A Textual Narrative Synthesis on the Application of Hattie and Timperley’s Model for Feedback in Resident Education
Main Article Content
Abstract
Background: Because competency-based assessment focuses on skill acquisition, educators need to provide feedback in resident training programs that is timely, specific, and actionable for improvement of these skills. Hattie and Timperley’s model offers medical faculty a tool for providing quality feedback.
Objective: The literature was reviewed to discover residency programs that use Hattie and Timperley’s Model for Feedback and to encourage faculty to consider utilization of Hattie and Timperley’s Model for Feedback for physician learners.
Methods: Google Scholar, Scopus, ERIC, and the Web of Science databases were searched for relevant articles. The inclusion criteria were peer-reviewed publications in English that referenced the Hattie and Timperley seminal article in studies of resident education.
Results: While the Hattie and Timperley seminal article is widely referenced in the literature (n=26,955), the Model for Feedback does not appear to be utilized as often in resident training program feedback processes. Themes emerged from this study that discuss feedback as resident assessment, assessment of feedback given to residents, and models for feedback that are being used to assess resident competence.
Conclusions: While Hattie and Timperley’s review article was frequently cited for background for feedback, the model does not appear to have been widely adopted as a framework for providing feedback for residents. Since faculty in residency training has the autonomy to choose their models and tools, the Hattie and Timperley Model for Feedback—focusing on a combination of assessment activities to enhance learning and teaching—should be considered.
Keywords:
Feedback in medical education, Hattie and Timperley Model, Resident training, Competency-based assessment, Narrative synthesis, Feedback frameworks, Faculty development, Educational assessment, Graduate medical education, Feedback utilization
Article Details
How to Cite
FIGG, Bethany et al.
A Textual Narrative Synthesis on the Application of Hattie and Timperley’s Model for Feedback in Resident Education.
Medical Research Archives, [S.l.], v. 13, n. 6, july 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6711>. Date accessed: 15 july 2025.
doi: https://doi.org/10.18103/mra.v13i6.6711.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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24. Driessen E, Scheele F. What is wrong with assessment in postgraduate training? lessons from clinical practice and educational research. Medical Teacher. 2013;35(7):569-574. doi:10.3109/0142159x.2013.798403
25. Gaunt A, Patel A, Fallis S, et al. Surgical trainee feedback-seeking behavior in the context of workplace-based assessment in clinical settings. Academic Medicine. 2017;92(6):827-834. doi:10.1097/acm.0000000000001523
26. Hewson MG, Little ML. Giving feedback in medical education. Journal of General Internal Medicine. 1998;13(2):111-116. doi:10.1046/j.1525-1497.1998.00027.x
27. Ibrahim J, MacPhail A, Chadwick L, Jeffcott S. Interns’ perceptions of performance feedback. Medical Education. 2014;48(4):417-429. doi:10.1111/medu.12381
28. Molloy E, Ajjawi R, Bearman M, Noble C, Rudland J, Ryan A. Challenging feedback myths: Values, learner involvement and promoting effects beyond the immediate task. Medical Education. 2019;54(1):33-39. doi:10.1111/medu.13802
29. Ramani S, Post SE, Könings K, Mann K, Katz JT, van der Vleuten C. “it’s just not the culture”: A qualitative study exploring residents’ perceptions of the impact of institutional culture on feedback. Teaching and Learning in Medicine. 2016;29(2): 153-161. doi:10.1080/10401334.2016.1244014
30. Telio S, Ajjawi R, Regehr G. The “Educational Alliance” as a framework for reconceptualizing feedback in medical education. Academic Medicine. 2015;90(5):609-614. doi:10.1097/acm.0000000000000560
31. Holmboe ES, Sherbino J, Long DM, Swing SR, Frank JR. The role of assessment in competency-based Medical Education. Medical Teacher. 2010; 32(8):676-682. doi:10.3109/0142159x.2010.500704
32. Scheele F, Teunissen P, Luijk SV, et al. Introducing competency-based Postgraduate Medical Education in the Netherlands. Medical Teacher. 2008;30(3):248-253. doi:10.1080/01421590801993022
33. Pendleton D, Schofield T. The Consultation: An Approach to Learning and Teaching. Oxford University Press (OUP); 1986.
