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 Table of Contents  
Year : 2021  |  Volume : 8  |  Issue : 2  |  Page : 70-74

Effectiveness of structured feedback after formative tests on first year MBBS students' performance in summative examination

Department of Biochemistry, SDM College of Medical Sciences & Hospital, Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India

Date of Submission20-Apr-2021
Date of Decision18-Oct-2021
Date of Acceptance31-Oct-2021
Date of Web Publication30-Dec-2021

Correspondence Address:
Dr. Vijayetha P Patil
Department of Biochemistry, SDM College of Medical Sciences & Hospital, Dharwad, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijamr.ijamr_90_21

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Background: Feedback gives an opportunity to students to analyze their work, performance, correct themselves and improves learning. The outcome also depends on the way it is delivered, and hence, we analyzed the effect of constructive feedback on students' performance and their perceptions. Objectives: The objective of this study is to evaluate the effect of a structured constructive feedback on the performance of low achieving students and to analyze their perceptions on feedback. Methodology: Students of the 1st year MBBS scoring <50% marks in Biochemistry test were included and divided into two groups randomly: Group A received feedback intervention and Group B was the control group. Structured constructive feedback based on Pendleton's rules was given to students in Group A after each formative assessment. Their logbook writing was also assessed. Performance score was compared between groups using student t-test. Students' perceptions on effect of feedback on their learning and performance were evaluated using a validated questionnaire. Results: We found significant improvement in the performance of Group A in the immediate assessment test following feedback (t = 2.09, P = 0.04), but subsequent tests did not show any difference between the groups. Logbook performance was better in Group A than Group B (t = 2.51, P = 0.02). Greater number of students in Group A passed the summative examinations as compared to Group B. Students reported good perceptions on the feedback sessions and wanted it frequently. Conclusions: Feedback helped the students to identify their areas of lacunae and measures to overcome them in their studies. Students who received feedback showed improved learning attitude. They were satisfied with the feedback sessions and valued it.

Keywords: Feedback, Pendleton's method, student perceptions on feedback, student performance

How to cite this article:
Patil VP, Patil VS. Effectiveness of structured feedback after formative tests on first year MBBS students' performance in summative examination. Int J Adv Med Health Res 2021;8:70-4

How to cite this URL:
Patil VP, Patil VS. Effectiveness of structured feedback after formative tests on first year MBBS students' performance in summative examination. Int J Adv Med Health Res [serial online] 2021 [cited 2023 Mar 25];8:70-4. Available from: https://www.ijamhrjournal.org/text.asp?2021/8/2/70/334372

  Introduction Top

Giving feedback is not only an essential part of medical education but it is also a responsibility that teachers often lack.[1] Cognitive theorists have shown that feedback assists learners to reconstruct their knowledge, change performance, and feel motivated enough for future learning.[2] Feedback gives an opportunity to the students to analyze their work and performance, correct themselves and improve learning outcomes in reaching a goal. On the teacher's part, it also conveys an attitude of concern for the progress and development of the person in a real sense. During formative assessments, the gap between desired performance and students' present state of knowledge, skill, or understanding can be recognized by the teacher and suggestions can be given on the action to be taken by learners to close that gap to achieve the desired outcome. Therefore, the best time to give feedback is during the regular formative assessments.[3] Further, feedback is more effective when given as soon as possible after performance and when it is considered as a process and not a onetime quick fix.[4]

The words we use, the amount of feedback to be given should be considered before we give feedback. It should be descriptive, nonjudgmental, specific, and directed toward the changes to be brought about in the person.[5] The extent of feedback should be limited to what can be absorbed by the student in that session.[6] The outcome of the feedback also depends on the way it is delivered. Sometimes, feedback given incorrectly can leave students feeling bruised, demoralized, embarrassed, and lacking in self-worth which will spoil student-teacher relationship and student will no longer want to receive feedback.

The most widely accepted model for giving feedback in medical education is the Pendleton's rules. We choose this method of feedback over the others since Pendleton's rules are structured in such a way that the positives are highlighted first, in order to create a safe environment and can be practiced well even by beginners and less experienced teachers.[2],[3],[7] It is very much required for the 1st year MBBS students who are new to this profession and still learning how to cope with its demands.

Hence, we took up this study to assess the usefulness of giving structured constructive feedback to low achieving students in Biochemistry with the following objectives:

  1. To evaluate the effect of a structured constructive feedback and follow-up on the performance of low achieving students
  2. To analyze the students' perceptions on the effect of structured constructive feedback
  3. To assess the quality of the structured feedback given by the teacher.

  Methodology Top

An educational interventional study was conducted in the Department of Biochemistry at SDM College of Medical Sciences & Hospital, Dharwad. Institutional ethical clearance was obtained. Informed consent was taken from the study group. First year undergraduate students scoring low marks (<50% in theory) in first formative assessment was included and divided into two groups randomly by arranging them alphabetically and assigning odd numbers to Group A and even numbers to Group B. Thirty students were included in the study.

