Effective Feedback in Medical and Health Science Education, in Malawi: Perceptions and Experiences

Background Well-delivered feedback can positively influence learning behaviours and bring actual and desired performances closer together. This is especially important for patient safety in health professions education. Feedback only aids learning when used effectively and accepted by its recipients. Most current literature on effective feedback is from western perspectives that we cannot assume will be applicable to all cultures. This study seeks to contribute to discourses relating to feedback effectiveness, exploring concepts of optimizing it in a sub-Saharan healthcare education institution. Methods This qualitative study investigated student and lecturer perceptions and experiences of receiving and delivering feedback at College of Medicine (CoM), Malawi, and how stakeholders felt this influenced self-reported behavioural change in response . Data was collected using semi-structured interviews, with students and lecturers, from across all faculties at CoM, and subsequently analysed sequentially for emerging themes using a grounded theory approach. Results Inductive data analysis resulted in eight interconnected themes: conception of feedback; affective dimension; thirst for feedback; need to achieve; feedback conversations; self-preservation; feedback relationships; students’ ideal feedback which included the desire for pastoral support. Several tensions also emerged from student data: Firstly, a yearning for feedback but experiencing corrective feedback as emotional assaults requiring action for self-preservation. Secondly a preference for receiving affirmative feedback, despite acknowledging that corrective feedback can lead to improved performance. Thirdly, participants valuing dialogue highly as opportunities to seek clarification/understanding/justify themselves, which was deemed less likely with senior faculty whose feedback was paradoxically greatly respected. Whilst students greatly valued feedback from senior faculty, due to cultural respect for hierarchy, they felt less able to engage in the dialogue they desired. Finally, both stakeholder groups equated hard work with success and that critical feedback was perceived as accusations of student laziness. Conclusion ‘Best feedback practices’ articulated by students mostly aligned with western educational discourses but in contrast to international literature students desired lecturers to fulfil pastoral roles rather than simply provide feedback on tasks. Cultural expectations and respect for hierarchy needs to be considered when building evidence-based feedback in a Malawian context.