One of the main findings was the perceived power of the summative assessment culture. The fear of failure and the subsequent “punishment” of needing resits loomed large in students’ minds. This meant that exams were seen as a hurdle, not a stepping stone to future learning. Students who had passed the assessment felt that they had achieved their goal which meant that they did not perceive a “feedback gap” between their own performance and the required standard. As a result, they were not motivated to meaningfully engage with the feedback. This links with well-established literature that has demonstrated that motivation is vital to enable an appropriate response to feedback.
Students in the study felt a disconnection between the assessments and clinical workplace learning; this was reinforced by the attitudes of clinical teachers and family members. This finding resonated with situativity theory, which proposes that educators need to consider carefully the context in which information will (or will not) be used, rather than just concentrating on the content of the information to be imparted. The theory proposes that authentic learning environments should help the learning process. Unfortunately, the high-stakes punitive assessment hurdles are perceived by student as existing in a separate universe to the authentic learning which takes place within the clinical workplace.
The implication of these findings is that simply concentrating on trying to improve feedback delivery, by exhorting faculty to provide more, or better-quality, feedback, is doomed to fail as this approach fails to recognise the context in which the assessment and feedback take place. Similarly, urging students to reflect more carefully on the feedback is not going to be sufficient on its own, unless factors such as learners’ motivation and the disconnection from authentic learning are addressed. Although this study set out to explore the individual barriers to feedback receptivity, it therefore demonstrated that factors within a medical school’s assessment culture were very significant. As a result, the focus should be on the development of a feedback culture, as others have proposed.
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