Intervention for participants in Group A (n = 15) comprised of structured constructive feedback which was delivered individually by the same teacher to every student within a week after the test result and students were followed up till summative assessment [Figure 1]. The process of providing constructive feedback based on the Pendleton's method was followed as explained in [Figure 2].[8] Group B (comparison group, n = 15) did not receive structured constructive feedback. However, students in this group were given feedback following study completion.
Figure 1: Intervention for Group A

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Figure 2: Pendleton's method for giving constructive feedback

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Formative assessments were done after each topic was taught in the form of written tests, first internal assessment (IA) performance was noted at the end of first term and final summative assessment at the end of 1st year MBBS. Students were also asked to maintain a logbook to write down the clinical concepts in Biochemistry after each topic. The inputs from students and marks scored were noted down.

Performance score was compared between the groups and with their previous formative assessment performance using student 't'-test in Statistical Package for Social Sciences (SPSS) version 20 (IBM Corporation, New York, USA). Logbooks were assessed and given a score based on the content and clarity. Reasons for not performing well were noted during in-depth interview and analyzed by coding and narrative analysis. Students' perceptions on effect of feedback on their learning and performance were evaluated using a validated questionnaire [Table 1].[9] The quality of feedback given by the teacher was evaluated using a peer reviewed questionnaire. Items on the questionnaire assessed the conduct of the feedback session according to the Pendleton's rules [Table 2].
Table 1: Questionnaire to evaluate students' perceptions on the structured constructive feedback sessions[9]

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Table 2: Questionnaire to evaluate the quality of the feedback given

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  Results Top

Comparison of Group A and Group B with respect to performance scores in formative assessments and first IA is shown in [Table 3]. We found significant improvement in the performance of Group A in the second formative assessment but later tests and IA marks did not show any difference between the groups. Logbook assessment by independent t-test showed that Group A performed better than Group B. Logbooks were scored for 20 marks. The mean score of Group A was 16.0 (Standard deviation [SD] = 4.7) and that of Group B was 12.0 (SD = 4.2); this difference was statistically significant (t = 2.51, P = 0.02). We also compared the long-term outcome of the students in summative assessments. The number of students who passed the final Biochemistry exams in Group A (11 students, 69%) was more than in group B (7 students, 46%) though the difference was not statistically significant (χ2 = 2.22, P = 0.14). In both the groups, 1 student each was detained from writing the final exam as they did not attain the specified competencies.
Table 3: Comparison of Group A and Group B with respect to performance scores (percentage) in formative tests by independent t-test

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The output of in-depth interview of the students during feedback sessions was analyzed and coded [Table 4]. Predominant reasons expressed for not performing well were lack of time, distractions due to mobile phones and social media, lack of concentration, being introverted personality, difficulty in adjusting to the new environment, and a lack of focused study plan. Perceptions of the students on the feedback sessions showed an average score of 4.5/5 on Likert scale for the following items
Table 4: Narrative analysis of participant statements on barriers to effective learning and performance based on codes/themes

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  • Students need feedback and preferably soon after their tests
  • It makes them feel they are cared and encourages them
  • It makes them aware of their strengths and weakness and motivates to study
  • It helps them plan their study. In open ended question, 85% students expressed that they want feedback and preferably soon after every test. Quality of the feedback given by the teacher showed an average score of 4.7/5 on Likert scale.

  Discussion Top

Feedback sessions provided the students with an opportunity to create awareness and collect sufficient information on the lacunae they had and ways to improve them. Even though the scores in initial formative assessments were comparable to the control group, these sessions helped them to change their attitude towards learning which was evident in writing the logbooks well and the good performance in summative exams. Similar results were observed in a study done by Weston-Green et al.[10] but in a larger group. A study done by Fisher et al.[11] also supports this finding.

These sessions also helped the teacher to analyze the gap in knowledge and the probable reasons for their lower performance. The in-depth interview of students during feedback sessions showed that there were some common problems faced by them which they thought were the barriers to effective learning during the course of their study. We used grounded theory analysis for interpreting the students' perspectives and to code them into various themes. This in-depth interaction with students helped us to understand their behaviors, get an understanding of the barriers to attain their goal in studies, and to plan effective action for each student.

One of the common problems encountered by 1st year MBBS students is that they are in the transition period from preuniversity to university professional education system. Consequently, they were more concerned about securing higher marks than acquisition and application of knowledge. This problem was addressed in the feedback session and the students were advised to follow different study methods to suit their learning. Students also faced adjustment problems to the new course and place and difficulty in preparing a schedule for their study. Similar issues have been noted by prior investigators.[12] The teacher helped them to plan the schedule.

