title: Influence of feedback characteristics on perceived learning value of feedback in clerkships: does culture matter?
abstract: BACKGROUND
  Various feedback characteristics have been suggested to positively influence student learning. It is not clear how these feedback characteristics contribute to students' perceived learning value of feedback in cultures classified low on the cultural dimension of individualism and high on power distance. This study was conducted to validate the influence of five feedback characteristics on students' perceived learning value of feedback in an Indonesian clerkship context.
  
  
  METHODS
  We asked clerks in Neurology (n = 169) and Internal Medicine (n = 132) to assess on a 5-point Likert scale the learning value of the feedback they received. We asked them to record whether the feedback provider (1) informed the student what went well, (2) mentioned which aspects of performance needed improvement, (3) compared the student's performance to a standard, (4) further explained or demonstrated the correct performance, and (5) prepared an action plan with the student to improve performance. Data were analyzed using multilevel regression.
  
  
  RESULTS
  A total of 250 students participated in this study, 131 from Internal Medicine (response rate 99%) and 119 from Neurology (response rate 70%). Of these participants, 225 respondents (44% males, 56% females) completed the form and reported 889 feedback moments. Students perceived feedback as more valuable when the feedback provider mentioned their weaknesses (β = 0.153, p < 0.01), compared their performance to a standard (β = 0.159, p < 0.01), explained or demonstrated the correct performance (β = 0.324, p < 0.001) and prepared an action plan with the student (β =0.496, p < 0.001). Appraisal of good performance did not influence the perceived learning value of feedback. No gender differences were found for perceived learning value.
  
  
  CONCLUSIONS
  In Indonesia, we could validate four out of the five characteristics for effective feedback. We argue that our findings relate to culture, in particular to the levels of individualism and power distance. The recognized characteristics of what constitutes effective feedback should be validated across cultures.
authors.affiliation: Department of Medical Education, Faculty of Medicine, Universitas Gadjah Mada, Gd. Prof. Drs. Med. R. Radiopoetro, Lt. 6 Sayap Barat, Jl. Farmako, Sekip Utara, Yogyakarta, 55281, Indonesia. yoyosuhoyo@ugm.ac.id.|Institute for Medical Education, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands. yoyosuhoyo@ugm.ac.id.
authors.forename: Yoyo
authors.identifier: http://orcid.org/0000-0002-1231-2226
authors.initials: Y
authors.lastname: Suhoyo
authors.affiliation: Institute for Medical Education, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Elisabeth A
authors.initials: EA
authors.lastname: Van Hell
authors.affiliation: Department of Public an Individual Oral Health, Center for Dentistry and Oral Hygiene, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.|Education and Research Department, Hanze University of Applied Sciences, Groningen, The Netherlands.
authors.forename: Wouter
authors.initials: W
authors.lastname: Kerdijk
authors.affiliation: Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.
authors.forename: Ova
authors.initials: O
authors.lastname: Emilia
authors.affiliation: Institute for Medical Education, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Johanna
authors.initials: J
authors.lastname: Schönrock-Adema
authors.affiliation: Department of Public an Individual Oral Health, Center for Dentistry and Oral Hygiene, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.|Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Jan B M
authors.initials: JB
authors.lastname: Kuks
authors.affiliation: Institute for Medical Education, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Janke
authors.initials: J
authors.lastname: Cohen-Schotanus
mesh_terms: D002982:Clinical Clerkship; D002983:Clinical Competence; D003469:Culture; D004521:Educational Measurement; D005260:Female; D000068156:Formative Feedback; D006801:Humans; D007214:Indonesia; D007388:Internal Medicine / Q000193:education; D008297:Male; D009462:Neurology / Q000193:education; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Feedback, Clerkship, Culture