Facilitating Formative Feedback in Midwifery Education: A Narrative Review

Background: Clinical practice learning is the most important part of health education programs. The limitation of the presence of students at hospitals to avoid exposure to covid-19 causes the lack of training received by students Objective: The purpose of this study was to systematically map the results of research on clinical practice learning methods carried out by health professional education as learning recommendations during the Covid-19 pandemic. Method: This research was conducted with a five-stage review process, starting with searching for articles through relevant databases, namely Pubmed, Science Direct and Wiley, and finding 11 articles relevant to the inclusion criteria that have been determined. Result: Based on the review results, several clinical learning methods were found using E-learning through video, telehealth collaboration, and simulation based learning. There are several advantages and disadvantages to using each of these methods. Not all of these methods can be used as an evaluation of the student learning process. E-learning through videos can be done as a learning innovation to provide opportunities for students for patients with specific learning objectives. Conclusion: In conclusion, in practice there are clinical experiences that cannot be included by any method. Therefore, the standardization of student competencies is fulfilled by the Midwife Competency Test. However, clinical learning strategies in midwifery education can be done through E-learning with video conference, telehealth collaboration, and combination simulation methods with case studies which have the effectiveness to achieve certain learning objectives according to each method. In practice, information technology can be used as an innovation in distance learning. The implementation of this learning strategy requires good support and cooperation between institutions for clinical practice locations and the education institutions. And, Infrastructures need to be prepared to support the clinical practice learning process.

Background and aims: Experience is the main foundation of learning, but learning without thinking and reflective cannot happen to be related to action. Moving towards experience-based education is an effective replacement for traditional education so that active learning can take place. Reflection in medical sciences seeks to combine theoretical concepts with practice, increase experience-based learning, accept responsibility and continuous professional growth, increase critical thinking and judgment in critical and complex situations based on experience and clinical knowledge, and improve the quality of care, increase professional strength, improvement in performance by raising individual awareness, development of clinical knowledge and skills. Therefore, this study was conducted to synthesis the research in reflective models in learning based on reflective thinking in clinical learning of nursing students in 2020. Methods: In this systematic synthesis research, researches related to reflective models in clinical nursing learning were examined in three stages: determining the geography of the research, systematic critique of selected documents, and synthesizing a new creation of separate elements and combining them and evaluates and combines current and ongoing studies. Results: The results of combining the findings of the research selected for this study are in response to research questions such as: What are the existing models of learning based on in-depth thinking? What features, levels and steps do they have? And what are the researches related to this type of learning in clinical nursing education and how have they been done? Which were selected based on systematic criteria and parameters and during a systematic process compared and combined the findings of this research and finally were synthesized and processed in the form of findings to answer research questions. Seven models of applied reflective thinking in clinical learning were reviewed by experts: Borton, Gibbs, Smyth, John, Mezirow, Zarezadeh, Cottrell, which had commonalities and distinctions according to specific concepts of reflective learning. In all models, gaining experience and examining it to promote and improve learning by identifying a problem or event, and the beginning and end of this method, increases the potential of this type of learning for more application in clinical education, especially the nursing group. Reflective thinking had practical values such as: strengthening deep learning, understanding the learning process in students, helping to advance professionalism and learning throughout life, using previous learning knowledge and building, redefining and reconstructing knowledge based on new experiences. It is presented through the learning environment and emphasizes accepting responsibility for educating others. Reflective learning ensures that learning is not limited to formal environments and that every experience is considered a learning experience. It also offers new insights, changed ideas, and a corrective attitude or emotional trait. Conclusion: The result of research synthesis, strengthening the efficiency and positive effect of this type of learning on the acquisition of skills, student and teacher motivation and the ability to learn collaboratively as well as improving skills in the clinical environment, although moving beyond the traditional context of teaching and learning, demands and the result of combining the data of the studies also emphasizes the practical nature and construction of knowledge in learning based on insight and its special place to eliminate the theoretical and practical gap in clinical education witnessing the excellence of this operational part of clinical education and health promotion of community by providing proper performance of nursing staff.