34. Kusurkar RA, Croiset G, Ten Cate OTh. Twelve tips to stimulate intrinsic motivation in students through autonomy-supportive classroom teaching derived from self-determination theory. Medical Teacher. 2011;33(12):978-982. doi:10.3109/0142159x.2011.599896
35. Kluger AN, DeNisi A. The effects of feedback interventions on performance: A historical review, a meta-analysis, and a preliminary feedback intervention theory. Psychological Bulletin. 1996;119(2):254-284. doi:10.1037/0033-2909.119.2.254
36. Wisniewski B, Zierer K, Hattie J. The power of Feedback Revisited: A meta-analysis of educational feedback research. Frontiers in Psychology. 2020; 10. doi:10.3389/fpsyg.2019.03087
37. Eslava J, Arones M, Godoy Y, Guerrero F. Characterization of meaningful learning associated with feedback in a digital transformation. 2021 5th International Conference on Deep Learning Technologies (ICDLT). Published online July 23, 2021:128-131. doi:10.1145/3480001.3480023
38. Martinovic A, Kunold L. Unfortunately, your task allocation is in need of improvement. 2022 17th ACM/IEEE International Conference on Human-Robot Interaction (HRI). Published online March 7, 2022:909-913. doi:10.1109/hri53351.2022.9889503
39. Xiao Y, Watson M. Guidance on conducting a systematic literature review. Journal of Planning Education and Research. 2017;39(1):93-112. doi:10.1177/0739456x17723971
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41. Zelenski AB, Tischendorf JS, Kessler M, et al. Beyond "Read More": An Intervention to Improve Faculty Written Feedback to Learners. J Grad Med Educ. 2019;11(4):468-471. doi:10.4300/JGME-D-19-00058.1
42. Van der Kleij FM, Feskens RC, Eggen TJ. Effects of feedback in a computer-based learning environment on students’ learning outcomes. Review of Educational Research. 2015;85(4):475-511. doi:10.3102/0034654314564881
43. Yovanoff M, Pepley D, Mirkin K, Moore J, Han D, Miller S. Personalized learning in medical education: Designing a user interface for a dynamic haptic robotic trainer for central venous catheterization. Proceedings of the Human Factors and Ergonomics Society Annual Meeting. 2017; 61(1):615-619. doi:10.1177/1541931213601639
44. Govaerts M. Workplace-based assessment and assessment for learning: Threats to validity. Journal of Graduate Medical Education. 2015;7(2): 265-267. doi:10.4300/jgme-d-15-00101.1
45. Fluit C, Bolhuis S, Grol R, et al. Evaluation and feedback for effective clinical teaching in Postgraduate Medical Education: Validation of an assessment instrument incorporating the canmeds roles. Medical Teacher. 2012;34(11):893-901. doi:10.3109/0142159x.2012.699114
46. Eva KW, Armson H, Holmboe E, et al. Factors influencing responsiveness to feedback: On the interplay between fear, confidence, and reasoning processes. Advances in Health Sciences Education. 2011;17(1):15-26. doi:10.1007/s10459-011-9290-7
47. Desy J, Busche K, Cusano R, Veale P, Coderre S, McLaughlin K. How teachers can help learners build storage and retrieval strength. Medical Teacher. 2017;40(4):407-413. doi:10.1080/0142159x.2017.1408900
48. Johnson CE, Keating JL, Boud DJ, et al. Identifying educator behaviours for high quality verbal feedback in Health Professions Education: Literature Review and expert refinement. BMC Medical Education. 2016;16(1). doi:10.1186/s12909-016-0613-5
49. Accreditation Council for Graduate Medical Education Common Program Requirements. Accreditation Council for Graduate Medical Education. July 1, 2023. Accessed 2025. https://www.acgme.org/globalassets/pfassets/programrequirements/cprresidency_2023.pdf
2. Shweiki E, Beekley A, Jenoff J, et al. Applying expectancy theory to residency training: Proposing opportunities to understand resident motivation and enhance residency training. Advances in Medical Education and Practice. Published online April 2015:339-346. doi:10.2147/amep.s76587
3. Nasca TJ, Philibert I, Brigham T, Flynn TC. The next GME accreditation system — Rationale and benefits. New England Journal of Medicine. 2012;366(11):1051-1056. doi:10.1056/nejmsr1200117
4. Patterson, F. (2001). Competency based selection system for general practitioner registrars. BMJ, 323, 2-2.
5. Competency-Based Medical Education (CBME) | Association of American Medical Colleges. AAMC. https://www.aamc.org/what-we-do/mission-areas/medical-education/cbme.
