Listserv discussion of CMCL-FAIMER Regional Institute, Ludhiana



Fellows 2008:   Dr.Sheikh Sajjad Ahmed,Dr.Bharti Uppal,Dr. Anurag Chaudhary

Fellow 2007:     Dr.Anshu

Faculty:            Dr.Sheena Singh

The discussion for the month of April 2008 started on a very pleasant note. The topic for discussion was STUDENT FEEDBACK and on the very the day Anurag,Sajjad and Bharti U set the ball rolling. Before discussion could be carried forward it was important to define the term and keep various learning objectives in mind.




Learning objectives for the discussion were briefly as follows:


  • What is feedback and the need to have it from medical students?
  • How to have the feedback.
  • The time and setting for collection of feedback.
  • Validity of feedback.
  • How it is to be used for increasing the satisfaction levels of students.
  • Negative feedback.


  Anshu introduced the term in these words:


Feedback in medical education refers to information exchanged between a feedback provider and a feedback recipient. The word 'feedback' itself suggests movement--- 'the process of feeding' and a cycle---' back' refers to return.


So feedback works best when information is gathered and then used to bring about some kind of change in a cyclic manner. And so it works best when it is done continuously at regular intervals.


When giving feedback to students, our aim is to observe behavior, and to exchange information expecting an adjustment or change in behavior. When taking feedback from students, similarly, we are under the microscope -- and their observations are needed for us to adjust our behavior to their learning needs.


In both situations it is important for the recipient and the providers of feedback to have mutual respect and trust. When one gives feedback, the person expects his/ her opinion to be respected and valued. Else the entire purpose of feedback is lost. And one will never get honest feedback the next time around.



After this introduction to the concept, the important question that who should collect the feedback generated a good debate. Two possibilities were suggested                                               :


1.       Each teacher ought to collect feedback for his/her own classes.

2.      Collecting feedback should exclusively be the job of the Medical Education Units (MEU).



The arguments forwarded against assessment by MEUs were:


·        Issues of secrecy and confidentiality.

·        Validity of the feedback so collected.

·        Abuse of the information so collected as a political weapon in staff circles.



At this point Tejinder Singh intervened to put the problem in proper perspective by analyzing both situations on individual merits.


Student feedback can be used for both formative as well as for decision making (renewals, promotions, awards etc).


 For formative purposes i.e. to improve your own teaching, it is best for the teacher himself/herself to collect the feedback. This is recommended to be done when you are one thirds into the topics allotted to you so that there is enough time for improvement. Such feedback should have not more than 25-30 items. The items should not ask, what the students can not answer. One of the commonest mistake that can occur is to ask the students, is the teacher knowledgeable or did the teacher use appropriate assessment tools! The focus should be on specific teaching behaviors.

For summative purposes, the feedback should be collected at end of the course and may be the MEU is the right option here. However, for summative purposes, the suggested number of items is only 5-7 (!) in the form of global ratings. There is no point asking 20 questions at this stage. I have seen many medical schools doing the opposite- a short questionnaire for formative and a 20 item for the summative.



First week was dedicated to discussing what exactly feedback is and the importance of student

feedback which is actually to improve the medical education in terms of teaching and learning. In simpler words it could be said that the student feedback is an important tool to enhance quality of education in terms of:

·        Curriculum development
·        Co-curricular activities
·        Social welfare & extension
·        Research
·        Career guidance
·        Maintenance of infrastructure
·        Maintenance and utilization of learning resources like labs, computers, museum, library etc
  • Examination Evaluation

Timing for collection of feedback :                                                                             


  Anurag picked a very important aspect of the topic. Should student feedback be collected either at the end of semester or midway?


The arguments favoring the midway method were:

1. Allows teacher to respond immediately to learning and teaching issues expressed by students.

2. Provides a mechanism for students to communicate with the teacher.

3. Students enrolled in the class do not benefit from the results if the exercise is done towards end of the session.


                                       FOX EFFECT


Dr. Tejinder Singh had enlivened the discussion after introducing this interesting concept.

 It derives from the hypothesis that student ratings of educators depend largely on personality variables and not educational content.

