Exploring Adaptive Feedback Strategies in Competency-Based Medical Education
Keywords:
adaptive feedback, competency-based medical education, clinical teaching, qualitative research, formative assessment, feedback literacy, medical educationAbstract
This study aimed to explore how clinical educators employ adaptive feedback strategies within the
framework of competency-based medical education (CBME) to enhance learner development and
performance. This qualitative study employed a phenomenological approach to investigate the
experiences of clinical educators in CBME programs. Semi-structured interviews were conducted with
31 faculty members from various medical disciplines in Tehran, selected through purposive sampling.
Data collection continued until theoretical saturation was achieved. All interviews were transcribed
verbatim and analyzed using thematic analysis, following Braun and Clarke’s six-phase framework.
Nvivo software was used to facilitate data management and coding. The analysis focused on identifying
patterns and strategies used by educators to tailor feedback in diverse clinical and educational contexts.
Three main themes emerged: (1) Personalization of feedback, which included strategies such as
emotional sensitivity, alignment with milestones, and tailoring feedback based on individual learner
needs; (2) Contextual influences on feedback, which encompassed environmental constraints,
institutional culture, and hierarchical dynamics that shaped feedback delivery; and (3) Developmental
impact on learners, highlighting how adaptive feedback fostered motivation, self-regulation, and
feedback-seeking behavior. Participants emphasized the importance of empathy, trust, and situational
judgment in feedback practices, while also noting barriers such as time pressure and lack of formal
feedback training. Adaptive feedback is a dynamic, context-sensitive process that plays a critical role in
the success of CBME. Clinical educators utilize a range of strategies to tailor feedback based on learner
characteristics, contextual demands, and developmental goals. Supporting these practices through
institutional policy, faculty development, and cultural change is essential for fostering meaningful
learning and competency progression in medical education.
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References
Ajjawi, R., & Boud, D. (2017). Examining the nature and effects of feedback dialogue. Assessment & Evaluation in Higher Education, 42(2),
252–265. https://doi.org/10.1080/02602938.2015.1103365
Davoudi & Eskandari
8
Archer, J. C. (2010). State of the science in health professional education: effective feedback. Medical Education, 44(1), 101–108.
https://doi.org/10.1111/j.1365-2923.2009.03546.x
Bearman, M., Molloy, E., Ajjawi, R., & Keating, J. (2010). 'What should we teach the teachers?': Identifying the learning priorities of clinical
supervisors. Medical Teacher, 32(12), e347–e355. https://doi.org/10.3109/0142159X.2010.500709
Bing-You, R., Paterson, J., & Levine, M. (2017). Feedback falling on deaf ears: Residents' receptivity to feedback tempered by sender
credibility. Medical Teacher, 39(8), 845–852. https://doi.org/10.1080/0142159X.2017.1315065
Carless, D., & Boud, D. (2018). The development of student feedback literacy: Enabling uptake of feedback. Assessment & Evaluation in
Higher Education, 43(8), 1315–1325. https://doi.org/10.1080/02602938.2018.1463354
Ende, J. (1983). Feedback in clinical medical education. JAMA, 250(6), 777–781. https://doi.org/10.1001/jama.1983.03340060055026
Frank, J. R., Snell, L. S., Cate, O. T., Holmboe, E. S., Carraccio, C., Swing, S. R., ... & Harris, K. A. (2010). Competency-based medical
education: theory to practice. Medical Teacher, 32(8), 638–645. https://doi.org/10.3109/0142159X.2010.501190
Govaerts, M., Van der Vleuten, C. P. M., Schuwirth, L., & Muijtjens, A. (2013). Workplace-based assessment: Effects of rater expertise.
Advances in Health Sciences Education, 18(4), 559–571. https://doi.org/10.1007/s10459-012-9394-8
Harrison, C. J., Könings, K. D., Molyneux, A., Schuwirth, L. W., & Wass, V. (2013). Web-based feedback after summative assessment: How
do students engage? Medical Education, 47(7), 734–744. https://doi.org/10.1111/medu.12205
Molloy, E., & Boud, D. (2013). Seeking a different way of learning: the implications of workplace learning theories for medical education.
Medical Education, 47(3), 232–240. https://doi.org/10.1111/medu.12110
Nicol, D. J., & Macfarlane‐Dick, D. (2006). Formative assessment and self‐regulated learning: A model and seven principles of good
feedback practice. Studies in Higher Education, 31(2), 199–218. https://doi.org/10.1080/03075070600572090
Ramani, S., Könings, K. D., Mann, K. V., Pisarski, E. E., & van der Vleuten, C. P. M. (2019). About politeness, face, and feedback: exploring
resident and faculty perceptions of how institutional feedback culture influences feedback practices. Academic Medicine, 94(2), 191–198.
https://doi.org/10.1097/ACM.0000000000002414
Sargeant, J., Mann, K., Sinclair, D., Ferrier, S., & Muirhead, P. (2011). Learning in practice: Feedback in medical education: a review of the
literature. Academic Medicine, 86(6), 628–636. https://doi.org/10.1097/ACM.0b013e3182188c96
Telio, S., Regehr, G., & Ajjawi, R. (2015). Feedback and the educational alliance: examining credibility judgements and their consequences.
Medical Education, 49(9), 932–942. https://doi.org/10.1111/medu.12782
Ten Cate, O. (2013). Nuts and bolts of entrustable professional activities. Journal of Graduate Medical Education, 5(1), 157–158.
https://doi.org/10.4300/JGME-D-12-00380.1
van de Ridder, J. M. M., Stokking, K. M., McGaghie, W. C., & ten Cate, O. T. J. (2008). What is feedback in clinical education? Medical
Education, 42(2), 189–197. https://doi.org/10.1111/j.1365-2923.2007.02973.x
Watling, C., & Ginsburg, S. (2019). Assessment, feedback and the alchemy of learning. Medical Education, 53(1), 76–85.
https://doi.org/10.1111/medu.13645
Watling, C., Driessen, E., van der Vleuten, C. P. M., & Lingard, L. (2013). Learning from clinical work: the roles of learning cues and
credibility judgements. Medical Education, 47(2), 192–202. https://doi.org/10.1111/medu.12088
Zimmerman, B. J. (2002). Becoming a self-regulated learner: An overview. Theory into Practice, 41(2), 64–70.
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