A growing body of evidence demonstrates a critical role for effective, meaningful feedback to enhance student learning. Effective feedback can become part of the learning cycle that is not only a learning opportunity for the student but can also be used to inform the teacher and ongoing curriculum development. Feedback is considered particularly important during the first year of university and can even be viewed as a retention strategy that can help attenuate student performance anxieties and solidify perceptions of academic support. Unfortunately, the provision of individualized, timely feedback can be particularly challenging in first-year courses as they tend to be large and diverse cohort classes that pose challenges of time and logistics. Various forms of generic feedback can provide rapid and cost-effect feedback to large cohorts but may be of limited benefit to students other than signaling weaknesses in knowledge. The present study describes a method that was used to provide formative task-related feedback to a large cohort of first-year physiology and anatomy students. Based on student evaluations presented in this study, this method provided feedback in a manner that engaged students, uncovered underlying misconceptions, facilitated peer discussion, and provided opportunity for new instruction while allowing the lecturer to recognize common gaps in knowledge and inform ongoing curriculum development.
- first-year university
- large cohort
- medical science education
a growing body of literature has provided evidence of the potential for feedback to enhance student learning (7–9, 13). Hattie and Timperley (8) described feedback as “. . .one of the most powerful influences on learning and achievement. . .,” providing both students and teachers with knowledge of academic progress and performance and allowing both students and teachers to recognize and change gaps. Ramsden (22) suggested that the importance of effective formative feedback on student progress cannot be overstated, particularly when the feedback becomes a learning opportunity. Indeed, feedback can become part of a learning cycle that contributes to the learner, the teacher, and even the teaching program (11). Not only is feedback considered a critical part of learning, but it is a pivotal influence on student retention, particularly in the first year of university (15), in part due to its role in attenuating anxieties relating to assessment expectations and performance and by instilling a sense of achievement in students (12). In fact, Kift and Moody (12) have referred to the “. . .strategic promotion of assessment and feedback as a first year learning engagement and retention intervention.” Kerridge (11) discussed the early formation and solidification of students' perceptions of university as well as the importance of early academic support to assure the continuation of undergraduate study, while Fisher et al. (4) suggested “. . .meaningful, participative, formative assessment” as a method by which lecturers can support students.
According to Kift and Moody (12), the value of feedback can be enhanced by considering two aspects: the timing and method of feedback. Regarding the first aspect, timing, Kift and Moody (12) stated that if the task is simple, then feedback should be provided within 24 h as the process will be fresh in the mind of the student; however, for a more complex task, delayed feedback may be beneficial to give the student time for reflection. Regarding the second aspect, the method of feedback, several authors have echoed the notion that effective feedback should be task related and focus on student performance rather than personal attributes of the student (also referred to as feedback directed to the self) (8, 24). Task-related feedback refers to whether the work or product is correct or how well the task is being performed; therefore, it includes directions on incorporating correct, different, or further information. This is also referred to as corrective feedback and provides students with a platform upon which they can process and build information (8). In fact, Craig and Glover (2) suggested that the term “feedforward” may better describe comments to students about their assessment, as feedback should not be viewed as a final process to student learning but rather as a “springboard” toward furthering learning and improve future assessments.
Despite the importance of feedback, the 2009 Australasian Survey of Student Engagement Report by the Australian Council for Educational Research (21) revealed that only 40.2% of Australian first-year university students considered that they “received timely feedback on academic performance” and an astonishingly low rate of 9.9% of students reported that they had “discussed grades with teaching staff.” These figures appear to be in stark contrast to the response of first-year students surveyed in the United States, where 59.7% reported receiving timely performance feedback and 53.4% had discussed their grades with teachers (21).
One barrier to providing individualized meaningful, timely feedback to students may be that courses can have large and diverse student cohorts, particularly first-year classes (5, 14); therefore, teachers can face a challenge of time and logistics. Kift and Moody (12) made reference to the logistic difficulties of providing feedback to large cohorts of students on an individual level and suggested that feedback can be given as an overview of the performance of the cohort. Race (20) suggested the use of a one-page postsubmission handout detailing expectations per question, features of a high-scoring answer, and examples of common mistakes as feedback mechanisms for large classes. The use of online generic responses to provide rapid exam feedback to large cohorts of first-year students has also been described (5, 12). This method of feedback has its advantages, such as the provision of timely and constructive feedback to students in a manner that is cost and time effective for the lecturer (3), but this delivery method may not engage the student or facilitate peer and student-teacher dialogues, nor does it seek to understand and correct common misconceptions. Indeed, Craig and Glover (2) noted that feedback approaches often omit strategies for testing the usefulness and effectiveness of the feedback method. Craig and Glover (2) stated that standard online feedback tools are “. . .not written for students” and although they may signal weaknesses to the student, they do not provide guidance on how to correct for future work, i.e., feedforward. A large-scale study by Hounsell et al. (9) examined data obtained from undergraduate bioscience students regarding their experience and perceptions of feedback, with results identifying a need for useful and timely feedback for exams rather than the usual focus on coursework. Therefore, the aim of the present article was to present a method that was used to provide task-related (midsession exam) feedback to a large cohort of first-year anatomy and physiology students in a manner that engaged students, endeavoured to discover underlying misconceptions, facilitated peer support and discussion, and considered continuation between feedback and instruction where the two aspects intertwined to become new instruction. Student perceptions of the usefulness of the feedback intervention are presented.
