International Journal of Applied and Basic Medical Research

: 2021  |  Volume : 11  |  Issue : 1  |  Page : 1--3

Principles of effective educational feedback: A pictorial epilog

Rajiv Mahajan 
 Department of Pharmacology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India

Correspondence Address:
Rajiv Mahajan
Department of Pharmacology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab

How to cite this article:
Mahajan R. Principles of effective educational feedback: A pictorial epilog.Int J App Basic Med Res 2021;11:1-3

How to cite this URL:
Mahajan R. Principles of effective educational feedback: A pictorial epilog. Int J App Basic Med Res [serial online] 2021 [cited 2021 Sep 28 ];11:1-3
Available from:

Full Text

Formative assessment and the structured educational feedback as a part of it is a buzz word now, particularly with the introduction of competency-based curriculum in both postgraduate and undergraduate medical training courses in India. Every medical teacher is well aware of the concept of formative assessment and feedback, though the practical implementation may prove handy.

Principles of giving effective feedback to students have been well established.[1],[2],[3],[4],[5] Many models of giving feedback have also been documented, with prominent one being sandwich model and Pendleton model.[6],[7] Sandwich model is easiest to execute, particularly so at the undergraduate level where the student strength is more, accordingly time per student is less. Moreover, students at that stage are devoid of reflective behavior, which is so essential for the success of other models.

Let's refresh some of the very essential principles of giving feedback to the students by using pictorial demonstration of sandwich model.


If an extra-large-sized sandwich is served to you, which you can't even bite into, what will be your reaction? Obviously, you won't like it; even if it is very delicious. Sandwich must be biting sized [Figure 1]. Similarly, feedback must be content-controlled. It's best to discuss one aspect at a time during one feedback session. As stated by Ende – “feedback should be regulated in quantity.”[1] A feedback “served” to students with content-overload will prove to be useless for the students.{Figure 1}


When you go to a restaurant, what you order? Serve me a sandwich or you ask for a sandwich of your choice? We all order for our own specific sandwich, after matching our choice and specific ingredients or characteristics of that particular sandwich [Figure 2]. Similarly, educational feedback “served” to the students must be subjective and specific, based upon the behavior or characteristics or performance of the individual concerned student, and must not be generalized.{Figure 2}


We love to have a sandwich at snack's time in the evening, sometimes even as full lunch or dinner meal; but, will you like to be waken-up in the middle of the night and serve sandwich? [Figure 3]. You might be a hardcore sandwich lover, but you will never like to be knocked-off in the middle of night for being served a sandwich. Same is with educational feedback; it must be “served” to the students when it is expected; it should not come out of blue.{Figure 3}


A sandwich was prepared 3 days back, wrapped beautifully, and presented to you in the best of cutlery available. Will you like to eat it? No one will like to eat a sandwich prepared 3 days back. It must be freshly prepared and timely served [Figure 4]. Similarly, educational feedback to students must be “served” on time and must be based upon a “fresh” performance.{Figure 4}

 Relaxed Environment

Where will you like to have your favorite sandwich; in a crowded place, with hustle and bustle around, or in a relaxed environment? More often than not, the answer will be in a relaxed environment [Figure 5]. Though, sometimes, you may prefer “drive through”, most of the times you will like to relish your sandwich. Similarly, educational feedback to students must be “served” in a relaxed, nonthreatening environment. The opportunity must not be used to embarrass the students. However, sometimes, informal feedback may be given at any handy opportunity.{Figure 5}

There are other principles to be followed while providing educational feedback to students like - respect for the students, teachers and students acting as allies, feedback based on observable behavior only; the basic premise is that educational feedback must be received as constructive by the students in order to be effective.


Pictures available on Google platform have been used accordingly for various figures in this article so as to convey the message properly. Article does not endorse any product. Care has been taken to avoid any copyright infringement. The pictures have been downloaded from:;;;;;;;


1Ende J. Feedback in clinical medical education. JAMA 1983;250:777-81.
2Valdez-García JE, Cabrera MV, Barrientos ER. Principles of assessment and effective feedback. Ann Eye Sci 2017;2:42.
3Nicol DJ, Macfarlane-Dick D. Formative assessment and self-regulated learning: A model and seven principles of good feedback practice. Stud High Educ 2006;31:199-218.
4Ramani S, Könings KD, Ginsburg S, van der Vleuten CP. Feedback Redefined: Principles and Practice. J Gen Intern Med 2019;34:744-9.
5Chowdhury RR, Kalu G. Learning to give feedback in medical education. Obstet Gynaecol 2004;6:243-247.
6Dohrenwend A. Serving up the feedback sandwich. Fam Pract Manag 2002;9:43-6.
7Pendleton D, Schofield T, Tate P, Havelock P. The Consultation: An Approach to Learning and Teaching. Oxford: Oxford University Press; 2003.