UNIVERSIDAD DE COSTA RICA

Several conclusions were drawn after the analysis of transcription verbatim of this study. Firstly, the data collected demonstrated that learner’s associate the term ‘feedback’ with the information, message or teacher’s reaction after performance of an activity with an aim of giving an insight about performance. Learners expect to receive formative feedback during daily activities of their clinical practice irrespective of the level of their study or how long they have been in a unit.

Secondly, the results from this study concluded that learners perceived that feedback should be provided after any activity of patient care they engage in not necessarily only after assessments. However, most of the feedback they receive is evaluative (summative) and not formative since the feedback they receive comes mainly during performance of procedures for grading.

Besides, feedback provision in this study was found to be mostly done through written or verbal means and usually provided to one learner at a time, a result that which does not affords for flexible feedback provision considering the human resource strain the clinical area is currently facing.

As expected the results illustrated that both positive and negative feedback are prevalent during clinical teaching-learning. It can also be concluded that both positive/reinforcing feedback motivated the diploma in nursing learner in goal pursuit or relaxes the learner as he/she will be regarding herself to have reached the goal. On the contrary, negative/constructive feedback either demotivated some learners as he/she may feel incapable to reach the goal or motivated goal pursuit when it signalled insufficient goal progress in the learner. The study results revealed that negative feedback passed to learners through verbal means could be more destructive compared to written negative feedback. The judgemental language used and non-verbal cues used by clinical teachers neither draws the learner closer to the teacher nor trigger the learners’ interest to seek more feedback and practice.

The investigator can also conclude that feedback that clinical teachers provide to novice learners should be critically moderated as it can have detrimental effects or be a nutrient for professional

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and personal growth of these learners. Learners in this study mostly cited their first clinical year feedback encounters as their most fascinating or remembered scenarios.

The other conclusion reached is that the responses from focus groups made up of senior learners demonstrated that these learners tend to be more comfortable with negative feedback compared to their junior counterparts. Responses demonstrated that negative feedback to senior learners could elicit their self-regulation mechanisms and self-directed learning for goal attainment whereas novices preferred to positive (versus negative) feedback for goal pursuit. Basically, we argued that the amount of negative feedback should increase as the learner moves across the novice expert continuum in order to produce more educative and catalytic effects from feedback provided. It would be encouraging if clinical teachers in this context utilise the findings of this study by increasing negative feedback as the learner transit from novice (first year) to expert (third year) to promote the learner goal pursuit and ultimately improve their performance, a call similar to that by Fishbach, Eyal and Finkelstein (2010).

Due to observations that learners are more interested in marks than comments when feedback is provided, we argue that the program should conduct more formative assessments and feedback where no grades are utilised but rather emphasis is put on improvement of performance.

The investigator also concludes that most of the feedback provided to learners is of verification type making it ineffective to identify their weaknesses if not accompanied by the equally important elaborations to ensure learners’ errors on performance are addressed. Besides, the feedback message is usually contaminated with decretory language, personalisation and favouritism further making it difficult for the learner to accept it. Finally, feedback was found to lack necessary scaffolds to help improve learners’ cognitive footing.

Feedback provided to learners is haphazard with no model or standards followed or agreed by clinical teachers to ensure its effectiveness. Besides, a theory-practice disjunction exists where recommended feedback techniques or theories are rarely applied in practice.

The results supported the conclusions made by Molloy & Boud, in 2013, when they concluded that external feedback does not always concur with the learner’s internal perception of task achievement as it is either augmented or conflicted with conclusions reached by the learner during internal feedback. Likewise learners in this study accepted, rejected or ignored external feedback depending on their view of such external feedback in relation to their self-assessment. Moreover, learners in this study do not only rely on the teachers’ (external) feedback as but they often generate their own

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self-evaluation, reflection as well as self-regulatory mechanisms. These mechanisms have helped some learners to adapt better to handle negative feedback by directing their learning efforts as well as re-adjusting their learning goals and strategies.

In light of learning theories, it can be concluded that feedback provision in this study mainly follows the behaviourist perspective where the teacher tells the learner whilst the latter assumes a passive role. Feedback is rather being delivered like a ‘prescription of change’ (Chowdury & Kalu, 2004).

In summary, feedback is viewed, handled and used differently by learners who participated in this study. Precisely, the study results revealed that if feedback is provided it usually follows a ‘behaviourist feedback ritual’ (Molloy & Boud, 2013; Mory, 2004). Occasions when feedback is provided was described by learners to be characterised by teachers telling learners about their performance with little time allowed for a dialogue. We therefore, support the Molloy & Boud, (2013) proposed paradigm shift where learners and teachers are expected ‘’to view feedback as a system of learning, rather than discreet episodes of teachers ‘telling’ learners about their performance”.