Although there is an abundance of literature about clinical teaching in the health professions, a much smaller body of information focuses on the art and science of clinical teaching in midwifery and women's health. We reviewed preceptor handbooks, training manuals, and Web sites created by nursing and nurse‐midwifery education programs, medical and pharmacy schools, and national associations of health professionals. Using the search terms (clinical teaching, clinical learning, preceptor, clerkship, residency training, and midwifery education), we searched the MEDLINE and CINAHL databases and health sciences libraries for relevant articles and books. The information and practical strategies about clinical teaching that we found are synthesized and presented in this article. It includes a discussion of challenges in clinical teaching; an overview of expectations and responsibilities of the education program, students, and preceptors; suggestions about orienting students to clinical sites; clinical teaching strategies and skills; suggestions for incorporating critical thinking and evidence‐based care into clinical teaching; guidelines for giving constructive feedback and evaluation; characteristics of excellent clinical teachers; and suggestions about how education programs and professional associations can support and develop clinical sites and preceptors. The Appendix contains manuals, books, and Web sites devoted to clinical teaching.

Background/Objectives: Clinical instruction and mentorship are essential components of nursing education and early professional development. In Greece, while nursing curricula align with EU directives mandating both theoretical and clinical training, significant gaps persist in the quality, coordination, and legislative support of mentorship. This work aims to (i) synthesise evidence on clinical instruction and mentorship in Greece and draw on selected European examples to provide contextual insight, and (ii) integrate national stakeholder perspectives to generate actionable recommendations for a Greek clinical mentorship framework. Methods: A narrative literature review was conducted, identifying 19 eligible articles examining mentorship, clinical instruction and preceptorship in European and Greek contexts. In addition, a national stakeholder focus group with 25 participants, including representatives from academia, healthcare institutions, regulatory bodies, and nursing associations, was held in Athens in 2024. Data from both sources were thematically analysed and integrated to identify gaps, best practices, and context-specific recommendations. Results: Findings revealed inconsistent collaboration between universities and clinical institutions, limited training and recognition for clinical instructors, and the absence of a unified national framework. Stakeholders highlighted structural barriers to clinical mentoring such as understaffing and lack of policy support and expressed strong interest in a mentorship reform. Comparative analysis with European models demonstrated feasible pathways for Greece, including structured training, certification, and non-financial incentives. During the national stakeholder focus group, a dual-pathway mentorship system tailored for nursing students and newly hired nurses was most recommended to ensure both continuity and quality in professional development of nurses. Conclusions: Despite alignment with EU directives, Greece lacks an integrated national mentorship framework that ensures consistent clinical learning and supports workforce development. Two priority policy actions emerge from this work: (1) establishing a legally supported national certification and training system for clinical mentorship, and (2) educational structures in the clinical setting to improve educational quality, workforce retention and patient care outcomes.

IntroductionEstablishing a supportive clinical environment is paramount for enhancing nursing students’ engagement in clinical practice, their clinical proficiencies, and satisfaction. The increase in nursing student enrollment at the Nursing College, driven by the collaborative efforts between Abu Dhabi Health Services Company (SEHA) and universities, has given rise to concerns regarding the quality of education and clinical instruction. These concerns are primarily due to the increased student-to-instructor ratio. Furthermore, the unsupportive clinical settings and learning tensions underscore the need to understand students’ learning experiences and address research gaps within the field of clinical learning in the United Arab Emirates (UAE).ObjectivesThe purpose of this study is to investigate the undergraduate nursing students’ perceptions of their clinical learning environment, with a focus on perceived benefits and challenges.MethodsThis study used a cross-sectional survey design. The researchers administered a five-point Likert scale questionnaire, which had been adapted and contextualized, to a convenience sample of 217 third and fourth-year nursing students who willingly participated in this study.ResultsDespite the presence of positive aspects, such as diverse clinical experiences and strong support from both clinical instructors and peers, several challenges affect the students’ clinical learning. These challenges encompass disparate perceptions of supervision among staff nurses, learning tensions related to student academic workload, insufficient clinical supervision, and difficulties in finding assistance when needed.ConclusionThere is a clear need to enhance the overall ward learning environment to optimize students’ academic motivation and clinical skills. Several measures can be taken to achieve this goal, including incentivizing and reducing the workload of staff nurses, investing in the professional development of clinical instructors, promoting peer interactions and group learning, and adopting a block pattern of education in years three and four for better clinical knowledge assimilation and reduced theoretical workload.

