Understanding students' feedback use in medical progress testing: A qualitative interview study

How do medical students make sense of internal and external feedback to enhance their Dutch communication skills?

BACKGROUND

Feedback is crucial in medical education for developing communication skills and fostering comprehensive learning. Despite its importance, medical students often face challenges in effectively leveraging feedback. This study investigates how students perceive and make sense of internal and external feedback in a 2nd language (L2) medical Dutch course.

METHODS

Sixteen third-year international medical students (mean age = 23) participated in a medical Dutch course that included six structured sessions. Each session encompassed a briefing, simulated patient consultations (SPCs), and a debriefing. The curriculum integrated internal feedback from self-reflections and external feedback from peers, teachers, and simulated patients. Data were gathered through a students' feedback perception survey and semi-structured interviews and analyzed via inductive thematic analysis.

RESULTS

Survey data indicated a trend where the preference, satisfaction, and trust in external feedback were higher than those for internal feedback. However, both types of feedback were regarded as equally effective in facilitating learning progress. Through thematic analysis, we identified five crucial themes that show how students perceive and make sense of various forms of feedback: proactive engagement with feedback, critically analyzing and utilizing the exchange in dialogues and discussions, self-reflection and progress tracking, value from diverse perspectives, and moment-specific and actionable feedback.

CONCLUSIONS

This study emphasizes the vital roles of internal and external feedback in enhancing medical Dutch communication skills among medical students. Internal feedback encourages self-reflection and growth, essential for complex medical communications, while external feedback provides clear, specific and supportive guidance and experience from teachers, simulated patients and peers. These feedback mechanisms together improve students' skills in medical Dutch communication, leading to better doctor-patient interactions. Future research should focus on adapting these feedback strategies across diverse educational settings to further support the development of medical L2 communication skills in global medical contexts.

Does 'summative' count? The influence of the awarding of study credits on feedback use and test-taking motivation in medical progress testing

Despite the increasing implementation of formative assessment in medical education, its' effect on learning behaviour remains questionable. This effect may depend on how students value formative, and summative assessments differently. Informed by Expectancy Value Theory, we compared test preparation, feedback use, and test-taking motivation of medical students who either took a purely formative progress test (formative PT-group) or a progress test that yielded study credits (summative PT-group). In a mixed-methods study design, we triangulated quantitative questionnaire data (n = 264), logging data of an online PT feedback system (n = 618), and qualitative interview data (n = 21) to compare feedback use, and test-taking motivation between the formative PT-group (n = 316), and the summative PT-group (n = 302). Self-reported, and actual feedback consultation was higher in the summative PT-group. Test preparation, and active feedback use were relatively low and similar in both groups. Both quantitative, and qualitative results showed that the motivation to prepare and consult feedback relates to how students value the assessment. In the interview data, a link could be made with goal orientation theory, as performance-oriented students perceived the formative PT as not important due to the lack of study credits. This led to low test-taking effort, and feedback consultation after the formative PT. In contrast, learning-oriented students valued the formative PT, and used it for self-study or self-assessment to gain feedback. Our results indicate that most students are less motivated to put effort in the test, and use feedback when there are no direct consequences. A supportive assessment environment that emphasizes recognition of the value of formative testing is required to motivate students to use feedback for learning.