Nurse Education Today 34 (2014) 552–559

Contents lists available at ScienceDirect

Nurse Education Today

journal homepage: www.elsevier.com/nedt

Review

Students' and teachers' views of written feedback at undergraduate

level: A literature review
Natalie M. Agius a,⁎, Ann Wilkinson b,c,1
a
13J Bradmore Road, Oxford OX2 6QP, United Kingdom
b
Florence Nightingale School of Nursing and Midwifery, King's College London, United Kingdom
c
Department of Postgraduate Research, Florence Nightingale School of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA,
United Kingdom

a r t i c l e i n f o s u m m a r y

Article history: Objectives: To explore undergraduate students' expectations and teachers' views of written feedback.
Accepted 2 July 2013 Design: Narrative literature review.
Data Sources: Seven electronic databases were searched for primary research published in English with addi-
Keywords: tional manual searches and reference tracking.
Feedback Review Methods: Systematic approach to search strategy, selection and appraisal of papers, data extraction
Annotation
and synthesis following Hawker et al.'s (2002) guidelines.
Nurse education
Students
Results: 21 studies met the inclusion criteria. Four student themes were identified concerning written feed-
Higher education back: quality, quantity and location of feedback, feed-forward and timeliness. Teachers reported that time
pressures, institutional policies, and administrative issues affect feedback provision.
Conclusions: Rigorous research is needed to gain a better understanding of students' expectations of written
feedback. Strategies need to be adopted to meet students' expectations and educate students to take an active
role and reflect on the feedback received.
© 2013 Elsevier Ltd. All rights reserved.

Introduction interpretation and disadvantages, concluding that annotations require

simplicity and standardisation in order to enhance understanding. No
Feedback is considered a central factor within the learning process review was found considering students' expectations regarding written
(Nicol and Macfarlane-Dick, 2006) and the UK Quality Assurance feedback for academic work.
Agency for Higher Education (QAA, 2008) recognises feedback as a
measure of teaching quality. The UK National Student Survey (NSS) Aim
measures final-year degree students' satisfaction with their studies
and feedback has consistently been rated lowest despite strategies This paper aims to review and evaluate literature investigating the
devised and implemented by Higher Education Institutions (HEIs) views of students and staff on written feedback. The specific objectives
(Nicol, 2010). This suggests that students do not find their expecta- are to:
tions met. This has been a challenge for nursing education in the UK.
Black and Wiliam's (1998) seminal review considering 250 studies - explore undergraduate students' expectations of written academic
investigating formative assessment in a range of educational contexts feedback
concluded that good and extensive feedback leads to increased student - examine university teachers' views on written academic feedback
engagement and higher quality learning. More recently Parboteeah and - identify the implications for nursing education.
Anwar (2009) reviewed the impact of written feedback on students'
motivation to improve their learning. Similarly to Black and Wiliam's Method
(1998) findings, students' motivation appeared directly proportional
to the quality and amount of feedback received. Ball's (2010) review Search Strategy
explored different styles of annotation and their purposes, difficulty of
Seven electronic databases were searched from inception to
December 2012: British Nursing Index, CINAHL, EMBASE, ERIC, MEDLINE,
⁎ Corresponding author. Tel.: +44 7510147952.
PsycINFO, and SCOPUS (Table 1). Using Greenhalgh and Peacock's (2005)
E-mail addresses: [email protected] (N.M. Agius), [email protected]
(A. Wilkinson). snowball sampling technique, key journals were scrutinised for other
1
Tel.: +44 20 7848 3708; fax: +44 20 7848 35. relevant publications. In addition, reference lists in included studies

0260-6917/$ – see front matter © 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.nedt.2013.07.005
 N.M. Agius, A. Wilkinson / Nurse Education Today 34 (2014) 552–559 553

Table 1 Philippines, and Malaysia (n = 1 for each). Single HEI studies

Example of search strategy (PsychINFO).
predominated. Exceptions were: Bone (2006), 11 HEIs; Carless (2006),
AND AND 8 HEIs; Hounsell et al. (2008), 3 HEIs; and Higgins et al. (2002), 2 HEIs.
M t Students Expectations Feedback All studies were cross-sectional.
e e Mentor Perception
S r
The majority of the studies were qualitative (n = 11) or utilised
Teachers Attitudes
H* m both qualitative and quantitative methods (n = 8). The sampling
procedures, when reported, employed primarily convenience and
F purposive methods, with three studies using probability sampling
r Student$ Feedback
e Trainee$ Perception$ Annotation$ (Perera et al., 2008; Duers and Brown, 2009; Orsmond and Merry,
e Mentor$ Attitude$ Formative asseessment 2011). Pilot work was mentioned in four studies (Lizzio and Wilson,
Marker$ O Expectation$ O Summative assessment O 2008; Duers and Brown, 2009; Alamis, 2010; MacLellan, 2010), and
T Tutor$ R Experience$ R Feed?forward R
three reported psychometric testing of questionnaires (Carless, 2006;
e Teacher$ Expect$ Comment$
x Bevan et al., 2008; Lizzio and Wilson, 2008).
Lecturer$ Perspective$ Marking
t Sample sizes in quantitative studies varied between 44 (Weaver,
Staff Perceive$
Educator$ Reaction$ 2006) and 1740 (Carless, 2006). The majority reported samples greater
t
e Facult$ View$ than 90 respondents. There was variability in response rates (RRs),
r Academic$ Opinion$ mostly less than 70%. Three studies did not report RR (Carless,
m Understand$ 2006; Lizzio and Wilson, 2008; Alamis, 2010). Instruments were
s Thought$ researcher-developed except for two studies (Hounsell et al., 2008;
Think
Alamis, 2010), although it was unclear whether their measures were
⁎ Medical Subject Heading.
previously validated.

