Making Sense of Feedback in Public Health Assessments

Cartoon illustration of a person holding a pile of paper and receiving written paper from different hands surrounding her.
Jurgen Appelo (2010) 360-degree feedback CC BY 2.0

The importance of feedback in higher education is already well established. This is even more so the case given the move towards more student-centred learning. Though there is a lot of research to show that effective feedback can promote student learning, there remain few studies within the context of public health education.

Assessment in public health education is challenging. In addition to increasing numbers of students, the cohort has become more diverse in its cultural, professional and disciplinary backgrounds. I have discussed the challenges of public health assessment previously in several other articles here at Teaching@Sydney. What I have learnt is that while there is an increasing concern regarding feedback practices within public health education, that there are few studies specifically focused on this area. Studies examining assessment feedback in higher education tend to look at other disciplines and also focus largely on the undergraduate scene. So, given this, what can we learn from other disciplines?

What can we learn from other disciplines?

Brinko’s paper published in the early 1990s provides a holistic review on what effective feedback in higher education looks like. He states that feedback can be more effective when:

it considers the students’ experience and developmental stage, gathered from a number of sources, conveyed in a variety of modes, perceived as reliable, knowledgeable, and well-intentioned, contains both positive and negative feedback and in a ‘sandwiched’ format, allows response and interaction, frequently and timely, relates to goals and criteria, create cognitive dissonance and models for appropriate behaviours…

However, in practice, the implementation of effective assessment feedback designs could be more challenging. The impact of feedback also varies greatly depending on disciplinary contexts and the way in which feedback is given to students. Carol Evan from the University of Exeter and Institute of Education in London has reviewed literature on assessment feedback and summarised some principles of good feedback practices as follows.

  • Feedback is ongoing and an integral part of assessment
  • Assessment feedback guidance is explicit
  • Greater emphasis is placed on feed-forward compared to feedback activities
  • Students are engaged in and with the process
  • The technicalities of feedback are attended to in order to support learning
  • Training in assessment feedback/forward is an integral part of assessment design

Although we would assume these general characteristics of effective feedback can be appreciated by public health lecturers and our postgraduate students, it still remains to be known what the best practices are for the public health discipline.

The arguments for peer-feedback

One of the dilemmas from my public health colleagues is whether we should have peer-feedback (peer assessment) or not. There are mixed opinions on the value and practice of peer-feedback in higher education. It can be beneficial as a way of engaging students, recognising individual strengths and needs, especially from student-centred perspectives. However, there are some difficulties in employing peer feedback. A common observation is that not all students are comfortable with the process. More importantly, the ability of students to give feedback greatly varies, and it may take very long time for some students to be capable of providing appropriate feedback to peers, let alone the training that might be needed to help students reach this point.

In public health education, peer feedback can be effective for some assessment tasks, e.g. group oral presentations with targeted audience from communities, policy makers, and different stakeholders. Engaging students to give peer feedback from different perspectives would help students develop their own learning process. Peer evaluation and feedback has also been used by colleagues as a way to lower the chance of being ‘free riders’ in a group assignment. Nevertheless, students’ motivational believes, self-regulation and metacognitive processes, may all contribute to the impact of self-feedback on learning outcomes.

“We need more feedback on feedback.”

Dissatisfaction with feedback has been well reported from both sides. From the lecturer’s perspective, it can be frustrating to find that after hours spent on giving ‘sandwiched’ feedback on students’ assignments, that this resulted in no change to further assignments. Likewise, from the student’s perspective, receiving insufficient feedback, especially on ways to improve, is a common gripe. Without explicit communication with students on expectations, we probably need spend much more time to raise a feedback ‘banner’ each time when we are giving feedback. In short, what we really need to do is better understand what lecturers and students in public health want and need.

There is a need to investigate the theories and practices that could improve the feedback process in public health higher education, especially key factors that could affect the use of feedback. For example, we might expect that motivation to learn may be higher among public health postgraduates than undergraduates, which may lead to more engagement in feedback processes. Alternative investigations may also wish to explore the role of authentic assessment in the feedback process. For example, do authentic real-world public health scenarios lead students to be more engaged and motivated in the process, especially given the real-world need for the skills and knowledge of public health practitioners?

Though this may currently be unclear, in asking these questions we, as a discipline, can begin to explore what the answers may be, both by drawing on the wider scholarly literature and taking the time to look at what is going on in our own discipline and discuss this with one another.





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