6. Poeppelman RS, Liebert CA, Vegas DB, Germann CA, Volerman A. A narrative review and novel framework for application of team-based learning in graduate medical education. Journal of Graduate Medical Education. 2016;8(4):510-517. doi:10.4300/jgme-d-15-00516.1
7. Ende J. Feedback in clinical medical education. JAMA: The Journal of the American Medical Association. 1983;250(6):777. doi:10.1001/jama.1983.03340060055026
8. Govaerts M, van der Vleuten CP. Validity in work-based assessment: Expanding our horizons. Medical Education. 2013;47(12):1164-1174. doi:10.1111/medu.12289
9. Norcini J, Burch V. Workplace-based assessment as an educational tool: AMEE guide no. 31. Medical Teacher. 2007;29(9-10):855-871. doi:10.1080/01421590701775453
10. Watling CJ. Unfulfilled promise, untapped potential: Feedback at the Crossroads. Medical Teacher. 2014;36(8):692-697. doi:10.3109/0142159x.2014.889812
11. Kruger J, Dunning D. Unskilled and unaware of it: How difficulties in recognizing one’s own incompetence lead to inflated self-assessments. Journal of Personality and Social Psychology. 1999;77(6):1121-1134. doi:10.1037//0022-3514.77.6.1121
12. Sargeant J, Armson H, Chesluk B, et al. The processes and dimensions of informed self-assessment: A conceptual model. Academic Medicine. 2010;85(7):1212-1220. doi:10.1097/acm.0b013e3181d85a4e
13. Duitsman ME, van Braak M, Stommel W, et al. Using conversation analysis to explore feedback on resident performance. Advances in Health Sciences Education. 2019;24(3):577-594. doi:10.1007/s10459-019-09887-4
14. Hattie J, Timperley H. The power of feedback. Review of Educational Research. 2007;77(1):81-112. doi:10.3102/003465430298487
15. Kamali D, Illing J. How can positive and negative trainer feedback in the operating theatre impact a surgical trainee’s confidence and well-being: A qualitative study in the north of England. BMJ Open. 2018;8(2). doi:10.1136/bmjopen-2017-017935
16. Stegeman JH, Schoten EJ, Terpstra OT. Knowing and acting in the clinical workplace: Trainees’ perspectives on modelling and feedback. Advances in Health Sciences Education. 2012; 18(4):597-615. doi:10.1007/s10459-012-9398-4
17. Tham TC, Burr B, Boohan M. Evaluation of feedback given to trainees in medical specialties. Clinical Medicine. 2017;17(4):303-306. doi:10.7861/clinmedicine.17-4-303
18. van de Ridder JM, McGaghie WC, Stokking KM, ten Cate OT. Variables that affect the process and outcome of feedback, relevant for medical training: A meta-review. Medical Education. 2015; 49(7):658-673. doi:10.1111/medu.12744
19. Ali AS, Bussey M, O’Flynn KJ, Eardley I. Quality of feedback using workplace based assessments in urological training. British Journal of Medical and Surgical Urology. 2012;5(1):39-43. doi:10.1016/j.bjmsu.2011.10.001
20. Bartlett M, Crossley J, McKinley R. Improving the quality of written feedback using written feedback. Education for Primary Care. 2016;28(1):16-22. doi:10.1080/14739879.2016.1217171
21. Bing-You RG. Why medical educators may be failing at feedback. JAMA. 2009;302(12):1330. doi:10.1001/jama.2009.1393
22. Branfield Day L, Miles A, Ginsburg S, Melvin L. Resident perceptions of assessment and feedback in competency-based Medical Education: A FOCUS Group Study of one Internal Medicine Residency Program. Academic Medicine. 2020;95(11):1712-1717. doi:10.1097/acm.0000000000003315
23. Cantillon P, Easton G. Feedback – what’s new? Education for Primary Care. 2015;26(2):116-117. doi:10.1080/14739879.2015.11494323
24. Driessen E, Scheele F. What is wrong with assessment in postgraduate training? lessons from clinical practice and educational research. Medical Teacher. 2013;35(7):569-574. doi:10.3109/0142159x.2013.798403
25. Gaunt A, Patel A, Fallis S, et al. Surgical trainee feedback-seeking behavior in the context of workplace-based assessment in clinical settings. Academic Medicine. 2017;92(6):827-834. doi:10.1097/acm.0000000000001523
26. Hewson MG, Little ML. Giving feedback in medical education. Journal of General Internal Medicine. 1998;13(2):111-116. doi:10.1046/j.1525-1497.1998.00027.x
27. Ibrahim J, MacPhail A, Chadwick L, Jeffcott S. Interns’ perceptions of performance feedback. Medical Education. 2014;48(4):417-429. doi:10.1111/medu.12381
28. Molloy E, Ajjawi R, Bearman M, Noble C, Rudland J, Ryan A. Challenging feedback myths: Values, learner involvement and promoting effects beyond the immediate task. Medical Education. 2019;54(1):33-39. doi:10.1111/medu.13802
29. Ramani S, Post SE, Könings K, Mann K, Katz JT, van der Vleuten C. “it’s just not the culture”: A qualitative study exploring residents’ perceptions of the impact of institutional culture on feedback. Teaching and Learning in Medicine. 2016;29(2): 153-161. doi:10.1080/10401334.2016.1244014
30. Telio S, Ajjawi R, Regehr G. The “Educational Alliance” as a framework for reconceptualizing feedback in medical education. Academic Medicine. 2015;90(5):609-614. doi:10.1097/acm.0000000000000560
31. Holmboe ES, Sherbino J, Long DM, Swing SR, Frank JR. The role of assessment in competency-based Medical Education. Medical Teacher. 2010; 32(8):676-682. doi:10.3109/0142159x.2010.500704
32. Scheele F, Teunissen P, Luijk SV, et al. Introducing competency-based Postgraduate Medical Education in the Netherlands. Medical Teacher. 2008;30(3):248-253. doi:10.1080/01421590801993022
33. Pendleton D, Schofield T. The Consultation: An Approach to Learning and Teaching. Oxford University Press (OUP); 1986.