and secondary sources were searched manually to identify additional Students' Expectations and Teachers' Views of Written Feedback
papers. Eligibility criteria were applied (Table 2).
Four themes related to students' expectations were identified:
Quality Appraisal and Search Outcome quality of feedback, quantity and location of feedback, feed-forward,
and timeliness. Teachers' views will be integrated with the findings
The quality of quantitative studies was evaluated using Rees et al.'s concerning students.
(2010) checklist. For qualitative studies RATS (2011) and COREQ criteria
(Tong et al., 2007) were used due to the latter's focus on focus groups. Theme 1 — Quality of Feedback
Fig. 1 shows the search outcomes and main reasons for exclusions.
Codes were used to categorise study limitations and strengths (Table 3). Three main findings concerning quality were identified from 13
studies: balance between negative and positive comments, focused
Data Abstraction and Synthesis feedback, and linguistic clarity and legibility (Table 5).

Extracted data are summarised in Table 4. Each study was exam- Balance Between Negative and Positive Comments
ined for emerging themes related to the review objectives. Extracted
findings were assigned codes and a thematic analysis (Aveyard, The importance students attribute to receiving positive comments
2010) was conducted and used to present the information in the alongside critical ones emerged in seven studies (Table 5). Imbalance
review. between positive and negative feedback was generally perceived as
unhelpful.
Results Following semi-structured interviews with first-year students
(n = 19), Higgins et al. (2002) developed a questionnaire and sur-
Methodological Features veyed 94 students. The majority (n = 80, 86%) rated critical feedback
as important and 91% (n = 85) wanted explanations for their mistakes.
Twenty-one studies retained for full appraisal originated from six Qualitative findings indicated that students valued balance between
countries: UK (n = 14), Australia (n = 3), China, the USA, the positive and negative feedback.
Weaver (2006) conducted focus groups (FGs) and surveyed students.
Table 2 FG participants (n = 22) brought samples of corrected work for analysis.
Inclusion and exclusion criteria. The survey indicated that students (n = 18, 40%) felt demoralised by
Inclusion criteria Exclusion criteria negative feedback, with the majority (n = 34) strongly agreeing they
wanted more positive comments. Validity was limited by low RR (8%),
English language publications Studies including graduate,
post-qualification or distance learning however, analysis of essay samples demonstrated absence of positive
students feedback. Additionally, FG participants emphasised that positive com-
ments motivated students.
Studies exploring undergraduate Studies including pre-university Duncan (2007) offered second-year students feed-forward for
students' and/or university teachers teachers
their next essay in the form of an individualised learning plan based
expectations, experiences and/or
perceptions of written feedback on feedback analysis of their past essays. Examination revealed that
they lacked feed-forward and feedback consisted primarily of vague
Studies comparing expectations, Studies where the level of education of praise. FGs identified student anger when a high mark was not awarded
experiences and/or perceptions of the students involved is not reported
in the absence of clear critique.
university teachers and undergraduate
students about written feedback. Bevan et al. (2008) surveyed first-year students (n = 45,
Studies where the method of feedback RR = 56.9%) online, using a modified version of a pre-existing
provision is unclear questionnaire (Cronbach α = 0.748), followed by FGs with students
Studies which have both a high item (n = 20). The majority (n = 32, 72%) valued critical comments, how-
and a high unit non-response rates
ever, FG members also expected such comments to be accompanied
554 N.M. Agius, A. Wilkinson / Nurse Education Today 34 (2014) 552–559

Fig. 1. Flow diagram of paper selection.

