In competency-based medical education, feedback is vital because it helps students to analyze their strengths and flaws, which supports long-term improvement1. In addition to real application, medical education lays a major focus on theoretical understanding. To increase student performance, regular assessment and coordinated feedback are important2.

Feedback in Medical Education

Formative assessment with feedback has been shown to improve learning by deeper understanding and retaining3. A good feedback mechanism gives students specific, actionable guidance so they can develop self-regulation and metacognitive skills4. In medical education feedback is particularly useful in bridging the gap between theory and practice5.

Problems with Current Feedback Systems

Despite the benefits feedback in medical education is often unstructured, subjective and delayed and therefore ineffective6. Many students struggle to write comprehensive answers in exams and need guidance on how to structure their answers7. A structured feedback system can help students to articulate and apply their knowledge in assessments.

Feedback System in Pharmacology

Pharmacology is a tough subject that requires not only memorization but also analytical thinking for drug classification, mechanism and clinical applications. Previous studies have shown that structured feedback improves students’ understanding and recall of pharmacological concepts8. Given this, a feedback module was introduced at Maharajah’s Institute of Medical Sciences to help students to improve their academic performance.

This study aims to assess students’ perception of the feedback, its impact on their learning and its effectiveness in university exams.

Objectives

1. To evaluate students’ perception of the feedback system.
2. To collect suggestions to enhance the feedback process.
3. To analyze the impact of feedback on university examination results.

Study Design

A cross-sectional, questionnaire-based study was conducted among second-year MBBS students.

Study Setting and Participants

The study was carried out at Maharajah’s Institute of Medical Sciences, Vizianagaram. Total 295 students who had completed their pharmacology course and attended at least four feedback sessions were participated.

Data Collection and Analysis

A structured questionnaire was designed, validated and distributed. The questionnaire included:

Objective-type questions on students' perception of feedback. A 5-point Likert scale (Strongly Agree to Strongly Disagree). Open-ended questions for qualitative feedback.

Statistical Analysis:

Quantitative responses were analyzed using descriptive statistics (mean, percentages, and standard deviation). Thematic analysis was conducted on qualitative responses.

Demographic Characteristics of Participants:

A total of 295 second-year MBBS students participated in this study. The gender distribution was as follows:

The student participants were divided into two categories:

Quantitative Analysis of Students' Perception on the Feedback System:

A structured questionnaire assessed students' perceptions on a 5-point Likert scale, ranging from Strongly Agree (5) to Strongly Disagree (1). Descriptive statistics (mean scores, standard deviation (SD), and percentage agreement) for each question are summarized in the following table.

Key Observations from the Quantitative Data

85% of students felt that feedback helped them understand their strong and weak areas in the subject. 85% agreed that feedback improved their answer-writing skills for examinations. 84% felt motivated to work harder after receiving feedback. 53% of students believed that rewarding high-performing students encouraged better academic performance. Only 35% agreed that the feedback system simplified pharmacology learning, indicating a need for further refinement in feedback delivery. 86% strongly supported the feedback system.

Thematic Analysis of Qualitative Responses

A thematic analysis was done on the open-ended responses for the strengths and limitations of the feedback system.

Feedback Clarity and Objectivity

Many students liked that the feedback was clear, unbiased, and specific to their strengths and weaknesses. Some students suggested model answers or checklists would make the feedback even clearer.

Impact on Learning and Exam Preparation

Students said structured feedback sessions helped them improve their writing skills and understand pharmacology better. However, some students want more frequent feedback sessions to reinforce learning.

Personalization and Real-Time Feedback

A common suggestion was that feedback should be more tailored to individual learning pace.
Some students prefer feedback after assessments rather than waiting for the results day.

Motivation and Encouragement

Several students said recognizing top performers made them want to do better.
However, a few students felt only high achievers get detailed feedback, leaving the weaker ones with not much guidance.

Problems and Suggestions

Some students felt feedback sessions were too long and confusing.
A few students said exam feedback should also cover clinical applications, not just theory.

These qualitative insights highlight the effectiveness of the feedback system while also identifying key areas for enhancement.

 Correlation between Feedback and University Examination Results

To assess the impact of feedback on academic performance, a comparison was made between university examination results in pharmacology and overall university results as showed in the following table:

                       Key Observations from Exam Performance Data

Students who attended structured feedback sessions showed a higher pass percentage (89%) in pharmacology compared to the overall university pass percentage (79%). Distinction rates (19%) and first-class results (27%) in pharmacology were notably higher than the overall university average. This suggests a positive correlation between structured feedback and improved examination performance.