 Professional actor who looked distinguished and sounded authoritative was programmed to teach charismatically and non-substantively on a topic about which he knew nothing


  • Provided him with a sufficiently ambiguous title, Dr. Myron L. Fox,
  • The audience comprised not of high-school students but a group of highly trained educators
  • He was presented as an authority on the application of mathematics to human behavior;
  •  Dressed him up with fictitious but impressive curriculum vitae.


 Handsome majority of subjects responded favorably at the significant level to a questionnaire concerning their attitudes toward the lecture

 What should we keep in mind, in the backdrop of DR. FOX EFFECT?




  • Student satisfaction with learning may represent little more than the illusion of having learned


  • There is much more to teaching than making students happy


  • A balanced combination of knowledge and personality are needed for effective teaching even if the student does not require the former to sustain the illusion that he has learned
  • Interpretation of student feedback should be done carefully.



At this point some basic principles of feedback were highlighted.                                                            



Principles of Feedback:


  1. Feedback should be planned in advance. There should be a predetermined time (brief daily or weekly; more extensive mid- or end-rotation) for feedback discussions.
  2. Feedback should be performance specific.
  3. Feedback should not pertain to personal characteristics.
  4. Feedback should be descriptive, not judgmental.
  5. Feedback should be timely, in close proximity to the observation it addresses.
  6. Feedback should be concise and focused on a limited set of specific observations.
  7. Feedback should be based on first-hand observation and/or written evaluations.
  8. Feedback should balance positive and negative comments.
  9. Feedback should benefit the receiver, not soothe the giver.
  10. Feedback should be delivered in private.


During collection of feedback a few things have to be kept in mind so as to make the outcome reliable.


1.Be clear, why you want the feedback

2.Do not ask, what students can not answer

3.Look for improvements- not comparisons

4.Have a mechanism to help the faculty who get poor ratings

5. Do not depend on student feedback alone- compliment it with other sources of feedback.


Tools for collecting feedback:   Various strategies for getting feedback were discussed at length. All the fellows were showing great enthusiasm by now and lot of information was pouring in. Among others following protocols merit a special mention:



      • Printed Questionnaire
§         On Line questionnaire 
§ Blackboard anonymous surveys
§         Feedback of lecture comments with compulsory questions and standardized module 
 specific questions 
§         One to one verbal inclass(listen to student views and improve)
§         Peer review
§         Hiring communication consultants
§         Exam results if bad for a particular teacher
§         Suggestion by students in drop boxes
§         Dean/Reactor meetings with student representatives
§         Self Appraisal


·        Informal strategies:-

CHAIN LETTER: Send a sheet of paper (or several, for larger classes)
around the room with a few survey questions at the top and space for
comments.  Each student puts a tally mark to indicate responses to
questions, then writes comments.  As the sheets circulate, students
respond to each other's comments, creating revealing dialogue for the

:  An answering machine on your telephone allows students
to ask questions any time they come up. E-Mail also works well for this purpose.

DEAR PROFESSOR LETTERS:  About three weeks into the term, ask students
to write you a letter (anonymously, if they prefer), telling you (for
example) what they find most interesting about the course so far, what
questions they hope the course will answer, any problems they are
having with the readings, or a concept they are having trouble

FEEDBACK FORM: Take a few minutes at the end of a class, after the
third week and perhaps again at mid-semester, to have students
complete a feedback form.  It is best if you leave the room


ONE MINUTE PAPER:  At the end of any class ask students to write down
brief answers to two questions:  (1) What is the main point you
learned in class today?  (2)What is the major unanswered question you
leave class with today?

Having students do a one minute paper regularly in class has several purposes:

It focuses student attention on the "big idea" of the session.
It focuses student attention on unclear points.
It informs you of student questions and general misunderstandings.
It builds continuity over time.

Students need to know that their comments have been heard and taken
seriously, which means that you need to give them feedback on their
comments.  At the next class meeting take a little time to respond.


