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Cover page of the Journal of Health Sciences

 Table of Contents  
Year : 2019  |  Volume : 12  |  Issue : 3  |  Page : 268-269

Emphasizing the critical role of feedback in competency-based medical education

Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Date of Web Publication15-Oct-2019

Correspondence Address:
V Dinesh Kumar
Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/kleuhsj.kleuhsj_157_19

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How to cite this article:
Kumar V D, Rajasekhar S S. Emphasizing the critical role of feedback in competency-based medical education. Indian J Health Sci Biomed Res 2019;12:268-9

How to cite this URL:
Kumar V D, Rajasekhar S S. Emphasizing the critical role of feedback in competency-based medical education. Indian J Health Sci Biomed Res [serial online] 2019 [cited 2022 Aug 13];12:268-9. Available from: https://www.ijournalhs.org/text.asp?2019/12/3/268/269195

Dear Editor,

A paradigm shift of competency-based medical education (CBME) and the ripples caused by it in the Indian medical academia has made us view some of our conventional assumptions using a different perspective. The conceived intent was to move from content-focused approach to the outcome-focused approach and adoption of criterion-referenced assessment tools.[1] The efficacy of criterion-referenced assessment tools hugely depends on effective feedback provided to the learners. On critical review, we observed that, in most of our academic settings, the feedback occurs “on the run” with no structured scheduling or a theoretical basis. In a setting of CBME, we can consider the feedback under two categories: cognitive and behavioral. We usually provide the cognitive feedback [2] in the skill assessment exercises where it compares an actual performance of the students with the intended levels resulting in the address of the perceived performance gap. We provide the behavioral feedback [3] for the attitudinal competencies to make them achieve the desirable levels.

How the CBME-based feedback differs from the existing method? Let us consider students who are undergoing summative assessments at the end of each professional year. We judge them regarding the capability to pass to the next professional year or not. In this context, meaningful conversational feedback regarding their strengths and weaknesses seldom takes place. The competency-based assessment is based on the feedback calls for supporting the strengths and identifying the weaknesses of the students and devising a remedial action plan. Tekian et al.[4] postulated that the CBME feedback should incorporate both qualitative components that would help in addressing the intricate emotional aspects and quantitative components for keeping track of students' performance. Factors such as the level of motivation expressed by the learner, trust showed by the teacher, emotional transaction, and the context in which we give the feedback will determine the degree to which the students will internalize the feedback. The teacher should differentiate between the validation and toxic positivity, while giving the feedback. The process of validation makes the student understand the reality about his/her performance and leaves with hope about future performances. Toxic positivity might lead to overconfidence which would rather inhibit further improvisation in the learning process.

An effective feedback session should encompass three components: (a) feed up (what are the objectives), (b) feedback (level of accomplishment of objectives), and (c) feed forward (what could be done further).[5] The taxonomy of competency-based feedback includes reflecting on the specific task performance, analyzing the knowledge process required for performing the task, emphasizing on the self-regulatory (cognitive, metacognitive, and motivational) factors needed for the performance, and few constructive comments regarding the personal/emotional factors of the individual student.[5] An effective feedback should culminate in the formulation of a concrete and individualized action plans that will help the student in implementing the constructive changes in the subsequent sessions. To fortify the continuity in provider–receiver relationship, it is also important to consider the levels of autonomy of students as well and titrate the structure of feedback.

We should also mind the barriers existing in our academic setting. Further, cultural factors, particularly the imbalanced power relations existing between the provider and the receiver, influence the degree of bilateral dialogic interaction in the feedback process. If the provider is too skeptic, students might move to zones of discomfort and would lose their self-esteem. An offended learner might try to cover up his/her weakness and remain “silent” while receiving the feedback.[6] The faculty should also try to circumvent common biases arising out of prejudice [7] such as halo effect (a positive impression on the student resulting in a biased judgment of their academic performance), horn effect (a negative impression biasing the judgment), and similar-to-me effect (the observer's way of performance resulting in a bias of judgment). Unfortunately, the lack of awareness regarding these issues results in making the process of feedback a monologue that often provides no scope to understand the learner's perspectives. To solve these, faculty development programs should include the nuanced feedback techniques that include multiple approaches such as providing a framework for starting meaningful conversations, ways for harnessing the self-reflection abilities among the students based on their personality traits, and observation of the taped encounters.[8] Faculty development program should help the faculty move out from the state of providing “generalized positive feedback to all” to a state of “using multiple techniques of feedback delivery.”

To conclude, we can consider a structured feedback as a powerful tool for shaping the learning process in CBME where the learners encounter multiple preceptors. On realizing the drawbacks of existing practices and adequately structuring it, we can fortify the feedback process. In addition, being cautious of the above barriers would help in enhancing its benefits. An effective feedback should always help students to appraise their lifelong learning process and make them improve after subsequent encounters.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Carraccio C, Wolfsthal SD, Englander R, Ferentz K, Martin C. Shifting paradigms: From flexner to competencies. Acad Med 2002;77:361-7.  Back to cited text no. 1
Kluger AN, De Nisi A. The effects of feedback intervention on performance: A historical review, a meta-analysis, and a preliminary feedback intervention theory. Psychol Bull 1996;119:254-84. Available from: http://citeseerx.ist.psu.edu/viewdoc/summary?doi= [Last accessed on 2019 Jun 25].  Back to cited text no. 2
Ashford SJ, Blatt R, Van de Walle D. Reflections on the looking glass: A review of research on feedback-seeking behaviour in organisations. J Manage Dev 2003;29:773-99. Available from: http://citeseerx.ist.psu.edu/viewdoc/download?doi= and rep=rep1 and type=pdf. [Last accessed on 2019 Jun 25].  Back to cited text no. 3
Tekian A, Watling CJ, Roberts TE, Steinert Y, Norcini J. Qualitative and quantitative feedback in the context of competency-based education. Med Teach 2017;39:1245-9.  Back to cited text no. 4
Hattie J, Timperley H. The power of feedback. Rev Educ Res 2007;77:81-112.  Back to cited text no. 5
Greer AG, Pokorny M, Clay MC, Brown S, Steele LL. Learner-centered characteristics of nurse educators. Int J Nurs Educ Scholarsh 2010;7: Article6. doi: 10.2202/1548-923X.1710.  Back to cited text no. 6
MacDougall M, Riley SC, Cameron HS, McKinstry B. Halos and horns in the assessment of undergraduate medical students: A consistency-based approach. J Appl Quant Methods 2008;3:116-28. Available from: http://jaqm.ro/issues/volume-3, issue-2/pdfs/macdougall_riley_cameron_mckinstry.pdf. [Last accessed on 2019 Jun 25].  Back to cited text no. 7
Cole KA, Barker LR, Kolodner K, Williamson P, Wright SM, Kern DE. Faculty development in teaching skills: An intensive longitudinal model. Acad Med 2004;79:469-80.  Back to cited text no. 8


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