The use of feedback in teaching undergraduate dental students: feedback sandwich or Ask-Tell-Ask model?

(2023) 23:417 Lin et al. BMC Oral Health https://doi.org/10.1186/s12903-023-03141-5 BMC Oral Health Open Access RESEARCH The use of feedback in teaching undergraduate dental students: feedback sandwich or Ask‑Tell‑Ask model? Galvin Sim Siang Lin1*, Wen Wu Tan2, Hasnah Hashim2 and Chan Choong Foong3 Abstract Background Feedback is regarded as a key component of formative assessment and one of the elements with the greatest impact on students’ academic learning. The present study aimed to evaluate and compare students’ perceptions of the use of two feedback models, namely feedback sandwich and Ask-Tell-Ask (ATA), in teaching dental materials science courses. Methods All undergraduate second-year dental students were invited to participate in the dental materials science practical session and were randomly allocated into two groups: Group 1 (feedback) sandwich and Group 2 (ATA). The session began with the teacher giving a short briefing on the commonly used dental materials, followed by a short demonstration of the manipulation of those materials. Students were then allowed to mix and manipulate the materials, and teachers provided feedback accordingly. At the end of the session, 16 close-ended (five-point Likert scales) and an open-ended questionnaire were distributed to students to evaluate their perceptions of the feedback given. Internal reliability of the questionnaire items was evaluated using Cronbach’s alpha. Mean feedback scores were analysed using an independent t-test with ANCOVA for controlling gender and ethnicity. Thematic analysis was used to code the qualitative data. Results Sixty-nine students participated in the present study with the majority being females (72.5%) and Chinese (79.7%). Cronbach’s alpha analysis suggested removing three Likert-scale items, with the remaining 13 items being accepted. Generally, no significant difference was noted between the two groups (p = 0.197), but three items were found to be significant (p < 0.05), with higher mean scores in the feedback sandwich group. Moreover, no significant difference was noted between the two feedback models (p = 0.325) when controlling gender and ethnicity. The open-ended question showed that students in the feedback sandwich group expressed greater positive perceptions. Conclusion Although students generally had positive perceptions of both feedback models, they tended to favour the feedback sandwich. Neither gender nor ethnicity affected the students’ perceptions of the two feedback models. Keywords Dental education, Dental materials, Feedback, Teaching method, Undergraduate *Correspondence: Galvin Sim Siang Lin Full list of author information is available at the end of the article © The Author(s) 2023. 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The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Lin et al. BMC Oral Health (2023) 23:417 Background Dental education has evolved from traditional pedagogy with major didactic information acquisition towards the accomplishment of learning outcomes in competencybased education [1]. Dental students are expected to acquire certain competencies prior to graduation, and dental schools are responsible to ensure that future dental graduates are qualified and competent to practise independently in a safe manner and committed to continuing professional development [1, 2]. Therefore, a rigorous and comprehensive assessment system focusing on the use of assessments for learning is required for such an educational system. It is also crucial to pay more attention to formative assessments rather than solely evaluating students based on summative assessments since formative assessments may help steer students in attaining the essential competencies [3]. One way to offer effective formative assessment is through timely, precise, and focused feedback [4, 5]. Undeniably, feedback is regarded as a key component of formative assessment and one of the elements with the greatest impact on learning [6]. Feedback is a systematic method for evaluating performances in relation to intended learning outcomes. To enhance students’ learning, high-quality formative feedback is designed to assist them to recall their previous actions and reflect on their current performance [7]. Moreover, feedback is effective in assisting and directing students towards more significant self-directed assessment-seeking behaviour, which is essential in competency-based education [5]. Without detailed and helpful feedback to students, continuous performance enhancement may not be achievable. Nevertheless, both teachers and students must possess the necessary skills to provide and receive feedback to ensure effective learning [8]. Research has shown that students’ academic performance is greatly improved through feedback. For instance, a previous study found that feedback enhanced the operative dentistry performance of preclinical dental students [9]. Moreover, another study found that dental students highly valued the feedback they received and linked it to increased individual performance [10]. Feedback may be delivered in a variety of ways which include the feedback sandwich model and the Ask-TellAsk (ATA) model. The term "feedback sandwich" appears to have originated in the 1940s [11], but it was not until Mary Kay Ash, the founder of Mary Kay Cosmetics, popularized it in her book "Mary Kay on People Management" [12], where she emphasised the significance of sandwiching criticism between compliments. Schwenk and Whitman then highlighted the feedback technique as a teaching strategy to enhance medical teaching in 1987 [13]. The feedback sandwich model entails beginning Page 2 of 8 with praise, offering criticism, and then concluding with positive comments [14]. It has been proposed that starting and finishing feedback with praise enhances students’ comfort and trust, increases their tolerance to criticism, reduces the potential harm that criticism can do to their self-esteem, and boosts their learning motivation [14, 15]. In additio (...truncated)