Distraction in studies due to the use of social media and mobile phones was reported by more than 80% of the students. There was very little time for self-reading. Many students said that they were able to understand the subject in lectures and discussions but did not have time to go back and read it. Few students said they found it difficult to concentrate in the class and listen to the lectures. After the feedback session, the teacher could analyze that some of them were predominantly visual and some kinesthetic learners. Hence, they were advised appropriately to use  Atlas More Details and videos of the subject while studying. Some of them were very shy and did not want to discuss their problems. The teacher respected their views but kept a watch on them and guided whenever they wanted help. This in-depth interview that happened during the feedback sessions appeared to help students realize the lacunae in their learning and teachers to discuss and create different action plan of improvement for different students. Many students opened up about their problems in detail and sought measures to overcome them. They felt motivated and wanted feedback sessions after every formative assessment. As students gained feedback information, they were better able to adapt their goals, which benefited their study in the long run. It also helped them to answer the theory paper well and face viva voce confidently. A similar beneficial effect of detailed feedback on improvement of student performance has been noted by Aggarwal and colleagues.[13]

Analysis of students' perception on feedback session clearly showed that they wanted more of such sessions. Feedback was more meaningful as it was given immediately within a week after the assessments. Students could identify the gap and get insight into their actual performance and what is expected of them. Feedback also helped build rapport with the teacher and reduced anxiety and insecurity about their performance. It enhanced organized, self-regulated learning, and also benefitted in many ways. This finding is also supported in other studies.[14]

Overall, students appeared to be satisfied with the quality of feedback given and valued it. The content of feedback was appropriate. The students felt that the feedback was conducted according to how it was planned. It was interactive, highlighted the positives in the students and concluded with a plan of action to improve weaknesses.

Challenges faced

Time management was challenging. Since each student would come to meet the teacher only after the class hours and feedback had to be given immediately after the tests, arranging feedback sessions for all the students was time consuming yet fruitful. Few students were not open to discussing about their issues. It took some time to make them feel comfortable and appreciate that these feedback sessions were meant for their improvement.

Future directions

Feedback-seeking behavior needs to be emphasized in students. There is a need for giving constructive feedback to all the students which needs proper planning and time management. This should be included as a part of regular teaching learning activities. Results derived from this study will help the medical education unit to emphasize the role of providing feedback and incorporate/modify the methods for providing effective feedback. A single session of feedback is not very effective; this has to be considered as a continuous process to improve long term outcomes. Since there is a need to give feedback to all the students, there is also a need to train the faculty to improve their knowledge and skill in terms of giving effective feedback.

  Conclusion Top

Formative assessment carried out along with immediate feedback helps students to identify their areas of lacunae and measures to overcome them in future to improve performance. Students who received structured, constructive feedback showed improved learning attitude and also performed well in the long-term summative assessment.


The study did not receive any financial aid. The authors would like to thank Principal Dr. S.K. Joshi, Dr.Deepak R. Kanbur, Professor of Pathology for their support.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Haffling AC, Beckman A, Edgren G. Structured feedback to undergraduate medical students: 3 years' experience of an assessment tool. Med Teach 2011;33:e349-57.  Back to cited text no. 1
Cantillon P, Sargeant J. Giving feedback in clinical settings. BMJ 2008;337:a1961.  Back to cited text no. 2
Chowdhury R, Kalu G. Learning to give feedback in medical education. Obstet Gynaecol 2004;6:243-7.  Back to cited text no. 3
Brinko KT. The practice of giving feedback to improve teaching: What is effective? J High Educ 1993;64:574-93.  Back to cited text no. 4
Burr SA, Brodier E, Wilkinson S. Delivery and use of individualized feedback in large class medical teaching. BMC Med Educ 2013;13:63.  Back to cited text no. 5
Khanam KA, Afroza S. Views of teachers, intern doctors and students regarding feedback on formative assessment during MBBS course in Bangladesh. Bangladesh J Med Educ 2016;7:2-8.  Back to cited text no. 6
Pendleton D, Schofield T, Tate P, Havelock P. The Consultation: An Approach to Learning and Teaching. Oxford: Oxford University Press; 1984.  Back to cited text no. 7
Dent JA, Harden RM. A Practical Guide for Medical Teachers. 4th ed. London ; New York: Elsevier Churchill Livingstone; 2013.  Back to cited text no. 8
Rowe AD, Wood LN. Student perceptions and preferences for feedback. Asian Soc Sci 2008;4:78-88.  Back to cited text no. 9
Weston-Green K, Wallace M. A method of providing engaging formative feedback to large cohort first-year physiology and anatomy students. Adv Physiol Educ 2016;40:393-7.  Back to cited text no. 10
Fisher R, Cavanagh J, Bowles A. Assisting transition to university: Using assessment as a formative learning tool. Assess Eval High Educ 2011;36:225-37.  Back to cited text no. 11
Almoallim H, Aldahlawi S, Alqahtani E, Alqurashi S, Munshi A. Difficulties facing first-year medical students at Umm Alqura University in Saudi Arabia. East Mediterr Health J 2012;16:1272-7.  Back to cited text no. 12
Aggarwal M, Singh S, Sharma A, Singh P, Bansal P. Impact of structured verbal feedback module in medical education: A questionnaire- and test score-based analysis. Int J Appl Basic Med Res 2016;6:220-5.  Back to cited text no. 13
Day IN, van Blankenstein FM, Westenberg M, Admiraal W. A review of the characteristics of intermediate assessment and their relationship with student grades. Assess Eval High Educ 2018;43:908-29.  Back to cited text no. 14


  [Figure 1], [Figure 2]

  [Table 1], [Table 2], [Table 3], [Table 4]


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