In the high-stakes environment of a delivery ward, a midwifery student manages a complex childbirth. Amid the tension, a professor offers a few carefully chosen words of guidance. This simple act—effective feedback—can transform clinical education from passive observation into active mastery 1 .
Explore the ResearchClinical education forms the very foundation of medical sciences, serving as the critical bridge where classroom theory meets real-world patient care. For nursing and midwifery students, this practical training is where textbook knowledge evolves into clinical competence and professional identity.
Yet, variations in feedback practices create significant challenges in training environments worldwide. Understanding the current state of feedback—through the eyes of both those who give and those who receive it—reveals powerful opportunities to enhance how we prepare future healthcare providers.
Feedback in clinical education is far more than casual criticism or praise. Educational experts define it as specific information about a learner's observed performance compared to established standards, with the goal of improving future performance 6 .
Between current and desired performance levels
Successful techniques and approaches
And clinical reasoning abilities
Professional confidence through guided improvement
Perhaps most importantly, feedback acts as a "mirror for learning," allowing students to see their performance more objectively, much like athletes reviewing game footage to refine their techniques 3 .
Recent research across multiple continents reveals both progress and persistent challenges in clinical feedback practices:
72% of nursing and midwifery students agreed they received "regular and constructive feedback" 9 .
Midwifery students reported generally satisfactory feedback experiences, with more than half indicating they often received useful, constructive feedback 8 .
Enhances learning through:
Diminishes learning quality through:
The effectiveness of feedback is heavily influenced by cultural and structural factors. In hierarchical and collectivistic cultures like Indonesia (and similar contexts in Asia, Africa, and Latin America), robust social hierarchies can reduce feedback dialogue to a minimum 2 .
Students often play subordinate roles in feedback conversations, while clinical supervisors may face dissatisfaction with the process despite their teaching authority 2 .
In Morocco, nursing and midwifery students reported moderate satisfaction with their clinical learning environments, with particular concerns about supervisory relationships 4 .
To determine the most effective feedback methods, researchers conducted a compelling experimental study comparing two common feedback types.
Researchers employed a crossover design with 30 undergraduate nursing students learning basic nursing skills 3 . The class was divided into two groups:
Received verbal feedback during the first half of their training sessions, then switched to written feedback in the second half
Received written feedback first, then verbal feedback
This innovative design allowed each student to experience both feedback methods while controlling for individual differences in learning ability. The same professor taught both groups, ensuring consistent teaching quality, and a second professor who was unaware of the feedback method used assessed the final performance.
The findings revealed significant differences between the two feedback approaches:
| Feedback Type | Average Performance Score | Satisfaction Score | Statistical Significance |
|---|---|---|---|
| Written Feedback | 17.7 ± 2.3 | 37.1 ± 3.5 | P = 0.001 |
| Verbal Feedback | 15.7 ± 2.5 | 33.6 ± 4.4 | P = 0.001 |
While the format matters, research identifies several core principles that distinguish effective feedback regardless of how it's delivered:
Based on directly observed behaviors 6
Provided close to the observed performance 6
Includes concrete suggestions for improvement 6
Focuses on actions, not personal attributes 6
Students benefit from receiving feedback from multiple sources, including educators, clinical staff, peers, and even patients 6 . This comprehensive approach provides a more complete picture of performance and helps identify both strengths and areas for growth.
The traditional view of feedback as information delivery is evolving toward feedback as dialogue 2 . This conversational approach encourages students to actively participate in identifying solutions rather than passively receiving criticism.
Based on the accumulating evidence, educators can employ several practical strategies to enhance their feedback practices:
| Strategy | Implementation Approach | Expected Benefit |
|---|---|---|
| Balance Feedback Types | Combine immediate verbal feedback with periodic written summaries | Maximizes timeliness while providing reference material |
| Structured Assessment | Use standardized rubrics with clear performance criteria | Increases transparency and reduces student anxiety |
| Cultivate Dialogue | Ask reflective questions like "How would you approach this differently next time?" | Develops clinical reasoning and self-assessment skills |
| Train Clinical Supervisors | Provide formal development in feedback delivery | Improves specificity and effectiveness of feedback |
| Leverage Technology | Use digital tools to supplement in-person interactions | Enhances accessibility and documentation |
Medical education researchers are developing more sophisticated frameworks to conceptualize feedback, including the emerging concept of "feedback literacy"—the understanding, capacities, and dispositions needed to make sense of feedback information and use it to enhance performance 5 .
A 2025 study introduced a medical student feedback literacy framework with seven elements, including some novel components exclusive to medical education such as patient safety and reflective practice 5 . This framework addresses the unique challenges medical students face when receiving feedback across diverse clinical environments with multiple supervisors.
Traditional approach where instructors provide information to students
Conversational approach encouraging student participation
Developing student capacity to understand and use feedback effectively
Feedback in clinical education represents far more than occasional suggestions for improvement—it forms the essential connective tissue between theoretical knowledge and clinical competence. The evidence clearly indicates that when delivered effectively, feedback significantly enhances both skill development and professional identity formation.
The research reveals several promising paths forward: embracing written feedback for its clarity and reference value, fostering feedback dialogues that respect cultural contexts, developing students' feedback literacy, and implementing structured assessment systems. What remains universally clear is that feedback must be recognized as a fundamental educational tool rather than an educational afterthought.
As we continue to refine feedback practices through evidence-based approaches, we contribute not only to the development of more competent nurses and midwives but ultimately to the quality and safety of patient care they will provide throughout their careers.
The conversation about feedback in clinical education continues to evolve. Share your experiences with clinical feedback—both giving and receiving—using #ClinicalFeedbackMatters.