title: Factors influencing students' receptivity to formative feedback emerging from different assessment cultures.
abstract: BACKGROUND
  Feedback after assessment is essential to support the development of optimal performance, but often fails to reach its potential. Although different assessment cultures have been proposed, the impact of these cultures on students' receptivity to feedback is unclear. This study aimed to explore factors which aid or hinder receptivity to feedback.
  
  
  METHODS
  Using a constructivist grounded theory approach, the authors conducted six focus groups in three medical schools, in three separate countries, with different institutional approaches to assessment, ranging from a traditional summative assessment structure to a fully implemented programmatic assessment system. The authors analyzed data iteratively, then identified and clarified key themes.
  
  
  RESULTS
  Helpful and counterproductive elements were identified within each school's assessment system. Four principal themes emerged. Receptivity to feedback was enhanced by assessment cultures which promoted students' agency, by the provision of authentic and relevant assessment, and by appropriate scaffolding to aid the interpretation of feedback. Provision of grades and comparative ranking provided a helpful external reference but appeared to hinder the promotion of excellence.
  
  
  CONCLUSIONS
  This study has identified important factors emerging from different assessment cultures which, if addressed by programme designers, could enhance the learning potential of feedback following assessments. Students should be enabled to have greater control over assessment and feedback processes, which should be as authentic as possible. Effective long-term mentoring facilitates this process. The trend of curriculum change towards constructivism should now be mirrored in the assessment processes in order to enhance receptivity to feedback.
authors.affiliation: Keele University School of Medicine, Keele, UK. c.j.harrison@keele.ac.uk.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Harrison
authors.affiliation: Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
authors.forename: Karen D
authors.initials: KD
authors.lastname: Könings
authors.affiliation: Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, USA.
authors.forename: Elaine F
authors.initials: EF
authors.lastname: Dannefer
authors.affiliation: Flinders Medical School, Adelaide, Australia.
authors.forename: Lambert W T
authors.initials: LW
authors.lastname: Schuwirth
authors.affiliation: Keele University School of Medicine, Keele, UK.
authors.forename: Valerie
authors.initials: V
authors.lastname: Wass
authors.affiliation: Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
authors.forename: Cees P M
authors.initials: CP
authors.lastname: van der Vleuten
keywords: Feedback; Programmatic assessment; Summative assessment