by clear explanations. Their finding was corroborated in Weaver's preferred focused comments. Third-year nursing students participating
(2006) and Lizzio and Wilson's (2008) studies. In the latter study, con- in FG discussions reported in Duers and Brown's (2009, p. 657) qualita-
tent analysis of second- and third-year students' (n = 57) written tive study found comments such as ‘weak section’ or ‘work on this’ to be
criteria evaluating the quality of their feedback was used to too vague and unhelpful.
develop and pilot a 27-item Likert scale questionnaire on feedback Only Bailey and Garner's (2010) study provides information about
quality (α = 0.91); students from other disciplines were then surveyed teachers' views on the provision of generalised feedback. Institutional
(n = 277). Critical comments presented in a considerate and encourag- pressure to give timely feedback resulted in the use of ‘cut-and-pasted’,
ing tone motivated students to persist when their performance on as- brief, and unspecific feedback, producing a standardised format.
sessment was less than expected. Furthermore, students in Poulos and
Mahony (2008) reported that while both positive and critical com-
ments were considered important, dominance of negative feedback Linguistic Clarity and Legibility
had a demoralising effect and reduced potential to stimulate learning.
Alamis (2010) reported similar results from second-year students Difficulty in deciphering lecturers' writing was identified in six
(n = 121) using a pre-existing questionnaire which was modified and studies (Table 5). Carless (2006) conducted a multi-site survey in
piloted after feedback analysis of 70 corrected essays. The majority of China (n = 460 teachers, n = 1740 students, eight HEIs) which fo-
students (n = 92, 76%) expected both positive and critical comments. cused primarily on assessment. The previously validated questionnaire
Teacher's views about balancing positive and negative comments (α = 0.82 student; α = 0.80 teacher) had two items related to feed-
were not addressed in any studies. Orrell (2006) and Bailey and Garner back. A further 52 students completed open ended questions
(2010) do, however, suggest that teachers recognised the value of posi- on feedback experience and 21 students and five teachers semi-
tive comments. Orrell (2006) observed sixteen experienced markers, structured interviews. Some learners could not decipher handwriting
interviewed them, and analysed their feedback to examine the congru- or understand what the teacher meant, which caused frustration. Aca-
ence between their feedback beliefs and practices. Their feedback prac- demic discourse and marking criteria terminology were poorly
tice did not match their views. While there was a general belief that understood.
students' accomplishments and improvements were highlighted, feed- Three further studies identified academic terminology as the main
back focused on grade justification. Semi-structured interviews with 48 reason for not understanding feedback (Higgins et al., 2002; Duncan,
teachers in Bailey and Garner's (2010) qualitative study suggested that 2007; Duers and Brown, 2009), while Lizzio and Wilson (2008) found
due to the sensitivity of feedback, teachers reported attempts to motivate that abbreviations were a problem. Nursing students preferred oral
students using frequent positive comments. Annotations were not feedback as it was perceived to be easier to interpret (Duers and
analysed to establish whether practice corresponded to intent. Brown, 2009). Respondents to Carless (2006) and Duncan (2007) advo-
cated the need for guidance on academic language and marking criteria.
Focused Feedback Teachers in Bailey and Garner’s (2010) and Koh’s (2010) studies
recognised that learners had difficulty understanding academic dis-
Seven studies addressed the importance of focused and specific course. Participants in Bailey and Garner’s (2010) study claimed
comments (Table 5). Students' perceptions that greater precision is that due to time pressures they still resorted to using marking criteria
needed were confirmed in both Weaver's (2006) and Duncan's (2007) terms. It is not mentioned whether these were explained to students.
analysis of feedback. Nurse educators (n = 20) interviewed by Koh (2010) believed using
Straub (1997) asked first-year students (n = 142) to rate assessment and marking criteria terminology helped students under-
(1 = definitely prefer, 4 = definitely do not prefer) 40 different stand the targeted standard. However, some reported that criteria
teacher comments written on an essay. Both student comments from were not explained to students and some teachers might have diffi-
open-ended questions and mean ratings suggested students strongly culty elucidating.
 N.M. Agius, A. Wilkinson / Nurse Education Today 34 (2014) 552–559 555

