A response to “Teachers and Feedback”

(This is a comment … okay more than a comment… to the post “Are teachers damaging the purpose of feedback.” As always, short comments we append to the post.  If you have something more to say, you can write to us directly.  We’ll review your comments and consider posting it.

– Jonathan (@sherbino))

 By Jan Bull (@itsjanbull)

As a student, I love getting feedback when it makes sense!  By day, I research the medical education literature. By night and weekend, I am a fulltime Masters of Acupuncture student. Whereas our program does not have every element of a “program of assessment” as outlined by van der Vleuten, it has some (van der Vleuten et al, 2015).   We are pass/fail and we are required to receive 80% on every quiz to be able to sit a midterm, and 80% on both the written and practical in order to sit for the final and 80% on the final to pass. It may not be perfectly competency-based, yet it is at least a fixed criterion that is not “norm-based.” There is no averaging.

As a learner, even if 80% is passing, my goal is still to achieve 100%.  I feel like my future patients would want me to be as skilled as possible. And when I receive less than 100% I like to know exactly what I didn’t get. Sometimes it is just a matter of reading the question properly or really doing a double-check on one’s own confirmation bias in answering or on a practical test not panicking! An interesting educational culture of the program is if you don’t pass re-sitting it is considered par for the course.  One of our faculty told us she had to re-sit her comprehensive THREE times.  She is also the most awesome teacher and practitioner ever.  It just took her more time to get it. And this is not looked down upon…instead it is looked upon as “you need more practice.”  There was a student in my anatomy class re-doing the whole class for the 3rd time because the teacher felt that she needed to really get the material.  He was not going to pass her to “pass her.”

In our program, much like van der Vleuten suggests, we receive numerical scores on straightforward anatomy and “point location” quizzes and tests. For more nuanced work such as rapport-building and healing presence, we receive a check, plus or minus, and specific narrative feedback from the teacher and each other.

I love getting the numerical scores because it provides immediate and concrete indication about whether I am on the right track. The fact that my program understands that there is a developmental trajectory for our competency blows me away.  0 equals you didn’t get the right point at all or even near the correct structure. 1 is getting pretty close to the right structure but perhaps too close to a tendon or bone. 2 is pretty darn good, it will do the job.  3 is absolutely spot on in every way.  And as much as possible, the faculty are blinded to the student because we mark the structures on our partner and leave the room for scoring. And, if a faculty scores a point less than 2…then they have another faculty member score the point separately and confer with each other.  On my last midterm out of 5 acupuncture points I was assigned to locate and mark on my partner, I received a 3, 3, 3, 2 and a 1.  I totally bombed one point.  Yet overall, I did better than expected for my level of development.  It is tremendously helpful to have the exact feedback of how well I located those points.

However, for our rapport-building work, it simply cannot work the same way.  In our program we work in dyads and triads together. We don’t use “cases” … we ARE the cases. It is real life and often poignant. We are a longitudinal cohort and doing this requires we also build trust. We have had many of the same teachers in our classes and they are witness to our long-term development. In one session we were required to ask our partners to tell us about a time of great loss or sadness (much Kleenex was used in this session).  After a session, the “observer” shares their perspective, the “patient” theirs and the “practitioner” their perspective. Then we come back as a whole group with the teacher. We are pretty honest in a caring way with each other.  After one session, my “observer” wondered if I asked too many questions and should have had longer silences.  The “patient” however said on the contrary, she felt strong rapport and and felt comforted. Interesting.

I could care less about how I compare to other students normatively.   I am here to learn how to become the best healer I can. And I feel a great sense of obligation to learn and know what I need to know. Yet some things defy “knowing” per se. They require a lifetime of continuous experience and deliberate development.

Just a few thoughts from someone on the current hot seat of learning!