This ENhance Case Study on the theme of Student Focus has been written by Devi Kandel in the School of Health & Social Care. If you would like to share your practice with colleagues, please contact us at DLTE@napier.ac.uk. Colleagues can find out more about the module featured, Assessing Health and Planning Care, on ENU’s Curriculum Management Environment (CME).

Devi Kandel

As a lecturer in adult nursing, I have been involved in both formative and summative assessments for the Objective Structured Clinical Assessment (OSCA) in the Assessing Health and Planning Care module of the Singapore BSc Nursing programme, I’ve gained valuable insights into the role of feedback in student learning. This experience became even more enriching as I was pursuing a PgCert in Higher Education Teaching and Learning (HETL), where I searched deeper into the topic of assessment, particularly effective feedback.

In recent years, there has been a shift in the way we approach feedback, with an increasing emphasis on the concept of “feed-forward.” This forward-thinking approach helps students focus on what they should improve for future assessments, embedding feedback in everyday learning rather than limiting it to formal assignments (Bloxham & Boyd, 2007).

My experience with OSCA assessments, coupled with my academic journey in HETL, has led me to appreciate the importance of feedback in nurturing student growth. Whether through the adoption of feed-forward strategies or the move towards pass/fail grading, the goal is clear: to create an environment where students are motivated to reflect, improve, and succeed, not just in their grades, but in their development as capable, compassionate healthcare professionals. Effective feedback is not just about telling students what they did wrong; it’s about empowering them to recognise their potential and make meaningful progress.

By rethinking our approach to feedback and assessment, we can foster a culture of learning that truly supports student growth and prepares them for the challenges of the nursing profession. While the shift to a pass/fail system presents its own set of challenges, its potential to reduce anxiety, promote intrinsic motivation, and focus on holistic development outweighs these hurdles. It’s about creating a supportive, collaborative learning environment that encourages nursing students to focus on learning to improve their practice and, ultimately, deliver better patient care.

In the context of nursing, the absence of a constructive feedback culture in clinical environments can have significant consequences. Without timely, actionable feedback, areas for improvement may go unnoticed, underperformance may remain unaddressed, and good practice may not be reinforced (Cantillon & Sargeant, 2008). This is equally relevant in higher education, where feedback serves the vital purpose of bridging the gap between actual and desired performance, encouraging students to reflect on their work and identify areas for improvement (Pitt & Quinlan, 2022).

Grades vs. Comments: Fostering Growth Mindset

A critical aspect of feedback in education, especially in nursing, is the form it takes. Feedback that is primarily grade-based often fosters a competitive environment where students focus on comparison with their peers. This can lead to a fixed mindset, where students believe their abilities are set in stone, rather than malleable and capable of improvement (Pitt & Quinlan, 2022). On the other hand, feedback that focuses on specific areas for improvement, typically in the form of comments, promotes a growth mindset. It signals to students that they have the ability to enhance their performance and that their success is within their control (Black & William, 2018). This type of feedback tends to be more constructive and better received by students.

Pass/Fail Assessment: A More Compassionate Approach

Reflecting on the literature (Jarvis, 2010) and my own experiences with OSCA assessments, I’ve come to realise that grading practical performance with a percentage can be problematic. The nuances of clinical skills cannot always be captured accurately with numerical grades. Instead, a broad pass/fail approach, as advocated by Jarvis (2010), seems more appropriate. This approach is seen as more humanising and compassionate, fostering a sense of belonging and reducing anxiety for students (QAA, 2023). It also encourages intrinsic motivation rather than a focus on external rewards, such as grades.

When the emphasis shifts away from competitive grading, students are more likely to engage in meaningful conversations about learning, rather than simply aiming to achieve higher grades. This collaborative culture of learning is essential in nursing, where the ultimate goal is to improve patient care rather than simply outperform peers. On the flip side, grade-based assessments can encourage strategic, superficial learning behaviours, where the focus becomes achieving higher scores rather than mastering the subject matter (Boud & Falchikov, 2007). After gaining this knowledge, I began to share my knowledge and a new perspective on a pass/fail assessment model as opposed to the grading model with the faculty. I worked in collaboration with the module leader at the time to put this proposal forward to the School Quality Committee for approval and achieved it.

This pass/fail assessment encouraged students to focus on being a safe practitioner, working in collaboration with fellow students, rather than being competitive and not sharing their ideas and knowledge with others. After this mock assessment majority of them felt confident enough to transfer their skills and knowledge into clinical practice.

Challenges in Shifting to Pass/Fail Assessment

While the move toward a pass/fail assessment system offers many potential benefits, it is not without its challenges. One of the primary concerns is the initial resistance from both students and faculty who are accustomed to traditional grading systems. Many students felt uncertain about how to gauge their performance without a clear numerical grade, which then led to anxiety about whether they were meeting expectations. For faculty, the shift requires a change in mindset from focusing on grades to focusing on a more holistic evaluation of students’ practical abilities, which can be more time-consuming and require careful consideration of each student’s skills in action.