Theme 2 — Quantity and Location of Feedback Feed-forward was emphasised in only four teacher studies (Bevan
et al., 2008; Bailey and Garner, 2010; Koh, 2010; Orsmond and Merry,
Twelve studies suggest that students valued extensive, detailed 2011). However, most participants in Bailey and Garner (2010) con-
feedback (Table 5). Higgins et al.'s (2002) respondents expected rec- sidered feed-forward unnecessary when high marks were awarded.
iprocity of effort in feedback on their work. Similarly Straub's (1997) From these four studies, only Orsmond and Merry (2011) compared
and Lizzio and Wilson's (2008) respondents perceived detailed teachers' (n = 6) intentions with their feedback practices. Despite
comments with examples and explanations as evidence of deeper their intentions, none of the teachers provided suggestions for im-
engagement from lecturers, as opposed to grammatical corrections. provement. Only 48% (n = 24) of lecturers in Perera et al.'s (2008)
Bone (2006) conducted FG interviews with students (n = 65) and survey reported providing suggestions for improvement, when 93%
tutors (n = 12, 11 HEIs), to explore their perceived benefits of forma- (n = 278) of students expected them.
tive assessment on learning. Students emphasised the importance of
detailed feedback, however, there was a distinction between forma-
Theme 4 — Timeliness
tive and summative feedback; students saw little point in receiving
feedback concerning completed modules.
Students expected early feedback and stressed the importance of
Hounsell et al. (2008) surveyed first- and final-year students
its immediacy in six studies (Table 5). The reason reported for want-
(n = 782), followed by FGs (n = 32) with students (n = 69) from
ing feedback early was its relevance for future work (Bone, 2006;
the same sample. Thematic analysis of the qualitative data revealed
Duncan, 2007; Poulos and Mahony, 2008). These three studies, how-
that students from both years were dissatisfied with the scantiness
ever, referred mainly to formative rather than summative feedback in
of their feedback. Perera et al. (2008) surveyed third-year students
relation to timeliness.
(n = 407) and teachers (n = 51). Only 38% (n = 19) of teachers re-
Timeliness was mentioned by teachers in three studies (Bevan et al.,
ported giving explanations for marks provided, while 75% (n = 305)
2008; Bailey and Garner, 2010; Koh, 2010). They acknowledged the im-
of students believed effective feedback involved more than grades.
portance of the prompt return of feedback to benefit students. In Koh
Robinson et al. (2011) tested whether high or low marks versus
(2010), however, teachers attributed less relevance to time with summa-
limited or extensive feedback had an effect on students' ratings of
tive feedback because they perceived it to be too late for students to act
feedback. The quantity of feedback for the essay had a statistically
on.
significant effect (F(1,152) = 113.46, p = 0.001) on students' percep-
tion of the value of feedback, irrespective of whether a low or high
mark was awarded. Other Factors Affecting Feedback Quality
Pokorny and Pickford's (2010) thematic analysis of FG interviews
revealed that first- and third-year students (n = 18) preferred margin Teachers in Bailey and Garner (2010) and Tuck (2012) had further
comments to feedback on cover sheets. This was echoed by respondents concerns about writing feedback. These related to institutional policies
in Bevan et al. (2008) who preferred annotations because they distin- regarding feedback, awareness that a colleague might read their com-
guished good writing from one needing improvement. ments, and the need to provide grade justification in case of student ap-
MacLellan (2010) survey demonstrated a statistically significant peal. The latter finding was echoed by Orrell (2006). Teachers felt that
difference between teachers' and students' perceptions of detailed these factors negatively affected the quality, amount and form of feed-
feedback (p = b0.05). While 49% (n = 39) of teachers thought their back. Lecturers in Tuck (2012) also stressed the labour of writing feed-
feedback was frequently helpful in its detail, only 12% (n = 15) of the stu- back. These aspects of feedback-giving emerged in these two studies
dents agreed. However, the structure of this item was double-barrelled,
posing a risk of response error and views were not triangulated against Table 3
any qualitative data. Carless' (2006) survey showed similar results; Codes used in Table 4 to categorise the studies' strengths and limitations.
however, validity was also threatened by a double-barrelled item. Code Study limitations
FGs in Carless (2006) revealed that providing detailed feedback was
A Small sample size which has implications for generalisability of findings
undermined by time limitations and large classes.
B One HEI thus limiting generalisability of findings
In three studies teachers perceived that students were primarily in- C Non-probability sampling so participants may be atypical of the population
terested in marks (Carless, 2006; Bailey and Garner, 2010; Tuck, 2012). D Demographics of sample not reported
Tuck's (2012) qualitative study examining teachers (n = 14, 6 HEIs) E Low response rate which decreases representativeness of the study
employed various data collection methods (Table 4), however only in- F Validity and reliability of tool uncertain
G Sampling strategy not fully explained
terview findings were reported. As many students did not collect essays, H 1st year students with possibly limited experience with feedback at
teachers perceived that their efforts were undervalued with students university
solely interested in marks. They perceived that giving marks hampers I No clear theoretical framework identified
students' engagement with feedback, a view echoed in Orrell (2006). J Limited number of quotes used to support findings
K Researcher's relationship with participants not reported
L Qualitative data analysis technique not mentioned
Theme 3 — Feed-forward
Study strengths

Eleven studies indicated that students value and expect feedback 1 Interviewer unknown to students
that incorporates advice for improvement (Table 5). Respondents in 2 Pilot work carried out
3 Clear description of data analysis and data collection methods
Straub (1997) and Alamis (2010) showed resistance when advice was
4 Methodology triangulation improves validity of the study
worded in the form of imperatives rather than suggestions. Although 5 Multiple HEIs which adds to the generalisability of the findings
feed-forward provision was considered important by students, essays 6 High response rate
analysed by Duncan (2007) and Weaver (2006) showed that guidance 7 Large sample size
8 Tool tested for internal consistency
for improvement was not prevalent in written comments. The expecta-
9 Members validations to verify researchers' interpretations
tion of feed-forward generally stemmed from students' aspiration to 10 Findings supported by representative quotations
improve future assessment grades (Carless, 2006; Hounsell et al., 2008; 11 Discussion of the theoretical framework of research
Lizzio and Wilson, 2008). Healthcare students in Poulos and Mahony 12 More than one researcher themed and coded the data
(2008), however, reported wanting feed-forward to improve not only 13 Discussion of how discrepant findings were addressed
14 The study addresses ethical issues appropriately
their grades, but also their practice following graduation.
 556
Table 4
Methodological features of included studies.

Author/s & location Primary aim/s Study design, data collection, data analysis methods N a Sampling, discipline (year of study) Key strengths &
(RR) limitations

Alamis (2010) Investigate students' experiences and preferences Cross-sectional, quantitative and qualitative study 141 Convenience; B C D F 2 14
Philippines with feedback and perceptions of the Survey, piloted SCQb (descriptive statistics) (–c) english (2nd)
characteristics of helpful feedback Analysis of corrected essays (n = 70)
Bailey and Garner (2010) Explore teachers' perceptions of the purpose of Cross-sectional, qualitative study 48 Purposive; students from various disciplines B I L 7 11 14
UK written feedback within the context of their Semi-structured interviews

