Feedback: much more than a tool Ste ´phane Voyer & Daniel D Pratt Although its form and content can vary substantially, learners and educators at all stages of medical education rely on feedback as an assessment of competence and as a guide to further learning. Two articles in this issue illustrate these two foci: one focuses on feedback in relation to setting goals for further learning, 1 and the other subsumes feedback under the larger umbrella of assessment. 2 Both articles present important findings. As such, there is much to commend in each of them. At the same time, each provides an opportunity to look more deeply at some conceptual confusion about feedback that is common in medical education. Chang et al. 1 investigated the ability of medical students to write self- directed learning goals in response to feedback received on clinical performance examinations. Feed- back was received in four different formats: firstly, as numerical scores on students’ performance of history taking, physical examina- tion, and communication of their assessment and plan with standardised patients (SPs); secondly, as numerical scores indicating how well students had performed relative to their peers on data gathering and communication skills; thirdly, as written comments from SPs about students’ communication skills, and, fourthly, as video-recordings of a student’s three most challenging encounters. These encounters were self-selected and independently watched; no verbal feedback was given. Learners rely on feedback as an assessment of competence and as a guide to further learning Archer and McAvoy 2 investigated three questions relating to the use of feedback: can multi-source feedback and patient feedback reliably iden- tify poorly performing doctors? What factors might confound these feedback scores? Do self- (practi- tioner-) nominated reviewers give more favourable reviews than employer-nominated reviewers? In testing these questions, the authors used two well-known instruments that yield numerical ratings and free-text commentary by peers and patients. Feedback, therefore, was delivered in the form of numerical data and free text generated for the purposes of making high-stakes decisions. Both articles represent good research in medical education in that they ask important questions and employ rigorous designs to address those questions. At the same time, they represent concep- tions of feedback and attributions of effect that are problematic in at least three ways: 1 the language and forms of data we use in relation to feedback have become conflated and often confuse judgements about per- formance with guidance for fur- ther learning; 2 feedback is too often portrayed as the unidirectional transmis- sion of information from one person to another, in a manner that ignores the social and nor- mative contexts in which it oc- curs, and 3 we neglect the role of identity in the provision of feedback about competency. Although Chang et al. 1 observed a remarkable capacity in students to generate specific learning goals, many low performers, particularly those who performed poorly in communication skills, were unable to formulate learning goals corre- sponding to the areas of deficiency identified in their performance feedback. The authors accounted for the inability of poor performers to formulate appropriate learning goals by citing a number of popular explanations, including lack of insight, lack of motivation (e.g. to invest the resources necessary to improve in a skill as complex as communication), and excessive focus on performance goals. 1 The forms of data we use in feedback often confuse judgements about performance with guidance for further learning Feedback, when used optimally for educational purposes, offers both assessment of performance and guidance M E D U 4 0 6 6 B Dispatch: 28.6.11 Journal: MEDU CE: K. Karthik Journal Name Manuscript No. Author Received: No. of pages: 3 PE: Sharmeela commentary Vancouver, British Columbia, Canada 3 Correspondence: Ste ´phane Voyer, Centre for Health Education Scholarship (CHES), Jim Pattison Pavilion North, Suite 3300, 910 West 10th Avenue, Vancouver, British Columbia XXX XXX 1 , Canada. Tel: 00 1 604 875 4111; Fax: 00 1 604 874 8221; E-mail: stephane.voyer@mail.mcgill.ca 2 doi: 10.1111/j.1365-2923.2011.04066.x ª Blackwell Publishing Ltd 2011. MEDICAL EDUCATION 2011 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55