title: Variables that affect the process and outcome of feedback, relevant for medical training: a meta-review.
abstract: BACKGROUND
  Feedback is considered important in medical education. The literature is not clear about the mechanisms that contribute to its effects, which are often small to moderate and at times contradictory. A variety of variables seem to influence the impact of feedback on learning. The aim of this study was to determine which variables influence the process and outcomes of feedback in settings relevant to medical education.
  
  
  METHODS
  A myriad of studies on feedback have been conducted. To determine the most researched variables, we limited our review to meta-analyses and literature reviews published in the period from January 1986 to February 2012. According to our protocol, we first identified features of the feedback process that influence its effects and subsequently variables that influence these features. We used a chronological model of the feedback process to categorise all variables found.
  
  
  RESULTS
  A systematic search of ERIC, PsycINFO and MEDLINE yielded 1101 publications, which we reduced to 203, rejecting papers on six exclusion criteria. Of these, 46 met the inclusion criteria. In our four-phase model, we identified 33 variables linked to task performance (e.g. task complexity, task nature) and feedback reception (e.g. self-esteem, goal-setting behaviour) by trainees, and to observation (e.g. focus, intensity) and feedback provision (e.g. form, content) by supervisors that influence the subsequent effects of the feedback process. Variables from all phases influence the feedback process and effects, but variables that influence the quality of the observation and rating of the performance dominate the literature. There is a paucity of studies addressing other, seemingly relevant variables.
  
  
  CONCLUSIONS
  The larger picture of variables that influence the process and outcome of feedback, relevant for medical education, shows many open spaces. We suggest that targeted studies be carried out to expand our knowledge of these important aspects of feedback in medical education.
authors.affiliation: Department of Education, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
authors.forename: J M Monica
authors.initials: JM
authors.lastname: van de Ridder
authors.affiliation: Department of Medical Education, Feinberg School of Medicine Northwestern University, Chicago, Illinois, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: McGaghie
authors.affiliation: Department of Educational Sciences, Utrecht University, Utrecht, the Netherlands.
authors.forename: Karel M
authors.initials: KM
authors.lastname: Stokking
authors.affiliation: Center for Research and Development of Education, University Medical Centre Utrecht, School of Medical Sciences, Utrecht University, Utrecht, the Netherlands.
authors.forename: Olle T J
authors.initials: OT
authors.lastname: ten Cate
mesh_terms: D004501:Education, Medical / Q000592:standards*; D005246:Feedback; D006040:Goals; D006801:Humans; D007858:Learning; D012649:Self Concept; D013647:Task Performance and Analysis