Forty-five subjects were randomly assigned to three groups of 15 each. Each subject attempted to deliver a duckpin bowling ball at a specified velocity equal to 70% of his maximum velocity. The velocity objective was given in seconds and hundreths-of-a-second, and each subject performed 60 trials under conditions of repetitive trial presentation with an intertrial interval of 50 sec. The experimenter verbally presented information feedback (IF) immediately after each delivery. Three experimental conditions involved: (a) quantitative IF accurate to hundreths-of-a-second; (b) quantitative IF accurate to tenths-of-a-second; and (c) qualitative IF. The findings indicated that practice involving more precise IF (quantitative IF) results in a significantly higher level of performance than less precise IF (qualitative IF). Also, there is an optimum precision of IF beyond which additional exactness will not enhance motor skill acquisition.

AAIM Recommendations to Promote Equity in the Clerkship Clinical Learning Environment

For nursing students, practical training in healthcare during a pandemic can be considered a critical environment. This study aimed to describe how the Covid-19 pandemic affected registered nursing students’ clinical learning and what learning strategies they would use in a clinical environment. The study had a qualitative, exploring approach. Data were generated using twelve semi-structured interviews with final-year nurse students and were analysed by thematic analysis. The Covid-19 pandemic can be seen as a critical environment that has unintended consequences on learning. The analysis revealed that the Covid-19 pandemic affected nursing students in both their adaptive and developmental learning as they in practicum had to handle personal responsibility for their work, reflection, and learning. In the chaotic situation, students and supervisors became like novices, struggling to go with the flow while shouldering responsibility for their own learning. The students’ learning extended to tasks outside the course syllabus. They acquired extensive knowledge about working during a pandemic, including basic hygiene routines and working at a safe distance. The students developed new knowledge due to the increased demand for flexibility and creativity. They had more contact with patients as well as their relatives and developed an ethical approach related to the pandemic.

Formative assessment has been identified as a promising intervention to support students’ learning. How to successfully implement this means of assessment, however, is still an open issue. This study contributes to the implementation of formative assessment by analyzing the impact of a training measure on teachers’ formative feedback practice, with a special focus on mediating and moderating variables. Research questions are as follows: (1) Is there an indirect training effect on teachers’ instructional feedback practice via (a) teachers’ declarative feedback knowledge and (b) the ability to generate feedback in a test situation? (2) Is this indirect effect moderated by teachers’ self-efficacy? A total of 67 secondary education mathematics teachers participated in the study, taking part in professional development either on formative assessment and feedback (PD-FA) or on mathematical modelling and problem solving (PD-PM). Training was provided in two sessions (T1 and T2; each lasting 3 days) with 10 weeks in between T1 and T2. Teachers’ self-efficacy regarding feedback was measured before T1 with a questionnaire. Declarative feedback knowledge and the ability to apply this knowledge were tested after T2. Teachers’ instructional feedback practice was assessed with a student questionnaire (before T1 and 4–6 weeks after T2). Path analyses show that (1) there is no indirect training effect (PD-FA vs. PD-PM) on the development of teachers’ feedback practices in mathematics instruction; but an indirect effect on the ability to generate feedback in a test situation via teachers’ declarative feedback knowledge. Teachers participating in PD-FA show a higher level of declarative feedback knowledge than teachers in the PD-PM condition. Declarative feedback knowledge in turn is positively related to the ability to generate feedback in a test situation. (2) This indirect effect is moderated by teachers’ self-efficacy. Teachers with a high level of self-efficacy are better able to use their knowledge to generate feedback in a test situation than teachers with a low level of self-efficacy.

Clinical experiences can be stressful for students. Instructors can have a positive impact on learning, but have also been identified as a potential source of stress among many nursing students. This review was conducted to identify strategies that instructors can implement to create a positive environment and maximize learning. A narrative review was conducted to explore current literature for instructor strategies that promote learning among undergraduate nursing students in the clinical setting. Fourteen articles were identified, from which 6 themes to support clinical learning emerged: open communication, approachability and accessibility, role modeling, empathy, clinical-specific orientation, and effective feedback delivery. The findings reaffirm existing literature and highlight the need for quantitative research and consistent application of effective strategies. Integrating novel frameworks to apply these approaches will help instructors support students to remain in the learning zone and improve clinical learning outcomes.