N.M. Agius, A. Wilkinson / Nurse Education Today 34 (2014) 552–559

teaching practice
Bevan et al. (2008) Explore students' and tutors' expectations and Cross-sectional, quantitative and qualitative study 45 Purposive; ABCEH
UK views on feedback provision and utility Students: online survey (56.9%) bioscience (1st) 1 4 8 10 14
4 semi-structured FGsd 20
Teachers: interviews 21
Bone (2006) Examine the use of formative assessments in Cross-sectional, qualitative study Convenience; H I L 1 5 10 14
UK different institutions and explore students' and Students & teachers: Se = 65 law (1st) teachers' perceptions of
perceptions of teachers' benefits of formative FG interviews Tf = 12 formative feedback not
feedback reported
Carless (2006) Examine students' and tutors' experiences with Cross-sectional, quantitative and qualitative study Convenience; C D (for quantitative
China assessment and feedback processes and differences Students: survey, 5-point Likert scale SCQ focused 1740 (–) education (3rd & 4th) for qualitative survey & interviews survey) C 4 5 8 10 14
in perceptions between tutors and students. on assessment with two items on feedback (α = to decrease language
0.82) (descriptive statistics, inferential statistics but and interviewer bias, 6
test not reported) interviews carried out
Survey, open-ended SCQ focused on feedback 52(–) by native research
Interviews (thematic analysis) 21 assistant
Teachers: survey, 5-point Likert type SCQ similar to 460 (–)
students (α = 0.80)
FG interviews (thematic analysis) 5
Duers and Brown (2009) Explore students' experiences with formative Cross-sectional, qualitative study 14 Random; B M I K 2 10 14
UK feedback FG interviews (thematic analysis) Nursing (3rd)
Duncan (2007) To find out whether the provision of feed-forward Cross-sectional action research study Analysis of 16 Convenience; B I L 10 12 14
UK results in improved students grades in their next feedback on essays (150 sheets) BA in special needs & inclusion studies (2nd)
assignment FG interviews
Higgins et al. (2002) Investigate students' understanding and Cross-sectional, quantitative and qualitative study Convenience; C F H K 4 5 6 10 14
UK perceptions of written feedback Semi-structured interviews (thematic analysis) 19 business and humanities (1st)
Survey (SCQ) (descriptive statistics) 94
(77%)
Hounsell et al. (2008) Explore students' experiences with assessment and Cross-sectional, quantitative and qualitative study Purposive; C E F K 4 5 7 10 14
UK the provision of written feedback Survey; the experience of teaching and learning 782 bioscience (1st & final)
questionnaire (SCQ) (51%)
32 FGs (thematic analysis) 69
Koh (2010) Explore nurse education teachers' perspectives on Descriptive phenomenology Convenience; B 3 9 10 11 14
UK formative assessment and feedback Semi-structured interviews (Colaizzi) 20 nurse education teachers
Lizzio and Wilson (2008) To identify the criteria students use to evaluate the Cross-sectional, quantitative and qualitative study: Purposive; B C 2 4 7 8 10 14
Australia quality of written feedback and to understand Qualitative data: student written descriptions of 57 Qualitative data: psychology, law & arts (2nd &3rd)
students' perceptions of assessment feedback quality of feedback received (content analysis of
238 written comments)
Survey, 7-point Likert type SCQ (α of a 3-item 277(–) Survey: science, psychology, criminology, engineering
scale = 0.91, α of the other 24-item scale not (various levels)
mentioned)
MacLellan (2010) To investigate student and staff perceptions of Cross-sectional, quantitative study S = 130 Purposive; B C F 2 6 14
UK assessment and feedback students & teachers: (100%) education (3rd)
Survey, 4-point Likert type SCQ which was piloted T = 80
(80%)
Orrell (2006) To examine what kind of feedback is provided and Cross-sectional, qualitative study: 16 Purposive; B D I L 3 4 11 14
Australia the congruence between teachers' feedback Think aloud technique (Ericsson and Simon, 1984) teacher education and nurse education
believes and practices during marking while observing and tape-recording
spoken thoughts
Analysis of written feedback
Transcribed reflective response sessions (content
analysis using a grounded theory approach)
Orsmond and Merry (2011) To understand students' and tutors' perceptions of Cross-sectional, qualitative study: T=6 T = convenience B D J 3 4 14
UK feedback and students actions on receiving teachers & students S = random;
feedback Semi-structured interviews (Giorgi and Giorgi's S = 19 bioscience (2nd)
framework) analysis of feedback
Perera et al. (2008) To investigate students' and teachers' perceptions Cross-sectional quantitative and qualitative study Random; B F L 4 6 7 14
Malaysia and expectations on feedback students: Survey, 5-point Likert type SCQ 407 medical (3rd)
(descriptive statistics) (90%)
–

