title: Assessment and feedback to facilitate self-directed learning in clinical practice of Midwifery students.
abstract: BACKGROUND
  Clinical workplaces are hectic and dynamic learning environments, which require students to take charge of their own learning. Competency development during clinical internships is a continuous process that is facilitated and guided by feedback. Limited feedback, lack of supervision and problematic assessment of clinical competencies make the development of learning instruments to support self-directed learning necessary.
  
  
  OBJECTIVE
  To explore students' perceptions about a newly introduced integrated feedback and assessment instrument to support self-directed learning in clinical practice. Students collected feedback from clinical supervisors and wrote it on a competency-based format. This feedback was used for self-assessment, which had to be completed before the final assessment.
  
  
  METHODS
  Four focus group discussions were conducted with second and last year Midwifery students. Focus groups were audiotaped, transcribed verbatim and analysed in a thematic way using ATLAS.ti for qualitative data analysis.
  
  
  RESULTS
  The analysis of the transcripts suggested that integrating feedback and assessment supports participation and active involvement in learning by collecting, writing, asking, reading and rereading feedback. Under the condition of training and dedicated time, these learning activities stimulate reflection and facilitate the development of strategies for improvement. The integration supports self-assessment and formative assessment but the value for summative assessment is contested. The quality of feedback and empowerment by motivated supervisors are essential to maximise the learning effects.
  
  
  CONCLUSIONS
  The integrated Midwifery Assessment and Feedback Instrument is a valuable tool for supporting formative learning and assessment in clinical practice, but its effect on students' self-directed learning depends on the feedback and support from supervisors.
authors.affiliation: University College Arteveldehogeschool Ghent, Belgium. mieke.embo@arteveldehs.be
authors.forename: Mieke P C
authors.initials: MP
authors.lastname: Embo
authors.forename: Erik W
authors.initials: EW
authors.lastname: Driessen
authors.forename: Martin
authors.initials: M
authors.lastname: Valcke
authors.forename: Cees P M
authors.initials: CP
authors.lastname: Van der Vleuten
mesh_terms: D001530:Belgium; D003162:Competency-Based Education / Q000379:methods* / Q000458:organization & administration; D005246:Feedback; D017144:Focus Groups; D006801:Humans; D008880:Midwifery / Q000193:education*; D011231:Preceptorship / Q000379:methods* / Q000458:organization & administration; D011380:Programmed Instructions as Topic; D036301:Qualitative Research; D012655:Self-Evaluation Programs / Q000379:methods*; D012944:Social Support