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From the lived experiences of the participants who took part in this research there appear to be a number of intertwined core facets that together seem to influence the value and

impact of feedback on ongoing learning for pre-registration healthcare students. These will now be considered in turn.

Relationality

Utilisation of the community of practice theory by Wenger (1998) allowed this research to identify the challenges that these student participants encountered in relation to feeling part of a likeminded community. The “Identity of Feedback” chapter explored the tensions felt by the participants when being peripherally located in multiple communities of practice and the sense of ill fit that this generated. As novice healthcare practitioners there was evidence from the student narratives that feedback within a new environment often created an embodied, or emotional, response (Christie et al., 2008; J Sargeant, Mann, Sinclair, Vleuten, & Metsemakers, 2008; J. Sargeant et al., 2011) as the student strove to belong.

Belonging to a community of practice with a common purpose was a challenge for some of the students. In particular, I provided evidence from Dawn who experienced tension which appeared to stem from her being unsure about her purpose within a learning situation. The lifeworld “sociality” aspects – which I will call “relationality” to communicate the meaning of the relationship between aspects – of Dawn’s experience were significant to the perceived impact of her feedback experience. This research has illuminated disconnect with regards the primary purpose of a learning situation, with clear tensions between healthcare delivery and learning, and inconsistencies between authentic clinical practice and university-based clinical practice. It is fundamental that learning environments are clearly labelled as such in order that students understand that their role within them is learning. This links to evidence from the research data that signals that students do not always recognise potential

feedback situations, there is ambiguity regarding purpose of feedback and that learning from feedback is not always immediate.

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This research has also highlighted that there is a gap between the situated position of a novice and an expert within a single community of practice. The community of practice in which a student is placed to learn needs to be learning-focussed and clearly articulated by educators as a learning space. Educators need to give students permission and

encouragement to expose their learning needs without being fearful and take ownership of their ongoing learning such that they are fit for practise as a healthcare professional on qualification.

Purpose

This thesis has presented a chapter on the “Purpose of Feedback” which articulates the difficulties that students face in understanding feedback and the lack of clear direction that some students appear to experience when engaging with feedback. This research has shown that it is essential that the behaviour of educators is intended and their feedback intentional as there is some evidence that the language used by educators may have unintended consequences. There is suggestion from the research data that this is more acute if there is no opportunity for the student to clarify their understanding of feedback through dialogue with an educator.

This research gave rise to surprising evidence that some students and educators align feedback with therapy. My adoption of a phenomenological approach to this research, through which the participants were invited to discuss their lived feedback experiences, was welcomed by some as a form of healing. This is interesting from the perspective of my participants being situated within a healthcare discipline in which nurturing and caring are expected. As my participants were all drawn from a healthcare background, my research is unable to indicate whether this finding is unique to healthcare or more widespread. It does, however, highlight the multi-layered interpretation of feedback by its users, suggesting that feedback may have more than one purpose. Furthermore, the descriptions of experiences brought to life through the phenomenological approach show the ambiguity and

contradictions regarding the purpose and essence of feedback due to the complexity of the experiences explored.

Self

This research has identified a significant tension for students between their quest to take ownership of their learning and seek direction and explicit guidance from an educator. Whilst discussing this within the “Self”, this is undoubtedly also linked to “Purpose”,

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providing an illustration of how these aspects of the feedback experiences are entwined within one another. There is evidence that students are challenged by defence of their performance versus engagement with feedback for learning. Also implicit within the “Self” and interlinked to the “Purpose” is the extent to which students and educators are feedback literate such that they can accurately and effectively engage with feedback. This highlights potential differences between in the individuals’ “self” within a single community of practice, often adding a dimension of power or “gatekeeping” to the feedback experience.

Authenticity

Authenticity of the learning experience is a consistent message that has emerged from this research. Unsurprisingly, students desire learning experiences that are authentic to their intended professional practice. This research provides evidence to indicate that students are challenged by those learning experiences that do not mirror genuine clinical practice, and it has exposed the false authenticity within some aspects of university-based practice

learning.

8.3.1 Proposed model of integrated feedback

Self, Purpose, Authenticity and Relationality appear to be difficult to divorce from one another in the context of learning from a feedback experience such that it has the opportunity to support ongoing learning. With this in mind, Figure 3 offers a crude visualisation of how these appear to be linked in the context of this research.

Figure 3 on the following page shows the multiple communities of practice as the foundation of the model. These communities of practice should be learning-focussed,

offering opportunity for safe questioning and dialogue, and promoting an ethos or culture of reflection as the norm. Both student and educator members of these communities of

practice need to be appropriately feedback literate in order that they are clear about the purpose of a given feedback experience and have the skills necessary to support an agentic approach to ongoing learning.

Into the multiple communities of practice fits the self. The self represents the student, who needs to ensure that they remain learner-focused within the learning-focussed communities of practice. The self needs to push the boundaries of self-actualisation, at the expense of remaining secure, in order that they maximally gain from a feedback experience. The self needs to perceive his/herself as worthy of feedback.

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Figure 3: Model of integrated feedback

Into the self is situated the feedback experience. Without a clear purpose of feedback and it being explicitly related to the authenticity of intended healthcare practice, the perceived value and impact of the feedback on ongoing learning is unlikely to be maximised.