N.M. Agius, A. Wilkinson / Nurse Education Today 34 (2014) 552–559

post-survey discussions 51
teachers: survey 5-point Likert type SCQ (40%)
(descriptive statistics) –
post-survey discussions
Pokorny and Pickford (2010) To explore students' perceptions of useful feedback Cross-sectional, qualitative study 18 Purposive; B I M 1 10 14
UK 4 semi-structured FGs (thematic analysis) business (1st, 3rd)
Poulos and Mahony (2008) To examine students perceptions of useful feedback Cross-sectional, qualitative study – Voluntary; BKGI
Australia practices students: healthcare students (varying levels) 1 10 14
4 FG interviews (thematic analysis)
Robinson et al. (2011) To investigate what factors influence first-year Cross-sectional, quantitative study: 166 Convenience; psychology (1st) B C F H 3 6 14
UK students' satisfaction with feedback survey, 16 close-ended questions and one (100%)
open-ended question (SCQ) (descriptive statistics,
correlation analysis, t-tests, analysis of variance)
Straub (1997) To investigate students' preferences and reactions Cross-sectional, quantitative study 142 (83%) Convenience; writing (1st) B C F H 6 14
USA to different teacher comments survey, 4-point Likert type SCQ with open-ended
questions (means with no standard deviation)
Tuck (2012) To examine the lived experience of teachers as they Cross-sectional, qualitative study: 14 Purposive; different disciplines C I L 4 5 10 11 14
UK engage in feedback observation of feedback provision analysis of
feedback
interviews
Weaver (2006) To investigate students' attitudes, beliefs and Cross-sectional quantitative and qualitative study 4 –; A B C E F K P 4 14
UK perceptions of written feedback online survey, 5-point Likert type SCQ with (8%) business & design (1st, 2nd, 3rd)
open-ended questions 22
FGs (content analysis) with content analysis of
their feedback samples
a
Number of students who responded.
b
Self-completion questionnaire.
c
Not reported.
d
Focus groups.
e
Students.
f
Teachers.

557
558 N.M. Agius, A. Wilkinson / Nurse Education Today 34 (2014) 552–559

Table 5
Themes related to student expectations.

Themes Balanced positive Focused feedback Linguistic clarity Quantity and location Feed-forward Timeliness
and negative feedback and legibility of feedback

Alamis (2010) ✓ ✓
Bevan et al. (2008) ✓ ✓ ✓ ✓ ✓ ✓
Bone (2006) ✓ ✓ ✓
Carless (2006) ✓ ✓ ✓
Duers and Brown (2009) ✓ ✓
Duncan (2007) ✓ ✓ ✓
Higgins et al. (2002) ✓ ✓ ✓ ✓ ✓
Hounsell et al. (2008) ✓ ✓
Lizzio and Wilson (2008) ✓ ✓ ✓ ✓
MacLellan (2010) ✓
Perera et al. (2008) ✓ ✓
Pokorny and Pickford (2010) ✓ ✓
Poulos and Mahony (2008) ✓ ✓ ✓ ✓
Robinson et al. (2011) ✓ ✓
Straub (1997) ✓ ✓ ✓
Weaver (2006) ✓ ✓ ✓ ✓ ✓

possibly because the interviews focused on the teachers' lived and time constraints for educators, particularly in light of increas-
experience. ing student numbers. Moreover, institutional policies aiming to
standardise feedback through the use of feedback sheets and mark jus-
Discussion tification further increase workload. This may result in more general-
ised feedback at the expense of specific margin comments. The
Limitations increased use of Information and Communication Technology may
help markers deal with these constant challenges. For instance, general
Although a systematic search strategy was developed, some studies comments on feedback forms and feedback on common student mis-
may have not used consistent terminology. Moreover, language bias takes may be written electronically and thus quickly provided to stu-
exists since studies not published in English were excluded. Included dents, while sparing time for the provision of more detailed and
studies had methodological weaknesses, in particular small sample specific margin annotations.
sizes, non-probability sampling, low response rates, and non-validated Discrepancies between students' and teachers' perceptions of the
questionnaires which hamper generalisability. The multiplicity of in- helpfulness of detailed feedback (MacLellan, 2010) might result from
struments used to measure feedback creates difficulties in comparing learners' lack of insight into how comments can and should be used. Writ-
findings. Moreover, when data collection involved the self-reported ten feedback on its own does not bring improvement (Sadler, 1998; Nicol,
perceptions of feedback without the complimentary analysis of feed- 2010). If students view themselves as passive receivers of feedback with
back samples, subjectivity bias is possible. Further, if longitudinal de- no active role in their development, this creates a barrier to improvement.
signs were used, a better understanding of which feedback strategies Nursing students, therefore, particularly first-years, need to be educated
address students' and teachers' issues could be gathered. Nevertheless, on the importance of reflecting on feedback received. This might also be
the majority of studies used multiple methods of data collection, which stimulated by the adoption of other student-centred strategies such as
improve the validity of results. self- and peer-assessment, which promote student engagement.
Addressing the issue of understanding assessment criteria and aca-
Implications and Recommendations for Nursing Education demic discourse is imperative because lack of comprehension results in
the inability to act on feedback. The use of marking criteria is advocated
This review confirms findings of Parboteeah and Anwar (2009) in the literature as a tool aiding both students and teachers in assessment
and Ball (2010), that there is limited research examining student (Miller et al., 1998; Sadler, 1998, 2010). The QAA (2006) emphasises the
nurses' and their teachers' perspectives on written feedback (Orrell, importance of clear marking and assessment criteria. Guidance on criteria
2006; Duers and Brown, 2009; Koh, 2010). This is so despite the and academic discourse, therefore, needs to be provided to students. In
fact that written feedback is an important means for the development line with student-centred learning, adopting strategies that increase
of higher-order thinking skills as it promotes reflection and analysis student engagement with the standards and criteria of assessment per-
of one's work (Gopee, 2002). formance, such as the use of exemplars (Sambell, 2011) and self- and
Kluger and DeNisi (1996) note that an imbalance between positive peer-assessment (Nicol and MacFarlane-Dick, 2006), help students be-
and negative comments occurs regularly, particularly with high- and come familiar with the language and with how to utilise the criteria.
low-achieving students. Nicol and MacFarlane-Dick's (2006) feedback Moreover, having nursing students regularly engage in peer feedback is
principles stress the importance of identifying good practice to stu- important as it increases the likelihood that they become accustomed
dents. Students may not distinguish critical passages of writing from de- to receiving and providing peer review. This is crucial in healthcare for
scriptive ones if this is not mentioned. Consequently, learners might not quality improvement at both individual and institutional levels.
adjust their strategies for subsequent assessments. Studies demonstrat- While the importance of timely feedback has been a recurrent
ed that markers' comments have the power to affect students' motiva- issue in the literature (e.g. Higgins et al, 2002; Bloxham and Boyd,
tion. Balanced feedback comments, especially in the early years of 2007), the results of this review suggest that whenever the reasons
studies when learners are still adapting to a new system are, therefore, for students' dissatisfaction with turnaround times was reported, this
imperative. Teachers' feedback serves as an example for learners; the related to feedback on formative, rather than summative assessments.
consequence for nursing education is that students may adopt the The item on promptness of feedback in the NSS does not differentiate
same strategy and learn to provide respectful and balanced feedback between types of assessment when examining students' satisfaction
to patients or peers as they enter practice. with turnaround times and it is an aspect worth investigating in future
Students' expectation of margin annotations (Bevan et al., research. Although addressing the issue of slow turnaround times is dif-
2008; Pokorny and Pickford, 2010) results in increased workload ficult, the adoption of educational strategies such as the use of more
 N.M. Agius, A. Wilkinson / Nurse Education Today 34 (2014) 552–559 559

