582 Journal of Dental Education ■ Volume 81, Number 5 Types of Feedback in Competency-Based Predoctoral Orthodontics: Effects on Students’ Attitudes and Confidence Mitchell J. Lipp, DDS; Kiyoung Cho, BS; Han Suk Kim, DDS Abstract: Feedback can exert a powerful inluence on learning and achievement although its effect varies. The aim of this study was to investigate the effects of three types of feedback on dental students’ attitudes and conidence in a competency-based course in predoctoral orthodontics at New York University College of Dentistry. In 2013-14, all 253 third-year students in a course using test-enhanced instructional methods received written feedback on formative assessments. The type of feedback varied across three groups: pass/fail grades (PF) N=77, emoticons (EM) N=90, or written comments (WC) N=86. At the end of the course, students completed surveys that included four statements addressing their attitudes toward course instruction and conidence in their abilities. The survey response rate ranged from 75% to 100% among groups. The lowest response rate (75%) was in the PF group. In attitudes toward course instruction and conidence in their abilities, the WC group trended to more posi- tive responses than the other groups, while the PF group trended to negative responses. On two of the four statements, the trend for the WC group was signiicant (95% CI). In both statements concerning attitudes toward instruction, the PF group trended to negative responses that were signiicant (95% CI). These results support the effectiveness of descriptive written comments over pass/fail grades or emoticons in improving dental students’ conidence in their abilities and their attitudes toward instruction. Dr. Lipp is Clinical Associate Professor and Director of Predoctoral Orthodontics, Department of Orthodontics, New York Uni- versity College of Dentistry; Mr. Cho is a second-year dental student, New York University College of Dentistry; and Dr. Kim was a dental student, New York University College of Dentistry at the time of the study and graduated in 2016. Direct correspon- dence to Dr. Mitchell Lipp, Department of Orthodontics, New York University College of Dentistry, 345 East 24th Street, New York, NY 10010; 212-998-9512; mitchell.lipp@nyu.edu. Keywords: dental education, assessment, educational measurement, teaching feedback, competency based education, attitude, orthodontics Submitted for publication 8/18/16; accepted 11/23/16 doi: 10.21815/JDE.016.021 T his study continues an investigation in which evidence-based methods of assessment and instruction reported in the education and psy- chology literature are applied to a predoctoral dental course assessing competence in management of patients with malocclusion and skeletal problems. 1-3 In this course, assessment emulates the thinking activities of the practitioner: constructing problem lists, treatment objectives, and treatment plans based on patient records (radiographs, intraoral and facial photographs, and history). Students demonstrate competence relative to deined success criteria, the basis for evaluation. Modiications in assessment and instructional methods have been ongoing. In 2012, a test-enhanced method of instruction based on formative assessments with feedback was intro- duced. When compared to a traditional classroom approach (presentations and in-class exercises), the test-enhanced method generally boosted performance (i.e., higher grades), while not demonstrably affect- ing pass rates. 3 Although test-enhanced methods (in areas not related to competency-based dental educa- tion) have been reported to improve performance, they also delate students’ conidence compared to traditional studying. 4,5 Since students’ conidence is related to success and satisfaction, practitioners of test-enhanced instruction need to consider how to address this issue. 4 Feedback fosters learning when information given to the learner is related to a task and ills a gap between what is done and the goal. If the learner is committed to improvement, thereby reducing the gap, the learner will try again, and feedback information is looped back until performance standards (goals) are achieved. Hattie and Timperley suggested a framework for delivering feedback as a response to three questions: 1) where are you going? (what are the goals or performance expectations?); 2) how’s it going? (feedback on performance-identifying gaps relative to the goal); and 3) where to next? (feeding forward, guiding, and advancing the learner to the next step closer to the goal). 6 In a synthesis of 1,200 meta-analyses, Hattie reported effect sizes on student achievement demonstrating the powerful inluence