STUDENT RATING INSTRUMENTS. All departments require course evaluations
to be conducted at the end of the semester.  About three weeks before
the last class, ask about details for administering your department's
evaluation instrument.
It is important that you do not stay in the room while the students
complete the ratings.  You should also make it very clear to students
that you will not see the results until after grades are in.  Their
feedback will not influence their grades in any way.

 IDEA. The Center for Teaching Effectiveness (CTE) makes available, at
no cost to faculty and TAs, the IDEA (Individual Development and
Effectiveness Assessment), a nationally-normed student rating
instrument.  IDEA is based on student progress on instructional goals
and controls for class size and student motivation levels (two factors
that influence ratings of instruction).  IDEA provides a diagnostic
section for faculty development and space for additional questions
designed by the instructor.



GIFT as a methodology to make group feedback less time consuming and less cumbersome.


GIFT or Group Instructional Feedback Techniques center on getting student responses to three questions related to their learning in the class. 

·        What works?

·        What doesn't?

·        What can be done to improve it?


In an ideal administration of the Group Instructional Feedback Technique (GIFT), someone other than the teacher quickly pools students on thee questions mentioned above, determines the most frequent responses, summarizes them, and then reports back to the instructor.


This feedback is a GIFT in two senses.


First, it is already or at least partially summarized and analyzed data by the time it reaches the instructor. 

Second, it allows the instructor to see his or her course through the eyes of a detached but sympathetic observer.


If no outside "informer" is available, instructors can collect useful data from their own classes by giving students more responsibility in the process and adopting a few safeguards.



Difference between feedback and evaluation?


 TS settled the issue by explaining that there were similarities as well as differences between the two. Like assessment, feedback is inherently evaluative- i.e. it presents the students with information about what is good and what can be improved but it also helps the learner to find out ways to improve. Feedback does not become part of course grade and therefore remains formative. While assessment is announced to the student ('you got 60% marks'), feedback is done in dialogue with the learner. Explain to the student, what was the criteria used for assessment, how it was applied and where did the student fare in that criteria. This dialogue is important because it allows the teacher to be sure that students has understood why he got 60% and it starts the process of helping the student to learn self assessment





Validity of student feedback:

            Feedback has to be reliable to be productive. We have to make sure whether students are passing on the right feedback or are they just being polite. It is important to take students into confidence so as to assure the reliability of feedback.


At that stage it was important to give some time to negative feedback. Ciraj was quick enough to suggest a way for dealing with negative feedback knowing the expected negative feeling associated with being criticized.  To deal with negative feedback acronym, SARA summed up a very appropriate strategy:


* Surprise or shock:

You may have no idea how to respond at first. At this time, do nothing.

* Anger:

This stage also begs for inaction. Recognize your anger, do nothing, and know you'll move past it.

* Rationalization:

Here come all of your excuses and defenses. Before you share them with anyone else, listen to yourself and work to separate the purely defensive from the legitimate .                                                                                .


* Acceptance:

 In this final stage, ask questions about anything that's unclear. Receiving negative feedback doesn't mean you have to accept all of it, but you do need to think it through. Then take what's helpful and put it to use.


Suman added a few points more:

  1. Get your emotions under control.
  2. Find a private place. No one wants to receive negative feedback in front of others. Sometimes it is unavoidable, but that should be a last resort. 
  3. Focus on their actions, not on the person. You create an immediate barrier when you criticize the person. Focus instead on what you want to change. Focus on their performance.
  4. Be specific.
  5. Be timely.
  6. Be calm.
  7. Reaffirm your faith in the person.
  8. Stop talkingListen to what they have to say.
  9. Define positive steps.
  10. Get over it.
  11. Giving negative feedback is never easy, but if done properly it isn't unpleasant

The concluding moments of the final week were used to discuss a diversity of related subtopics like attributes of a successful instructor, background variables for student ratings etc. The discussion ended on a very cheerful note.


List of a few websites that were referred to during the discussion is as follows:


-Google search on Ramsden for course experience questionnaire.
-ABCDEFG for constructive feedback-JNMA J Nepal Med Assoc20077,July Sep:46(167):151-6



Dr. Sheikh Sajjad Ahmed