Table 2 Students’ perceptions of their experience of receiving feedback on written long cases, and the use of the eportfolio

Students valued tasks that reflected what they would be doing as interns and beyond. They recognised the benefit of practicing and improving competencies required in their future careers.

There was a bit of time pressure and it reflected something that eventually we’ll be doing in the real world…. the real world reality is that you’d have something and then quickly have to present it to someone more senior and it felt like you were actually practising that”. (A 6)

“I think a more realistic approach would be to have something written up that was just what you wrote down on the wards as – as interns, we’re going to be going to ED, writing down this case, presenting it to a consultant straight up and that’s going to be in the medical records forever…. I’ve seen a lot of bad notes written up and I’m like well I don’t want to be this person. (B2)

Quality of the feedback

Students appreciated the specificity of the feedback. Students were surprised by the detail and effort by the medical leads in providing feedback. They verbalised a desire for critique of their work rather than non-specific, generic comments.

Quantity of feedback

Students valued the depth and quality of the feedback and most students felt the incremental benefit from receiving written feedback on more than two of the 8 cases was not justified.

Personalised feedback

Students appreciated the personal nature of the feedback.

Source of feedback

Receiving written feedback helped students feel supported by Faculty. Students felt reassured that feedback was provided by a faculty member, familiar with the SMP assessment requirements, and it was important to students that feedback be aligned with summative assessment expectations.

Personal development

Students commented on the value of the feedback in improving and changing what they submitted.

The type of feedback was also important, aiming at producing reflective practice. The students’ approach was illustrative of Kolb’s cycle of reflection and modification of practice. Students valued critical feedback, rather than generic feedback. Some also used it to reflect on their progress and how to plan future learning opportunities.

Self directed learning

Students used the process of writing up the case to direct their learning. Their techniques reflect experiential and situated learning. By reflection on experience, they transform the medical problem associated with that patient into learning. The fact that it is within the authentic practice of medicine, enhanced and complemented the experience.

“I was surprised by the amount of feedback that I got…, it was again, just two cases that were reviewed but there was a substantial paragraph with different things. And again, I had like medical related and then content and, sort of, form related feedback. (C3)

“The feedback was excellent. Much more so than I – I kind of expect, you know, like most uni feedback is like congratulations on submitting your assignment…” (B3)

“I thought it was really good they included who the markers are, clearly put effort and they clearly read it and (gave) good feedback. I think we all thought it was very surprisingly in depth.” (B7)

“I was happy she gave me – I think she gave me two really good ones and I was happy with that. Oh, that’s good enough. You know, I can’t ask for more.” (A2)

“Getting personalised feedback for – for something indicates - -‘cause quite a rigorous exercise is very valuable.” (A1)

“I think it’s a good idea to get feedback from somebody (an academic) in SMP like that because then it gives us an idea of where we are and where we should be, what we should be aiming for in terms of our final assessments. So I think it is crucial that we do get feedback from them like that. Because…it’s variable, it’s variable depending on which department you’re in, who you are seeing at the time, and the feedback that you get. So I do value the feedback that we get from PebblePad.” (C4)

“I think because they’re designated people who have stated expectations of what a Sydney medical student long case should be, that was consistent, and…you get…explicit feedback..” (C 3)

“It’s nice to know what you did wrong so you can do better the next time…Tell us what we’re doing wrong, just about anything…’cause there must always be room for improvement…” “Do feel free to be harsh!” (B5)

“My first couple were really pretty crap and the feedback I think reflected that but because of the feedback changing it and shifting it….I found that through that process of getting that – that sort of constructive feedback which was very lengthy at first and then gradually got shorter…. it did improve the whole thing, even the verbal presentation too.” (C1)

“…you get feedback for each one individually, so it was sort of good to – to upload them sort of as I did them every week and then get feedback and then try and use that feedback…for subsequent ones….” (A3)

Technical barriers

There was general discontent with the technical aspects of the ePortfolio system, Pebblepad. Students had difficulties uploading cases and became frustrated with the duplications of the system. Some students also had trouble finding the feedback, which defeated the purpose of the exercise. These technical aspects detracted from otherwise positive experience of the students.

“There seemed to be a lot of redundant steps in the software, like having to click things multiple times and then click save and then click submit. Um, the issue I had was I’d submitted about three or four long cases and the clinical school told me I hadn’t submitted any, um, and it turns out I hadn’t clicked the final step.” (C2)

“I found it a bit cumbersome to use. … the interface..is really difficult, so initially it didn’t actually work on my computer.” (A1)