The effectiveness of terminal feedback delivery to improve the clinical skills of pre-registration health professional students in simulated environments: A systematic review


  • Jessica Stanhope University of South Australia University of Tasmania
  • Robyn Gill University of South Australia Country Health South Australia Flinders University



review, education, health, feedback, universities, clinical competence


Aim: To determine whether terminal feedback is effective in improving the practical, clinical skills of pre-registration health professional students in simulated environments, and how it is best delivered. Methods: Eight databases were searched systematically to identify studies addressing our aim. Eligible studies were published 2004–2014, in English language, within peer- reviewed journals. Study designs were determined and assigned to the National Health and Medical Research Council hierarchy of evidence, with the PEDro scale used to appraise ≥Level III_1 studies. Data regarding the country, participant characteristics, sample size, task critiqued, prior experience with the task, feedback delivered, follow-up time, outcome measures, methods of statistical analysis and the results were extracted and reported descriptively. Results: Eight studies (Levels II–V) were included. Most investigated medical students performing laparoscopic and/or knot tying tasks. PEDro scale scores ranged from 18–54%. Results were mixed when comparing terminal verification feedback and no feedback (n=3), and comparing different types of feedback (n=3). Overall, it would appear that, in terms of terminal feedback, elaborative feedback is more effective in improving the practical, clinical skills of pre-registration health professional students (n=4). Discussion: Whilst there is some indication that elaborative feedback may be more effective than no feedback, the small number of studies and poor methodological quality of the included studies precludes any strong conclusions from being drawn. There are a number of gaps in the current literature, particularly investigating non-medical professions, that should be addressed in future research. Furthermore, larger-scale, well-designed studies in the area are required to guide clinical teaching. 


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