The Art and Science of Clinical Feedback
May 07, 2025
Dr Jack Madden
Feedback is one of the most powerful influences on learning, yet in the clinical setting, it is often poorly executed or entirely absent. Whether you’re a seasoned nurse educator mentoring grads, or a junior nurse seeking to refine your practice, understanding the nuances of effective feedback can dramatically enhance professional growth.
Why Feedback Matters
- We are bad at giving feedback. Many nurse educators deliver feedback based on personal intuition or their own experiences, rather than using evidence-based methods. The busy, high-pressure environment of healthcare settings often compounds the problem, leading to rushed or absent feedback.
- Feedback is the single most important influence on learning. Without it, progress stagnates, and errors persist.
- Effective feedback isn’t just about giving—it’s about seeking and receiving it well. Understanding what good feedback looks like allows you to become an active participant in your own learning.
The Anatomy of Effective Feedback
For feedback to be truly valuable, it must contain three key elements:
- A mutual understanding between the educator and learner about the goal.
- A clear comparison between observed performance and the desired performance.
- Actionable steps to bridge that gap.
Pre-Feedback: Setting the Stage for Success
Effective feedback starts before the task even begins. For feedback to be impactful:
- It should be delivered by a trusted supervisor with high emotional intelligence.
- The task should be agreed upon beforehand, with clear learning objectives.
- The feedback should be formative, not summative (i.e., aimed at improvement rather than judgment).
- The complexity of the task should be appropriate to the learner’s level - neither too simple nor too advanced.
🚨 Poor Pre-Feedback Practices 🚨
- Giving feedback without consent or prior discussion of goals.
- Delivering feedback during a high-stakes assessment.
- If the learner does not trust the educator, feedback loses its impact.
- Assigning a task that is too challenging or too simplistic.
During the Task: Observing and Engaging the Learner
Feedback must be grounded in close observation of performance. Educators should:
- Monitor the learner’s actions carefully rather than making assumptions.
- Ensure the stakes are manageable - high-pressure situations are not ideal for learning.
- Encourage the learner to explain their thought process, rather than making judgments about decision-making.
🚨 Poor Intra-Feedback Practices 🚨
- The environment is too high-stakes for constructive learning.
- The learner’s performance is not adequately observed.
- Feedback is based on assumptions rather than direct assessment.
Post-Task Feedback: The Debrief That Makes a Difference
The way feedback is delivered after a task is just as important as the task itself.
- Timing is crucial—feedback should be given promptly in a private setting.
- A two-way discussion should take place, allowing the learner to process their emotions and reflect on their performance.
- The educator should ask questions that guide the learner to identify gaps in their own performance.
- Feedback should be specific, actionable, and limited to 1-3 key points.
- There should be an agreement on how to revisit the task for further improvement.
🚨 Poor Post-Feedback Practices 🚨
- Feedback is delayed, forgotten, or rushed.
- The learner has no opportunity to reflect or provide their perspective.
- Discrepancies arise between the learner’s and educator’s perception of the performance.
- The educator talks at the learner rather than engaging in discussion.
- Feedback is vague or personal, and not based on observed behaviour.
How to Maximise Your Learning Through Feedback
If you’re a junior nurse, here’s how to make the most of the feedback process:
- Find your learning edge. This is the space between tasks that are too easy and too hard - the zone where meaningful learning occurs.
- Differentiate between formative and summative feedback. Know when you need genuine performance-based feedback versus a competency assessment.
- Seek out the right supervisors. Ask for feedback on specific aspects of your performance that you find challenging.
- Be disciplined in repeating the process. Learning requires practice—schedule regular feedback sessions.
- Push for specificity. If your feedback is “just do more cases,” ask for 1-3 concrete improvements to focus on.
- The magic number is 8. Studies suggest that around eight observed performances, assessed by multiple educators, lead to the most meaningful improvement.
Putting it all together
Feedback in nurse education isn’t just about passing judgment—it’s about fostering continuous improvement. Whether you’re giving or receiving it, the principles of clarity, specificity, and mutual engagement are key to making feedback truly effective. By prioritising these elements, we can create an educational culture that drives excellence in nursing practice.
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