Another challenge was the lack of differentiation in performance that comes with a pass/fail system. In clinical education, particularly in nursing, it’s important to assess not only whether a student meets basic competency but also how well they perform to preserve patient safety. With a pass/fail system, it can be more difficult to distinguish between students who are merely meeting the minimum standards and those who are excelling. This can impact the way students view their own progress and may not provide enough detailed feedback for those striving to improve further.

There is also the challenge of aligning the pass/fail system with professional standards. In clinical education, where high standards are critical for patient safety, a pass/fail system mustn’t lower expectations or reduce the rigor of assessments. We developed clearly defined pass/fail essential criteria to ensure the integrity of the programme which was then well perceived by students and the faculty.

Traditional vs. Emerging Feedback Paradigms

The Advance HE (2015) framework identifies two key paradigms for feedback: the traditional and the emerging. The traditional model is educator-centric, where feedback is delivered to the student. However, the emerging, learner-centered paradigm prioritizes the development of students’ feedback literacy (Carless, 2015; Winstone & Boud, 2019; Nicol, 2021; Henderson et al., 2019). Feedback literacy refers to a student’s ability to seek, generate, evaluate, and use feedback effectively. It’s not just about receiving information but about engaging with it constructively and using it to enhance their performance (Carless & Boud, 2018; Molloy, Boud & Henderson, 2020).

In practice, the traditional model often leaves students struggling to decode feedback, especially when it is delayed or lacks clarity (Pitt & Quinlan, 2022). More immediate, actionable feedback—whether from peers, self-reflection, or teachers—guided by clear assessment criteria, has been shown to significantly enhance performance (Naghdipour, 2017; Nkealah, 2019; Cooke, 2016). The value of timely feedback cannot be overstated; it increases the likelihood that students will pay attention, understand, and act on the feedback provided (Gibbs, 2015).

References

AdvanceHE., 2015. Transformation Assessment in Higher Education Framework. Available from: Transforming Assessment in Higher Education Framework.pdf (advance-he.ac.uk).

Bloxham, S., & Boyd, P., 2007. Developing effective assessment in higher education : a practical guide. VLeBooks. ​​​​​​​

Boud, D. and Falchikov, N. eds., 2007. Rethinking assessment in higher education: Learning for the longer term. Routledge.

Cantillon, P., & Sargeant, J., 2008. Giving feedback in clinical settings. BMJ, pp. 337.

Carless, D., & Boud, D., 2018. The development of student feedback literacy: enabling uptake of feedback. Assessment & Evaluation in Higher Education, 43(8), pp. 1315-1325.

Cooke, B., 2016. Embedding digital (information) literacy in the first-year curriculum: an intervention. Journal of Applied Academic Practice, 4(2), pp.40-45.

Henderson, M, Molloy, E, Ajjawi, R and Boud, D., 2019. ‘Designing feedback for impact’, in Henderson, M, Ajjawi, R, Boud, D and Molloy, E (eds) The Impact Of Feedback In Higher Education: Improving Assessment Outcomes For Learners. Cham: Palgrave Macmillan, pp 267-285.

Jarvis, P., 2010. Adult education and lifelong learning: theory and practice. 4th edn. London: Routledge, pp. 210 – 216.

Molloy, E., Boud, D., & Henderson, M., 2020. Developing a learning-centered framework for feedback literacy. Assessment & Evaluation in Higher Education, 45(4), pp. 527-540.

Naghdipour, B., 2017. Incorporating formative assessment in Iranian EFL writing: A case study. The Curriculum Journal, 28(2), pp.283-299.

Nicol, D., 2021. The power of internal feedback: Exploiting natural comparison processes. Assessment & Evaluation in Higher Education, 46(5), pp.756-778.

Nkealah, N.E., 2019. Applying formative assessment strategies in the teaching of poetry: An experiment with third-year English studies students at the University of Limpopo. South African Journal of Higher Education, 33(1), pp.242-261.

Pitt, E. and Quinlan, K.M., 2022. Impacts of higher education assessment and feedback policy and practice on students: A review of the literature 2016-2021. Available from: AdvHE_Assessment and Feedback_Literature Review_2016-2021_1652888346.pdf.

Quality Assurance Agency [QAA]., 2018. The United Kingdom Quality Code for Higher Education Advice and Guidance Assessment. Available from: https://www.qaa.ac.uk/the-quality-code/advice-and-guidance/assessment.

Winstone, N. and Boud, D., 2019. Exploring cultures of feedback practice: the adoption of learning-focused feedback practices in the UK and Australia. Higher Education Research & Development, 38(2), pp.411-425.