Effective feedback is a vital part of medical education. It impacts students' learning experiences, knowledge retention, and academic performance. This study assessed students' perceptions of a structured feedback system in pharmacology, emphasizing its importance in improving understanding, motivation, and exam readiness. The findings indicate that many students found it helpful. This aligns with existing literature on the importance of timely and constructive feedback in medical education.

Effect of Feedback in Medical Education

Feedback is crucial in education as it helps students identify their strengths and weaknesses, guiding them toward improvement (Hattie & Timperley11, 2007). Interestingly, 85% of students indicated that feedback was key in clarifying their areas of weakness and strength, highlighting its importance in self-directed learning. These findings align with earlier research showing that structured feedback can enhance students' cognitive skills and performance in medical education (Shute4, 2008).

One of the key benefits of feedback is its effect on knowledge acquisition and conceptual understanding. A notable 84% of students indicated that the feedback system contributed to enhancing their writing skills, which is vital for effectively tackling pharmacology-related exam questions. Research by Archer, J. C7. (2010) supports this observation, indicating that medical students who receive comprehensive feedback tend to exhibit improved writing and reasoning abilities.

The Timing of Feedback and Learning Outcomes

The effectiveness of feedback is greatly affected by its timing. Immediate feedback offers quick clarification, while delayed feedback can promote deeper learning by fostering self-reflection (Kulhavy & Anderson13, 1972). Although our study did not specifically distinguish between immediate and delayed feedback, students noted that discussing exam answers on the day results were released was particularly beneficial. This is consistent with the findings of Van der Kleij et al15. (2015), who highlighted that the timing of feedback affects the depth of processing and retention among learners.

Motivational Impact of Feedback

Motivation is a key factor in achieving academic success, and feedback is vital in enhancing student engagement (Deci & Ryan8, 2000). A significant number of students (80%) reported that feedback inspired them to put in more effort. It reinforces the fact that constructive criticism promotes growth and improvement. Furthermore, 35% of students felt that recognizing high achievers motivated them to excel, which is consistent with research emphasizing the importance of positive reinforcement in educational environments (Dweck9, 2006).

Interestingly, a small group of students (approximately 10–15%) raised concerns about the feedback system, indicating that it could sometimes induce stress or anxiety. This observation aligns with findings from Sargeant et al5. (2008), which indicate that while feedback can be advantageous, negative or excessively critical feedback may deteriorate confidence if not communicated effectively. This underscores the necessity for faculty development in delivering balanced and encouraging feedback.

Correlation with Examination Performance

The primary goal of our study was to evaluate the impact of the feedback system on university examination results. Our results indicated that students who engaged in our feedback system tended to perform better in pharmacology exams. These findings are in consistent with earlier research, such as Eva et al10. (2012), which revealed that medical students receiving structured feedback achieved higher scores than their peers in assessments.

Correlation analysis showed that students who frequently took part in feedback discussions had higher rates of distinction in their university exams. This finding is in line with Henderson et al12. (2019), who noted that medical students in feedback-rich environments exhibited improved long-term retention and application of knowledge.

Comparison with Existing Literature

Our study’s findings align with previous research in medical education. For instance, Patel et al14. (2016) demonstrated that feedback modules in pharmacology significantly enhanced student engagement and knowledge retention. Additionally, Archer7 (2010) pointed out that feedback is most effective when it is specific, timely, and goal-oriented, which corresponds with our structured approach15.

Nonetheless, despite the advantages, implementing feedback presents challenges such as student receptivity, faculty preparedness, and time constraints (Watling et al16., 2013). Future research should investigate how training for faculty and coaching for students on effective feedback use can improve its overall impact.

Limitations and Future Directions

This study has certain limitations even if it offers valuable insights. The study was only carried out at one institution, which restricts the generalizability of the results. Response bias could be introduced by depending too much on self-reported perceptions. Future studies should think about employing objective performance metrics to assess feedback's efficacy in detail. The long-term impacts of feedback on clinical reasoning and pharmacological decision-making should also be investigated in future research. Examining how digital feedback technologies, such as AI-based evaluation systems, might enhance learning outcomes would also be helpful.

This research highlights the importance of structured feedback in pharmacology education. Many students indicated that the feedback system enhanced their ability to retain knowledge, identify their weaknesses, and improve their performance on assessments. To encourage students to become more involved in their studies and take charge of their learning, feedback can be a highly effective strategy. This study emphasizes the significance of faculty development programs to improve the quality of feedback provided.

This study highlights the importance of faculty development programs in order to enhance the delivery of effective feedback. By incorporating a more personalized and interactive feedback system, we could further enhance student outcomes, building on the positive reception of the current approach.

In conclusion, structured feedback is essential to medical education. It encourages self-directed learning, improves academic performance, and supports professional growth. To optimize student learning and guarantee long-term knowledge retention, future research should focus on improving feedback mechanisms in medical education.

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