The course and its students.
Introduction to Anatomy and Physiology II (MEDI 112) is a first-year course that gives students knowledge of the structure and function of integrated systems within the human body. Learning takes place in a large lecture theatre, with three 1-h lectures/wk for 13 wk, and theoretical learning is supported by weekly 2-h “wet” laboratory classes held either in the physiology or anatomy laboratories over alternating weeks as well as 1-h “dry” tutorial classes interspersed throughout the session.
As an open course with no prerequisites, Introduction to Anatomy and Physiology II enjoyed a cohort of 417 students in 2014 and included students enrolled in Medical Science, Science, Biotechnology, Nutrition, Exercise Science, and Medicinal Chemistry degrees as well as nonhealth science students from diverse degrees such as Engineering, Creative Arts, Management, Business, and Economics. As students came from a range of backgrounds, this cohort included a population of students with minimal prior knowledge of physiology and no scientific background.
Feedback was provided on the multiple-choice midsession exam (30 questions, 20% of the final grade, conducted in week 7 of the 13-wk academic session). In 2014, the class achieved a high average grade of 68%. Small low-risk assessments (e.g., pre- and postlaboratory quizzes) had been conducted early in the academic session to provide students with summative feedback that could be used to improve performance on major tasks.
Over the past few years, feedback on the midsession exam in this course had been provided through several approaches, including a workshop scheduled outside of lecture time, which had poor student attendance despite an opportunity for one-on-one time with the lecturer. Another approach was to show students the questions and answers to the midsession exam within the first 10 min of a standard lecture time. This would typically occur 2 wk after the exam date, and, due to logistical difficulties, students were not provided with copies of their answers. Further instruction to enhance student understanding of the content was limited due to time constraints to avoid impinging on lecture content. A student course evaluation in 2012 revealed that students identified a deficit in feedback in this course, with the statement “Feedback on my work was provided to me in time to prepare for other assessment tasks” receiving a mean grade of 1.39 (a mean above 0 indicates that student perceptions are more positive about the course, with a mean of 3 being the highest; a mean below 0 indicates negative perceptions with −3 being the lowest). This question was rated by students as the lowest of eight questions regarding the course, which is a trend also observed nationwide in universities in the United Kingdom (17). Overall, there was a highlighted necessity for a new approach to providing feedback to students to support the learning and teaching cycle.
This project complied with the Human Ethics Committee, University of Wollongong (approval number HE15/395). Feedback was conducted before the “last date to withdraw without academic penalty,” which was recommended by Kift and Moody (12) to relieve anxieties that students may have about their progress and commitment to the course and to assist students to experience a sense of achievement. The feedback lecture was scheduled into the normal lecture time and published in the course timetable of topics made available to students at the start of the academic session.
In lectures before the exam, students were instructed about the format of the midsession exam feedback lecture, which would be conducted during the normal lecture time in the week after the exam and would require students to discuss their answers with the class. At that time, students were advised that answers to the exam questions would be revealed only after interactive class discussions of the answers. The feedback lecture was to be a safe environment where students could share their understanding of the content; therefore, respect for other's views was expected and would be paramount to the success of the session. Assurance was provided that, unlike the regular scheduled lectures, this class would not be digitally recorded for dissemination through the online student management system for this course in an attempt to encourage more students to engage.
Immediately after the exam, general-purpose scannable multiple-choice exam answer sheets were marked by a computerised scanning system, and each student's individual mark was released to them via the university's student management system. Analysis was performed on student results, and the top 10 most difficult questions were identified.
One challenge was providing students with their answers as university privacy policies prohibit collated student marks being made available for the class to view, even if identification by student number replaced student names. The current student management system, although accessed by students through individual login security, did not enable the direct upload of individual student answers. In addition, a university records management policy dictated that the computerized answer sheets were kept by faculty members for a period of 1 yr; therefore, the original answer sheets could not be returned to students. To overcome this logistical obstacle, individual answer sheets were copied and provided to each student during the lecturer's standard consult time and over 2 days leading up to the feedback lecture once photo identification had been sighted. The remaining copies of the answer sheets were returned during the smaller laboratory classes. This process provided the lecturer with an opportunity to briefly discuss student feelings about the exam with individuals or in small groups. Approximately half of the student cohort claimed a copy of their answer sheet for use in the feedback session.
