Of the 94 participants, 89/94 (95%) completed the questionnaire. The responses are displayed in Figure 1. The main findings were that 80% of respondents reported feeling confident to make a judgement on a peer’s performance and 82% of respondents felt that they possessed adequate skills to deliver feedback. However, a significant number of respondents (42%) didn’t feel confident in providing negative feedback to their peers. Surprisingly 71% of respondents indicated that they did not need further training. However, most respondents (90%) found giving feedback to be a useful learning activity. These findings were unpacked to provide a richer understanding through the qualitative data.
Qualitative data consisted of open ended question responses (to which there was a response rate of 89/94, 95%), and a total of six focus groups, in which 41% (39/94) of students participated over the two year period. The qualitative findings contextualised the questionnaire results.
Analysis revealed three main themes. First, social discomfort in providing feedback to peers, including concerns regarding the accuracy of feedback, and the adequacy of their training. Second, the opportunity for self-reflection of clinical knowledge and skills, and third, the development of professionalism attributes including a sense of responsibility to assist their peers.
The most challenging aspect for students was being expected to provide negative feedback to their peers, with 33/89 (37%) of students commenting that they found it difficult to deliver negative feedback. They remarked that they found it “awkward” and “uncomfortable” and feared being overcritical.
I felt like I was being cruel, like how would I know better than them. I found it awkward (giving feedback) but making the judgement helped me learn a lot. S10
The social discomfort for students in giving feedback in our study resonated with the findings of Cassidy (2006) [7]. However, students noted that having a positive critique method [12] to follow was helpful to them.
“..if you frame it in a constructive way rather than just being critical, then it is always going to be okay.…you always ask them to reflect first and you go through the positives, and then after they have reflected, you can give your view as well. I think that’s a good way to do it… the way which it’s given is probably the most important thing.” S12
Students also had concerns regarding the accuracy of their feedback and felt discomfort with the responsibility they associated with their judgements. Seventeen percent (15/89) of respondents said that they did not feel competent enough to make a judgement on their peer’s performance, and could not be sure that the feedback they were giving was correct.
I feel like I’m not qualified to give feedback. S9
As noted by Cassidy (2006), a small but significant minority of students had concerns about the adequacy of the training provided [7]. Thirteen percent (12/89) of respondents commented that they were “unsure how to be constructive” in their feedback and felt that they needed “more training” (S15). Students also emphasised that they wouldn’t feel comfortable giving feedback if the academic co-examiner were not beside them. This appeared to suggest that students would be reticent to give feedback if it were not within a structured learning situation such as the formative clinical assessment.
A significant number of students [57% (51/89)], found that having to make a judgement and provide feedback, which necessitated defining and articulating others’ strengths and weaknesses, made them reflect and critically evaluate their own knowledge, skills, and how they would have presented the same case.
So I learnt, from articulating the things that they did or didn’t do very well or missed out, I learnt just as much from that as they did. S31
Students found that it helped them to understand the priorities of presenting, and also identified weaknesses in their own knowledge.
You compare that to yourself …and well, I wouldn’t have done that much better, so I really need to practice in this area. S2
Seventeen percent (15/89) of students placed value on the professional experience and practice they gained from giving feedback to their peers, stating that it is a “core skill” that “must be learnt”.
It just gives you some exposure to how you should be doing it, like do you think you did well, what do you think you could do better… I think it’s good to have for the future. S17