Feedback in the nonshifting context of the midwifery clinical education in Indonesia: A mixed methods study

Esti Nugraheny, Mora Claramita, Gandes R Rahayu, Amitya Kumara


Clinical education in some countries applies a hospital-based learning approach where each student rotates to one division to another division (call of shifting). However, for clinical midwifery education in Indonesia each student remains in a community midwifery clinic (call of nonshifting). Because of the differences in the shifting system used, the question of “How is feedback in the nonshifting context of the clinical midwifery education being given?” needs to be explored.
Materials and Methods: This was a mixed methods study and was carried out in a School of Midwifery in Indonesia during 2014 and 2015. We explored the supervisors’ and students’ perception on the feedback delivery. Students’ perceptions were collected through focus group discussions whereas supervisors’ perceptions were recorded through interviews. The quality of feedback was observed using a checklist. Qualitative data were analyzed using Atlas Ti and quantitative data were analyzed using a descriptive statistic method.
Results: From the qualitative data, students and supervisors perceived their feedback as “more intensive.” They reported authenticity in the monitoring and feedback from the day-to-day delivery of patient care with their supervisors. Students and supervisors also described their feedback as “more integrated.” The feedback process stimulated students to value history taking, physical examination, and midwifery care. On the other hand, quantitative data from observations presented that “intensive and integrated feedback” were not supported by the quality of the feedback based on literature of the theory of facilitating learning (the mean was 4.67 on a scale of 0–9).
Conclusions: The nonshifting clinical midwifery education can be a better alternative for facilitating the process of providing integrated and intensive feedback. To improve the quality of the feedback, training on providing feedback in a nonshifting context is fundamental in Indonesia.


Community-based education; constructive feedback; midwifery clinical education; nonshifting context

Full Text:



McGaghie WC, Issenberg SB, Petrusa ER, Scalese RJ. A critical review of simulation‑based medical education research: 2003‑2009. Med.Educ 2010;44:50‑63.

Cantillon P, Sargeant J. Giving feedback in clinical settings. BMJ 2008;337:1292‑4.

Gigante J, Dell M, Sharkey A. Getting beyond “Good job”: How to give effective feedback. Pediatrics 2011;127:205‑7.

Global Standards for Midwifery Education. The International Confederation of Midwives (ICM) Web site. http://www.unfpa. org/sowmy/resources/docs/standards/en/R427_ICM. Published 2011. Accessed January 28, 2014.

Embo MPC, Driessen EW, Valcke M, Van der Vleuten CPM. Assessment and feedback to facilitate self‑directed learning in clinical practice of midwifery students. Med Teach 2010; 32:263‑9.

Schuwirth LWT, Van der Vleuten CPM. Programmatic assessment: From assessment of learning to assessment for learning. Med Teach 2011;33:478‑85.

Sharif F, Masoumi S. A qualitative study of nursing student experiences of clinical practice. BMC Nurs 2005;4:6.

Botma Y, Hurter S, Kotze R. Responsibilities of nursing schools with regard to peer mentoring. Nurse Educ Today 2013;33:808‑13.

Al‑Kadri HMF. Does Assessment Drive Students’ Learning? Nederland: School of Health Professions Education Maastricht University; 2011.

Harden RM, Dent JA. A Practical Guide for Medical Teacher. 4th ed. British: Churchill Livingstone Elsevier; 2013.

Kilminster S, Cottrell D, Grant J, Jolly B. AMEE Guide No. 27: Effective educational and clinical supervision. Med Teach 2007;29:2‑19.

Brunero S, Stein‑Parbury J. The effective feedback of clinical supervision in nursing an evidenced based literature review. Aust J Adv Nurs 2008;25:86‑94.

Teunissen PW, Stapel DA, Van der Vleuten C, Scherpbier A, Boor K, Scheele F. Who wants feedback? An investigation of the variables influencing residents’ feedback‑seeking behavior in relation to night shifts. Acad Med 2009;84:910‑7.

Lin CS, Chiu TF, Yen DHT, Chong CF. Mini‑clinical evaluation exercise and feedback on postgraduate trainees in the emergency department: A qualitative content analysis. J Acute Med 2012;2:1‑7.

Baglin MR, Rugg S. Student nurses’ experiences of community‑based practice placement learning: A qualitative exploration. Nurse Educ Pract. 2010;10:144‑52.

Creswell JW, Clark VLP. Designing and Conducting Mixed Methods Research. 2nd ed. USA: Sage Publication; 2011

Hewson MG, Little ML. Giving feedback in medical education: Verification of recommended techniques. J Gen Intern Med 1998;13:111‑6.

Manerikar V, Manerikar S. Cronbach’s alpha. A Peer review research journal. aWEshkar WeSchool Vol XIX Issue 1 March 2015:117-9.

Friese S. Qualitative Data Analysis with Atlas Ti. 2nd ed. London: Sage Publication; 2014.

Bienstock JL, Katz NT, Cox SM, Hueppchen N, Erickson S, Puscheck EE. To the point: Medical education reviews‑providing feedback. Am J Obstet Gynecol 2007; 196:508‑13.

Ramani S, Krackov SK. Twelve tips for giving feedback effectively in the clinical environment. Med Teach 2012;34:787‑91.

Brauer DG, Ferguson KJ. The integrated curriculum in medical education: AMEE Guide No. 96. Med Teach 2015,37:312‑22

Claramita M, Nugraheny MDF, van Dalen J, Van der Vleuten CPM. Doctor‑patient communication in Southeast Asia: A different culture? Adv Health Sci Educ 2013; 18:15‑31.

Susilo AP, van Dalen J, Scherpbier A, Tanto S, Yuhanti P, Ekawati N. Nurses’ roles in informed consent in a hierarchical and communal context. Nurs Ethics 2013;20:413‑25.

Geertz C. The religion of Java. Chicago: The University Chicago Press; 1976.

Claramita M, Prabandari, van Dalen J, Van der Vleuten CPM. Developing and validating a guideline on doctor‑patient communication for southeast asian context. South‑East Asian J Med Educ 2010;4:23‑30.

Hunter B, Lecturer RNS. Emotion work and boundary maintenance in hospital‑based midwifery. Midwifery 2005;21:253‑66.

Pelgrim EAM, Kramer AWM, Mokkink HGA, Van der Vleuten CPM. The process of feedback in workplace‑based assessment: Organization, delivery, continuity. BMC Med Educ 2012;46:604‑12.

Boehler M, Rogers D, Schwind CJ, Mayforth R, Quin J, Williams R, Dunnington D. An investigation of medical students reaction to the feedback: A randomised controlled trial. Med Educ 2006;40:746‑9.

Rae AM, Cochrane DK. Listening to students: How to make written assessment feedback useful. Act Learn High Educ 2008;9:217‑30.

Veloski J, Boex JR, Grasberger MJ, Evans A, Wolfson DB. Systematic review of the literature on assessment, feedback and physicians’ clinical performance: BEME Guide No. 7. Med Teach 2006;28:117‑28.


  • There are currently no refbacks.