On commencement of the feedback lecture, students were requested to sit toward the front of the theatre to aid facilitation of peer-peer and peer-lecturer discussions in the large-lecture theatre setting. A presentation posed each of the 10 most difficult questions along with a chart showing the percentages of students who responded to the answers of A, B, C, D, and E. By raising their hand, students indicated whether they were willing to discuss an answer or make comment on a question. Through the use of a roving radio microphone, students could engage in the whole of the class discussion and debate. At first, the discussion included several students, but as the feedback session continued, student participation became widespread as students engaged with the discussion and with their peers. Other students joined the discussion and debated the answer until a consensus had been reached. Through student explanation of their answers, underlying misconceptions were identified. The relevant lecture slides were then revised with a focus on the common misconceptions and new instruction and learning could occur. The answer was then confirmed, and the next difficult question was posed.
The overall cost of the feedback session was 5 h of administration for 417 students.
What the students thought.
Approximately two-thirds of the student cohort attended the exam review session, which was greater than the general lecture attendance throughout the academic session. The attendance of two-thirds of the student cohort at the exam review session was unexpected given that only half the cohort obtained a copy of their answer sheets for use during the review. This may demonstrate a requirement to improve communication about the processes of the review session, to find ways of improving the accessibility of student answer sheets, and to refine balance in timing (i.e., providing students with sufficient time to obtain their answer sheets from the academic staff versus the importance of providing timely feedback soon after an assessment). Scheduling the midsession exam review session into the lecture topic timetable and not digitally recording the feedback session for dissemination through the online student management system site may have contributed to the successful attendance rate.
An online questionnaire entitled “Feedback on the Feedback Session” was posted on the student management system after the feedback lecture. In the instructions, students were asked to inform the midsession exam review process for future years by commenting about whether they thought the feedback lecture was useful. Fifty-one students completed the survey, with the following responses to the statement “I found the feedback session useful”:
Strongly agree: 41%
Strongly disagree: 2%
Samples of student comments are shown in Table 1. Overall, there were 41 positive comments (including 25 comments expressing thanks for the feedback session) and 11 comments containing suggestions for improvement, mainly pertaining to requests for all of the exam questions to be revealed rather than a focus only on the top 10 difficult questions.
Common misconceptions identified during the analysis of student results and the discussions during the feedback session were used to inform the ongoing curriculum development of the course.
The present study outlines a method of providing formative feedback to a large cohort class of first-year anatomy and physiology students in a manner that was timely, engaged the students, facilitated peer and student-teacher dialogues, and sought to identify and correct common misconceptions. Using this method, students were provided feedback within 7 days of the assessment. This timing is in line with Kift and Moody (12), who stated that timing is an important contributor to the value of the feedback and suggested that a simple task requires feedback within 24 h, whereas a complex task would benefit from delayed feedback to ensure sufficient reflection time. In addition, a number of authors have suggested that feedback should be task-related corrective feedback, i.e., whether the work is correct or performed well, and incorporate further information to enhance knowledge and build skills to allow improvement in future tasks (8, 18, 24). The methods of the present study used the knowledge of student misconceptions to reiterate the content in a targeted manner, thus assisting students to build knowledge through feedback. In this manner, the feedback mechanism informed both the students and teacher; indeed, common misconceptions can also be used to inform the ongoing curriculum development of the course. In addition, this method allowed correction of faulty interpretations as well as providing knowledge to students who have a complete lack of understanding, therefore entangling instruction with feedback.
Task-related feedback can be diminished when combined with feedback directed to the self; Bennett and Kell (1) cited the following example: “Good boy, that is correct.” This is an interesting point to consider when attempting to achieve class engagement in a large-lecture theatre, as traditional theory suggests that the teachers should create an environment where students feel that they are respected and safe to ask, answer, and discuss questions with minimal risk of embarrassment. The First Level Assessment and Feedback Project suggests that assessment can deeply affect students; therefore, feedback needs to be provided in a manner that “. . .encourages positive motivational beliefs and self-esteem” (19). Students can feel encouraged and nurtured by the teacher; indeed, simple communication from the teacher (such as body language and tone of voice) may enhance the discussion. Therefore, there are important relationship aspects to the provision of interactive feedback, and if an environment of trust and safety is not created by the educator, then the same successful peer-peer and peer-lecturer interactions described in the present study may not be achieved. In the present study, students described the feedback session as “relaxed,” “interactive,” and “conversation-like.” These student descriptors coincide with recommendations by Craig and Glover (2) that feedback should be interactive, “. . .a dialogue, not a monologue. . .,” personalized, and presented in easy-to-understand language. Kerridge (11) suggested that encouraging student-student discussion can allow classmates to explain information in a language that is accessible and readily understood, which may be achieved using the method described in the present study.
