An Exploration of Feedback Using Hattie and Timperley's Feedback Levels

Effective feedback is recognized as essential to clinical training. Hattie and Timperley conducted a comprehensive review of feedback to develop their Model of Feedback to Enhance Learning (MFEL). The MFEL proposes that effective feedback can focus on any of four levels: task, process, self-regulation, and self. While Hattie and Timperley are frequently cited for their review, few studies in medical education have used the MFEL to explore feedback. We used the MFEL to examine the content of documented workplace-based feedback to explore how this model applies in a family medicine residency program.

We conducted this retrospective cross-sectional observational secondary data analysis (learning analytics) study in a Canadian university-based family medicine residency program. Our data source was de-identified field notes (a tool to document workplace-based feedback) for residents at two teaching sites. We coded the feedback using the levels from the MFEL. We used descriptive statistics to analyze the frequencies of each level and combinations of levels.

Of the 2,250 field notes examined, 422 (18%) were excluded because they contained no feedback. The majority (1,105; 60%) included a single feedback level, while 705 (38%) contained two levels, and 17 (1%) included three levels. No field notes included all four levels. Of the field notes containing one feedback level, the most common levels were task (835; 76%) and process (248; 22%). The most common combination of levels was process and task (649; 92.1%).

Hattie and Timperley's MFEL offers a way to explore feedback documented in medical education programs and may help programs identify opportunities for faculty development to improve feedback effectiveness.