34. Kusurkar RA, Croiset G, Ten Cate OTh. Twelve tips to stimulate intrinsic motivation in students through autonomy-supportive classroom teaching derived from self-determination theory. Medical Teacher. 2011;33(12):978-982. doi:10.3109/0142159x.2011.599896
35. Kluger AN, DeNisi A. The effects of feedback interventions on performance: A historical review, a meta-analysis, and a preliminary feedback intervention theory. Psychological Bulletin. 1996;119(2):254-284. doi:10.1037/0033-2909.119.2.254
36. Wisniewski B, Zierer K, Hattie J. The power of Feedback Revisited: A meta-analysis of educational feedback research. Frontiers in Psychology. 2020; 10. doi:10.3389/fpsyg.2019.03087
37. Eslava J, Arones M, Godoy Y, Guerrero F. Characterization of meaningful learning associated with feedback in a digital transformation. 2021 5th International Conference on Deep Learning Technologies (ICDLT). Published online July 23, 2021:128-131. doi:10.1145/3480001.3480023
38. Martinovic A, Kunold L. Unfortunately, your task allocation is in need of improvement. 2022 17th ACM/IEEE International Conference on Human-Robot Interaction (HRI). Published online March 7, 2022:909-913. doi:10.1109/hri53351.2022.9889503
39. Xiao Y, Watson M. Guidance on conducting a systematic literature review. Journal of Planning Education and Research. 2017;39(1):93-112. doi:10.1177/0739456x17723971
40. Popay J, Roberts H, Sowden A, et al. Guidance on the conduct of narrative synthesis in systematic Reviews. A Product from the ESRC Methods Programme. Version 1. Semantic Scholar. doi:https://doi.org/10.13140/2.1.1018.4643
41. Zelenski AB, Tischendorf JS, Kessler M, et al. Beyond "Read More": An Intervention to Improve Faculty Written Feedback to Learners. J Grad Med Educ. 2019;11(4):468-471. doi:10.4300/JGME-D-19-00058.1
42. Van der Kleij FM, Feskens RC, Eggen TJ. Effects of feedback in a computer-based learning environment on students’ learning outcomes. Review of Educational Research. 2015;85(4):475-511. doi:10.3102/0034654314564881
43. Yovanoff M, Pepley D, Mirkin K, Moore J, Han D, Miller S. Personalized learning in medical education: Designing a user interface for a dynamic haptic robotic trainer for central venous catheterization. Proceedings of the Human Factors and Ergonomics Society Annual Meeting. 2017; 61(1):615-619. doi:10.1177/1541931213601639
44. Govaerts M. Workplace-based assessment and assessment for learning: Threats to validity. Journal of Graduate Medical Education. 2015;7(2): 265-267. doi:10.4300/jgme-d-15-00101.1
45. Fluit C, Bolhuis S, Grol R, et al. Evaluation and feedback for effective clinical teaching in Postgraduate Medical Education: Validation of an assessment instrument incorporating the canmeds roles. Medical Teacher. 2012;34(11):893-901. doi:10.3109/0142159x.2012.699114
46. Eva KW, Armson H, Holmboe E, et al. Factors influencing responsiveness to feedback: On the interplay between fear, confidence, and reasoning processes. Advances in Health Sciences Education. 2011;17(1):15-26. doi:10.1007/s10459-011-9290-7
47. Desy J, Busche K, Cusano R, Veale P, Coderre S, McLaughlin K. How teachers can help learners build storage and retrieval strength. Medical Teacher. 2017;40(4):407-413. doi:10.1080/0142159x.2017.1408900
48. Johnson CE, Keating JL, Boud DJ, et al. Identifying educator behaviours for high quality verbal feedback in Health Professions Education: Literature Review and expert refinement. BMC Medical Education. 2016;16(1). doi:10.1186/s12909-016-0613-5
49. Accreditation Council for Graduate Medical Education Common Program Requirements. Accreditation Council for Graduate Medical Education. July 1, 2023. Accessed 2025. https://www.acgme.org/globalassets/pfassets/programrequirements/cprresidency_2023.pdf