feedback with action,” the responses from all the 3 years ranged between neutral and disagree, indicating some students would have felt that feedback received was too late to make any necessary corrections. If a behavior needs correction, the teacher should provide feedback as soon as possible after the encounter so that the learner has sufficient time to reflect and act. If feedback is not given until the very end of the experience, the learner will not have an opportunity to remediate the behavior during the clinical course/rotation.
Content of feedback
Feedback that addresses both strengths and mistakes evenhandedly is found to be beneficial by learners when given gently, supportively, caringly, and with concern for their situation. Students in our study indicated their preference of receiving both positive and negative comments about their clinical performance. Acknowledging and reinforcing exemplary behavior and supporting good practices motivate the learner to repeat them and prompt him/her to seek more feedback., Positive feedback on what they were doing correctly gives learners the confidence in their skills and creates a better learning environment. Learners have reported that constructive feedback was beneficial, especially when it focused on specific performance accompanied by reasons why the performance was incorrect or faulty.
Our students did not agree that marks/grades are an important part of feedback, which is similar to the study done by Alfehaid et al. In a study by Gerzina et al., teacher and student groups saw an important purpose in the evaluation of student competence in clinical sessions, but neither group agreed nor disagreed with the use of grade descriptors such as “pass” and “fail.”
Students in our study prefer feedback that gives specific information about their performance, comparative to an established range of standards. This is supported by another study by Alves De Lima in 2008 where students believed that feedback from the clinical instructor should enable them to compare their performance against set standards which, in turn, identify good practices as well as deficiencies. Good performances can go unrecognized and problems concerning clinical competence could go uncorrected for long periods in the absence of adequate feedback. Good feedback provides the learner with information on current performance so that they can make necessary changes to improve their future performance.
The concept of feedback process is not new. However, for the success of the process it is important for clinical instructors to internalize this concept to continuously improve the learners' clinical performance. This study only evaluated dental students' perception of feedback; however, further research is required to understand faculty or instructors' opinions to improve the feedback process and make it effective in the clinical environment. This process will require highlighting student perception, as well as identifying skills gaps on the side of the instructors and closing this loop with effective faculty development workshops to achieve an efficient feedback process.
| Conclusion|| |
Students are aware of the purpose and importance of feedback and they prefer timely, structured, and constructive feedback on their clinical performance. The dental clinical environment is stimulating, dynamic, and the role of faculty feedback is crucial for students to reflect on their learning and improve future performance.
The authors would like to thank Prof. Dr. Michael Botelho, Assoc. Prof. Dr. Raghunandanan Menon and Dr. Fawaz Siddiqui. A special thanks to the students of Penang International Dental College who participated in the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Fugill M. Teaching and learning in dental student clinical practice. Eur J Dent Educ 2005;9:131-6.
Anderson VR, Rich AM, Seymour GJ. Undergraduate dental education in New Zealand: 2007-2009 final-year student feedback on clinical learning environments. N Z Dent J 2011;107:85-90.
Ende J. Feedback in clinical medical education. JAMA 1983;250:777-81.
Hesketh EA, Laidlaw JM. Developing the teaching instinct, 1: Feedback. Med Teach 2002;24:245-8.
Cantillon P, Sargeant J. Giving feedback in clinical settings. BMJ 2008;337:a1961.
Krackov SK. Expanding the horizon for feedback. Med Teach 2011;33:873-4.
Engerer C, Berberat PO, Dinkel A, Rudolph B, Sattel H, Wuensch A. Specific feedback makes medical students better communicators. BMC Med Educ 2019;19:51.
Kluger AN, DeNisi A. The effects of feedback interventions on performance: A historical review, a meta-analysis, and a preliminary feedback intervention theory. Psychol Bull 1996;119:254-84.
Bynum WE. Filling the feedback gap: The unrecognized roles of shame and guilt in the feedback cycle. Med Educ 2015;49:644-7.
Ten Cate OT. Why receiving feedback collides with self determination. Adv Health Sci Educ Theory Pract 2013;18:845-9.
Junod Perron N, Nendaz M, Louis-Simonet M, Sommer J, Gut A, Baroffio A, et al
. Effectiveness of a training program in supervisors' ability to provide feedback on residents' communication skills. Adv Health Sci Educ Theory Pract 2013;18:901-15.
Mitchell JK, Gillies RA, Mackert R. Setting expectations about feedback in dental education. MedEdPORTAL 2017;13:10580.
Jothi N, Yusoff SB. Knowledge and perception of medical students on feedback. Educ Med J 2015;7:e44-55.
Ramani S, Krackov SK. Twelve tips for giving feedback effectively in the clinical environment. Med Teach 2012;34:787-91.
Jahangiri L, McAndrew M, Muzaffar A, Mucciolo TW. Characteristics of effective clinical teachers identified by dental students: A qualitative study. Eur J Dent Educ 2013;17:10-8.
Krackov SK. Giving feedback. In: Dent JA, Harden RM, editors. A Practical Guide for Medical Teachers. 4th
ed. London, United Kingdom: Churchill Livingstone Elsevier; 2013. p. 323-32.
Shrivastava SR, Shrivastava PS, Ramasamy J. Effective feedback: An indispensable tool for improvement in the quality of medical education. J Pedagog Dev 2014;4:12-20.
Schartel SA. Giving feedback-An integral part of education. Best Pract Res Clin Anaesthesiol 2012;26:77-87.
Henderson P, Ferguson-Smith AC, Johnson MH. Developing essential professional skills: A framework for teaching and learning about feedback. BMC Med Educ 2005;5:11.
Hewson MG, Little ML. Giving feedback in medical education: Verification of recommended techniques. J Gen Intern Med 1998;13:111-6.
Alhaqwi AI. Importance and process of feedback in undergraduate medical education in Saudi Arabia. Saudi J Kidney Dis Transpl 2012;23:1051-5. [Full text]
Glover PA. Feedback: “I listened, reflected, and utilized”. Third-year nursing students' perception and use of feedback in the clinical setting. Int J Nurs Pract 2000;6:247-52.
Fernando N, Cleland J, McKenzie H, Cassar K. Identifying the factors that determine feedback given to undergraduate medical students following formative mini-CEX assessments. Med Educ 2008;42:89-95.
Sweet J, Wilson J, Pugsley L. Chairside teaching and the perceptions of dental teachers in the UK. Br Dent J 2008;205:565-9.
Bing-You RG, Paterson J, Levine MA. Feedback falling on deaf ears: Residents' receptivity to feedback tempered by sender credibility. Med Teach 1997;19:40-4.
Alfehaid LS, Qotineh A, Alsuhebany N, Alharbi S, Almodaimegh H. The perceptions and attitudes of undergraduate healthcare sciences students of feedback: A qualitative study. Health Prof Educ 2018;4:186-97.
Gerzina TM, McLean T, Fairley J. Dental clinical teaching: Perceptions of students and teachers. J Dent Educ 2005;69:1377-84.
Alves de Lima AE. Constructive feedback. A strategy to enhance learning. Medicina (B Aires) 2008;68:88-92.
van de Ridder JM, Stokking KM, McGaghie WC, ten Cate OT. What is feedback in clinical education? Med Educ 2008;42:189-97.
[Table 1], [Table 2], [Table 3]