To examine current approaches in research, teaching, and Evidence Based Practice (EBP) in midwifery and nursing education and how they interconnect. A mixed-methods systematic review. Seven databases were used: Academic Search Complete, ASSIA, CINAHL, Cochrane Library, Education Source, Medline, and Scopus. Grey literature was searched from GreyNet International, The Society for Research on Educational Effectiveness, Virginia Henderson Global Nursing e-Repository, The National Institutes for Health Library, and the DART-Europe E-theses Portal. This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. It includes studies conducted in higher and professional practice education in midwifery and nursing between 2013 and 2024. Included studies were published in English, reported the design, development, implementation, and/or evaluation of research or EBP intervention with primary data as part of their research, regardless of study design. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Extracted data were analysed using reflective thematic analysis and descriptive statistics. A total of 59 studies, and 7214 participants were included. Four themes representing the interconnections between teaching, research and EBP were identified: 1) Pedagogical approaches employed in teaching and learning interventions 2) Theories, models, and frameworks to bridge the theory-practice gap 3) Collaborative approaches and partnerships as a conduit for the acquisition of knowledge and transferable skills 4) Capabilities developed in research and EBP. This review is the first to demonstrate how different educational interventions, models and findings relate to teaching research and EBP and their application in midwifery and nursing. Despite numerous educational strategies for integrating research into teaching, there is no conclusive evidence on the best methods for teaching EBP. The field needs clear guidelines, educational toolkits, and comprehensive materials to effectively bridge the gap between knowledge and practice and to address the challenges of EBP education and its clinical application.

Feedback is an integral part of education and there is a substantial body of trials exploring and confirming its effect on learning. This evidence base comes mostly from studies of compulsory school age children; there is very little evidence to support effective feedback practice at higher education, beyond the frameworks and strategies advocated by those claiming expertise in the area. This systematic review aims to address this gap. We review causal evidence from trials of feedback and formative assessment in higher education. Although the evidence base is currently limited, our results suggest that low stakes‐quizzing is a particularly powerful approach and that there are benefits for forms of peer and tutor feedback, although these depend on implementation factors. There was mixed evidence for praise, grading and technology‐based feedback. We organise our findings into several evidence‐grounded categories and discuss the next steps for the field and evidence‐informed feedback practice in universities. Context and implications Rationale for this study To gain a better understanding of effective formative assessment and feedback approaches in higher education (HE). To promote a more evidence‐informed approach to teaching and learning in universities. Why the new findings matter The findings highlight a small number of promising strategies for formative assessment and feedback in HE. They also draw attention to a lack of (quality) evidence in this area overall. Implications for policy‐makers and practitioners Universities and their regulators/funders should be encouraging and supporting more, high‐quality research in this important area. Researchers in the field also need to look to developing more ambitious, higher‐quality studies which are likely to provide robust, causal conclusions about academic effectiveness (or other outcomes). Those involved in teaching and learning in university should use the findings to inform evidence‐informed approaches to formative assessment and feedback and to challenge approaches which do not appear to have foundations in strong evidence. Students could be made more aware of teaching and learning approaches that are likely to support their academic progress.

Surgeons have an opportunity to improve teaching quality through feedback provision

BackgroundConsistent formative feedback is cornerstone to competency-by-design programs and evidence-based approaches to teaching and learning processes. There has been no published research investigating feedback from residents’ perspectives. We explored the value residents place on feedback in routine operating room settings, their experiences, and understanding of the role of feedback in their training and developing professional identity.MethodsInterpretive phenomenological analysis of residents’ experiences with feedback received in clinical settings involved two focus groups with 14 anesthesia residents at two time points. Analysis was completed in the context of a teaching hospital adapting to new practices to align with nationally mandated clinical competencies. Focus group conversations were transcribed and interpreted through the lens of a social constructivist approach to learning as a dynamic inter- and intra-personal process, and evidence-based assessment standards set by the International Test Commission (ITC).ResultsResidents described high quality feedback as consistent, effortful, understanding of residents’ thought processes, and containing actionable advice for improvement. These qualities of effective evaluation were equally imperative for informal and formal evaluations. Residents commented that highest quality feedback was received informally, and formal evaluations often lacked what they needed for their professional development.ConclusionResidents have a deep sense of what promotes their learning. Structured feedback tools were seen positively, although the most important determinants of their impact were faculty feedback- and broader evaluation-skills and motivations for both formal and informal feedback loops.

Nursing students' experiences and expectations of clinical learning: A qualitative study