As suggested by Craig and Glover (2), feedback should not be the final process to student learning during a task. Instead, feedback should springboard toward improving future assessments, aptly referred to as feedforward (2). Based on the comments of the students in the present study, it seems that providing feedback that is engaging and enhances learning is appreciated and perceived as useful to the students; however, an important indicator of the success of the feedback would be to assess whether the knowledge and tools were provided to feedforward into future assessments. A study by Price et al. (16) identified difficulties of accurately measuring the aspects of feedback that truly influence the leaner and the learning process in a meaningful and lasting manner, describing such an undertaking as “. . .perhaps impossible.” Indeed, data have shown an increase in student retention and overall trending improvement in student final grades in this course compared with 2013; however, pinpointing the role of feedback in these positive student outcomes is not possible with the design of this study, and further research is required. Despite the difficulties of measuring actual benefits of feedback, it can only be denoted as such if feedback is used by the learner to change a gap between current performance and the performance aspired to by the student, anything outside of this could only be referred to as “dangling data” (23). The method of feedback described in the present study has several other limitations. It addressed the top 10 difficult questions, and several student comments demonstrate that this may not be applicable to every student involved in the feedback lecture. This issue was addressed by offering to meet with students during usual consultation hours to provide individualized feedback on questions that were not covered during the feedback session. By addressing the top 10 difficult questions, only 2 individual students took up the offer to meet in consultation hours, indicating that this method permits more efficient use of staff (and presumably student) time. This part of the method aligns with Craig and Glover (2), who recommended a focus on several aspects of the assessment that would make a difference to student learning rather than delivering a large amount of poor feedback quickly. A 3-yr study by Price et. al. (16) on the perceptions of feedback by students in several United Kingdom business schools reported that students “. . .often very keenly felt (perhaps wrongly) that staff did not care enough to spend time on the feedback, particularly where tick box feedback sheets had been used which students regarded as ‘an insult’.” The feedback method of the present study did aim to provide more personalized feedback to a large cohort of students, but this should be balanced against the time cost of administration to the lecturer, which may not be feasible in some institutions. The question of how the feedback method described in this study can be made scalable and sustainable still remains. Using technology to upload the student's answers to the questions to a platform that would allow viewing through individual password access or gaining assistance through existing faculty administrative infrastructure may lessen the administrative load of returning copied answer sheets. However, this would also diminish the lecturer's face-to-face opportunity to discuss grades with students during the collection of their answer sheet, albeit brief but valuable and, as mentioned previously, rarely performed in the Australian context (21). Another limitation to the present study is that the number of student responses to the questionnaire was low; therefore, responses that were obtained may provide an inaccurate view of the class' real opinion of the feedback lecture. An improved response rate may be achieved through the use of a paper-based questionnaire during the feedback session rather than by postsession online format; however, it would be necessary to consider the impact of time and the logistics of such a task when working with large student cohorts and large-theatre settings in the confines of the lecture time.
The literature provides evidence that feedback comes in many different forms and that a single method cannot be standardized (2, 6, 10, 18). In constrast to a “one-size fits all” approach, effective feedback methods should be adapted to suit student's present requirements. In line with the Australian Learning and Teaching Council's mission statement, which is to “promote and support strategic change in higher education institutions for the enhancement of learning and teaching, including curriculum development and assessment” (12), the present article proposed a method of providing timely formative task-related feedback to a large cohort first-year anatomy and physiology class in a manner that achieved student engagement, facilitated peer-to-peer and student-lecturer discussions, and sought to discover and respond to underlying misconceptions through a close entanglement of feedback and instruction.
No conflicts of interest, financial or otherwise, are declared by the author(s).
K.W.-G. and M.W. conception and design of research; K.W.-G. performed experiments; K.W.-G. analyzed data; K.W.-G. interpreted results of experiments; K.W.-G. prepared figures; K.W.-G. drafted manuscript; K.W.-G. and M.W. edited and revised manuscript; K.W.-G. and M.W. approved final version of manuscript.
The authors sincerely thank Prof. Ian Wilson (School of Medicine, University of Wollongong) and Emeritus Prof. Chris Rust (Oxford Brookes University) for valuable input during the editing of this manuscript.
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