formative assessments, exemplars, and peer feedback may partially sat- Greenhalgh, T., Peacock, R., 2005. Effectiveness and efficiency of search methods in sys-
tematic reviews of complex evidence: audit of primary sources. British Medical
isfy students' expectations related to feedback timeliness. Journal 331, 1064–1065.
Hawker, S., Payne, S., Kerr, C., Hardey, M., Powell, J., 2002. Appraising the evidence:
Conclusion reviewing disparate data systematically. Qualitative Health Research 12 (9),
1284–1299.
Higgins, R., Hartley, P., Skelton, A., 2002. The conscientious consumer: reconsidering
Primary research on students' experiences with academic feed- the role of assessment feedback in student learning. Studies in Higher Education
back in nursing education is limited. More robust evidence about stu- 27 (1), 53–64.
Hounsell, D., McCune, V., Hounsell, J., Litjens, J., 2008. The quality of guidance and feed-
dents' and teachers' views of academic feedback at the undergraduate
back to students. Higher Education Research and Development 27 (1), 55–67.
level is required. In particular, qualitative data on students' experi- Kluger, A.N., DeNisi, A., 1996. The effects of feedback interventions on performance: a
ences of academic feedback which might be used to create a data col- historical review, a meta-analysis, and a preliminary feedback intervention theory.
Psychological Bulletin 119, 254–284.
lection instrument which, following validation, can be utilised in a
Koh, L.C., 2010. Academic staff perspectives of formative assessment in nurse educa-
large-scale, multi-institutional study to test for relationships between tion. Nurse Education in Practice. http://dx.doi.org/10.1016/j.nepr.2009.08.007.
important student variables. Moreover, in future studies particular Lizzio, A., Wilson, K., 2008. Feedback on assessment: students' perceptions of quality and
attention needs to be paid to avoid the shortcomings of previous studies effectiveness. Assessment and Evaluation in Higher Education 33 (3), 263–275.
MacLellan, E., 2010. Assessment for learning: the differing perceptions of tutors and
in terms of coverage and longitudinal perspectives. students. Assessment and Evaluation in Higher Education 26 (4), 307–318.
Quality feedback is essential for nursing students to develop their Miller, A., Imrie, B., Cox, K., 1998. Student Assessment in Higher Education: a Handbook
critical thinking skills. This, however, is hindered if students do not for Assessing Performance. Kogan Page, London.
Nicol, D., 2010. From monologue to dialogue: improving written feedback processes in
understand their feedback or become de-motivated. Ideally, there- mass higher education. Assessment and Evaluation in Higher Education 35 (5),
fore, as this review also suggests, feedback is balanced and feeds for- 501–517.
ward to improve nursing students not only in their academic work 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
but also in their practice. Nevertheless, students need to be prepared (2), 199–218.
to take up an active role and engage with feedback. Orrell, J., 2006. Feedback on learning achievement: rhetoric and reality. Teaching in
Higher Education 11 (4), 441–456.
Orsmond, D., Merry, S., 2011. Feedback alignment: effective and ineffective links be-
Acknowledgements tween tutors' and students' understanding of coursework feedback. Assessment
and Evaluation in Higher Education 36 (2), 125–136.
The research work disclosed in this publication is funded by the Parboteeah, S., Anwar, M., 2009. Thematic analysis of written assignment feedback: im-
plications for nurse education. Nurse Education Today 29 (7), 753–757.
Strategic Educational Pathways Scholarship (Malta). The scholarship
Perera, J., Lee, N., Win, K., Perera, J., Wijesuriha, L., 2008. Formative feedback to students:
is part-financed by the European Union-European Social Fund the mismatch between faculty perceptions and student expectations. Medical Teacher
(ESF) under Operational Programme II-Cohesion Policy 2007–2013, 30, 395–399.
‘Empowering People for More Jobs and a Better Quality of Life’. Pokorny, H., Pickford, P., 2010. Complexity, cues and relationships: student perceptions
of feedback. Active Learning in Higher Education. http://dx.doi.org/10.1177/
1469787409355872.
References Poulos, A., Mahony, M.J., 2008. Effectiveness of feedback: the students' perspective.
Assessment and Evaluation in Higher Education 33 (2), 143–154.
Alamis, M.P., 2010. Evaluating students' reactions and responses to teachers' written QAA, 2006. Code of practice for the assurance of academic quality and standards in
feedbacks. Philippine ESL Journal 5, 40–57. higher education. Section 6: Assessment of students. (Retrieved from http://
Aveyard, H., 2010. Doing a Literature Review in Health and Social Care: A Practical www.qaa.ac.uk/Publications/InformationAndGuidance/Documents/COP_AOS.pdf
Guide. Open University Press, Maidenhead. on 19 October 2011).
Bailey, R., Garner, M., 2010. Is the feedback in higher education assessment worth the QAA, 2008. Outcomes From Institutional Audit: Assessment of Students (2nd Series).
paper it is written on? Teachers' reflections on their practices. Teaching in Higher The Quality Assurance Agency for Higher Education, Mansfield.
Education 15 (2), 187–198. RATS, 2011. Qualitative Research Review Guidelines. RATS (Retrieved from http://
Ball, E.C., 2010. Annotation an effective device for student feedback: A critical review. www.biomedcentral.com/info/ifora/rats on 20 October 2012).
Nurse Education in Practice. http://dx.doi.org/10.1016/j.nepr.2009.05.003. Rees, A., Claire, B., Booth, A., 2010. Critical Appraisal of the Evidence. In: Gerrish, K., Lacey,
Bevan, R., Bage, J., Cann, A., Willmott, C., Scott, J., 2008. Seeing eye-to-eye? Staff and A. (Eds.), The Research Process in Nursing. Wiley-Blackwell, Chichester, pp. 79–91.
students' views on feedback. Bioscience education. Retrieved from http://www. Robinson, S., Pope, D., Holyoak, L., 2011. Can we meet theory expectations? Experiences
bioscience.heacademy.ac.uk/journal/vol12/beej-12-1.aspx (on 13th February 2012). and perceptions of feedback in first year undergraduate students. Assessment and
Black, P., Wiliam, D., 1998. Assessment and classroom learning. Assessment in Educa- Evaluation in Higher Education. http://dx.doi.org/10.1080/02602938.2011.629291.
tion 5 (1), 7–74. Sadler, D.R., 1998. Formative assessment: revisiting the territory. Assessment in Educa-
Bloxham, S., Boyd, P., 2007. Developing Effective Assessment in Higher Education. tion: Principles, Policy and Practice 5 (1), 77–84.
Open University Press, Maidenhead. Sadler, D.R., 2010. Beyond feedback: developing student capability in complex apprais-
Bone, A., 2006. The impact of formative assessment on student learning: a law-based al. Assessment and Evaluation in Higher Education 35 (5), 535–550.
study. Retrieved from http://www.ukcle.ac.uk/projects/past-projects/bone/ (on 13th Sambell, K., 2011. Rethinking Feedback in Higher Education: an Assessment for Learn-
February 2012). ing Perspective. The Higher Education Academy, Bristol.
Carless, D., 2006. Differing perceptions in the feedback process. Studies in Higher Edu- Straub, R., 1997. Students' reactions to teacher comments: an exploratory study. Re-
cation 31 (2), 219–233. search in the Teaching of English 31 (1), 91–119.
Duers, L.E., Brown, N., 2009. An exploration of student nurses' experiences of formative Tong, A., Sainsbury, P., Craig, J., 2007. Consolidated criteria for reporting qualitative re-
assessment. Nurse Education Today 29 (6), 654–659. search (COREQ): a 32-item checklist for interviews and focus groups. International
Duncan, N., 2007. ‘Feed-forward’: improving students' use of tutors' comments. Assess- Journal for Quality in Health Care 19 (6), 349–357.
ment and Evaluation in Higher Education 32 (3), 271–283. Tuck, J., 2012. Feedback-giving as social practice: teachers' perspectives on feedback as
Ericsson, K.A., Simon, H.A., 1984. Protocol Analysis. Institute of Technology Press, institutional requirement, work and dialogue. Teaching in Higher Education 17 (2),
Massachussetts. 209–221.
Gopee, N., 2002. Demonstrating critical analysis in academic assignments. Nursing Weaver, M.R., 2006. Do students value feedback? Student perceptions of tutors' written
Standard 16 (35), 45–52. responses. Assessment and Evaluation in Higher Education 31 (3), 379–394.