Narrative Feedback Research Articles

Digital, Social Micro-Interventions to Promote Physical Activity Among Midlife Adults With Elevated Cardiovascular Risk: An Ambulatory Feasibility Study With Momentary Randomization.

Although regular physical activity (PA) mitigates the risk for cardiovascular disease (CVD) during midlife, existing PA interventions are minimally effective. Harnessing social influences in daily life shows promise: digital micro-interventions could effectively engage these influences on PA and require testing. This feasibility study employed ecological momentary assessment with embedded micro-randomization to activate two types of social influences (i.e., comparison, support; NCT04711512). Midlife adults (N = 30, MAge = 51, MBMI = 31.5kg/m2, 43% racial/ethnic minority) with ≥1 CVD risk conditions completed four mobile surveys per day for 7 days while wearing PA monitors. After 3 days of observation, participants were randomized at each survey to receive 1 of 3 comparison micro-interventions (days 4-5) or 1 of 3 support micro-interventions (days 6-7). Outcomes were indicators of feasibility (e.g., completion rate), acceptability (e.g., narrative feedback), and potential micro-intervention effects (on motivation and steps within-person). Feasibility and acceptability targets were met (e.g., 93% completion); ratings of micro-intervention helpfulness varied by intervention type and predicted PA motivation and behavior within-person (srs=0.16, 0.27). Participants liked the approach and were open to ongoing micro-intervention exposure. Within-person, PA motivation and behavior increased from baseline in response to specific micro-interventions (srs=0.23, 0.13), though responses were variable. Experimental manipulation of social influences in daily life is feasible and acceptable to midlife adults and shows potential effects on PA motivation and behavior. Findings support larger-scale testing of this approach to inform a digital, socially focused PA intervention for midlife adults.

Is that SMART? Leveraging Collaboration and Peer Feedback to Enable Practice in Appraising and Presenting Journal Articles

AbstractIn an innovative journal club exercise, groups of students collaboratively appraise and present a journal article and then provide SMART narrative feedback to a peer group on their presentation. Feedback is exchanged between groups that presented the same journal article, increasing the likelihood that feedback will be meaningful and high-quality.

Characteristics of positive feedback provided by UK health service users: content analysis of examples from two databases

BackgroundMost feedback received by health services is positive. Our systematic scoping review mapped all available empirical evidence for how positive patient feedback creates healthcare change. Most included papers did not...

Characterizing narrative feedback and predictors of feedback content on an entrustable professional activity (EPA) assessment tool

PurposeAlthough EPA assessment tools generally allow for narrative feedback, limited data exist defining characteristics and predictors of such feedback. We explored narrative feedback characteristics and their associations with entrustment, case-specific variables, and faculty/trainee characteristics.MethodsOur general surgery residency piloted an intraoperative Entrustable Professional Activities (EPA) assessment tool in 2022. The tool included an entrustment score, four sub-scores, and narrative feedback. Given strong intercorrelations (r = 0.45–0.69) and high reliability (α = 0.84) between sub-scores, we summed the four sub-scores into a composite score. We coded narrative feedback for valence (reinforcing vs constructive), specificity (specific vs general), appreciation (recognizing or rewarding trainee), coaching (offering a better way to do something), and evaluation (assessing against set of standards). Multivariable regression analyzed associations between feedback characteristics and entrustment score, composite score, PGY level, case difficulty, trainee/faculty gender, gender matching, faculty years in practice, faculty case volume with trainees, faculty evaluation score, and trainees’ under-represented in medicine (URiM) status.ResultsForty-six faculty completed 325 intraoperative EPA assessments for 44 trainees. Narrative feedback had high valence (82%) and specificity (80%). Comments frequently contained appreciation (89%); coaching (51%) and evaluation (38%) were less common. We found that faculty gender, trainee gender, and gender match predicted feedback characteristics. Generally, entrustment level, composite score, and PGY level correlated with feedback types (Table).ConclusionEntrustment and performance relate to the type of feedback received. Gender and gender match resulted in different types of feedback. Evaluative feedback was the least prevalent and warrants further exploration since evaluation is critical for learning.

The Perceived Usefulness of Patient Narrative Feedback in Primary Care Settings

The Perceived Usefulness of Patient Narrative Feedback in Primary Care Settings

The Power of Words: Employee Responses to Numerical vs. Narrative Performance Feedback

The Power of Words: Employee Responses to Numerical vs. Narrative Performance Feedback

Developing culturally competent physicians: Empathy, inclusivity, moral distress training and ethical reflections during the Medicine Clerkship

Purpose We aimed to develop a tool that would allow assessment of ethics competency and moral distress during the Internal Medicine Clerkship and to introduce curricular changes that could empower students to better address ethical dilemmas and challenges encountered during the clerkship. Materials and Methods A structured ethics assignment was introduced where students could reflect on impactful stressful scenarios and address questions related to emotional responses, identified ethical issues, management themes, and professional obligations. A 4-tiered grading rubric and individual narrative feedback was provided for each assignment, and small-group debriefing sessions were introduced for reflective thought and future planning. De-identified assignments were analyzed and classified into subgroups according to 5 main ethical issue subgroups and 10 specific management themes. Assignments were also analyzed for the presence of moral distress. Results 357 students completed the reflective ethics activities. The most commonly identified ethical issues were related to Shared Medical Decision Making (>40%), Primary of Patient Welfare challenges, (>20%), and Social/Organizational dilemmas. Management themes often pertained to Patient Wishes/Legal Obligations, Professional Behaviors, and Limited Resources. 87% of assignments demonstrated moral distress. Conclusion Medical school is a stressful time and challenges are augmented during clinical years. Our reflective activity demonstrated significant exposures to ethical dilemmas, reviewed earlier principles of ethics training, and provided a safe forum in which to discuss these important aspects of healthcare. We captured powerful images of challenging situations eliciting moral distress, and students greatly appreciated the activity. We encourage future investigations that support student well-being and enable smooth transitions into residency training.

Using Natural Language Processing to Visualize Narrative Feedback in a Medical Student Performance Dashboard.

Clinical competency committees rely on narrative feedback for important insight into learner performance, but reviewing comments can be time-consuming. Techniques such as natural language processing (NLP) could create efficiencies in narrative feedback review. In this study, the authors explored whether using NLP to create a visual dashboard of narrative feedback to preclerkship medical students would improve the competency review efficiency. Preclerkship competency review data collected at the Northwestern University Feinberg School of Medicine from 2014 to 2021 were used to identify relevant features of narrative data associated with review outcome (ready or not ready) and draft visual summary reports of the findings. A user needs analysis was held with experienced reviewers to better understand work processes in December 2019. Dashboards were designed based on this input to help reviewers efficiently navigate large amounts of narrative data. The dashboards displayed the model's prediction of the review outcome along with visualizations of how narratives in a student's portfolio compared with previous students' narratives. Excerpts of the most relevant comments were also provided. Six faculty reviewers who comprised the competency committee in spring 2023 were surveyed on the dashboard's utility. Reviewers found the predictive component of the dashboard most useful. Only 1 of 6 reviewers (17%) agreed that the dashboard improved process efficiency. However, 3 (50%) thought the visuals made them more confident in decisions about competence, and 3 (50%) thought they would use the visual summaries for future reviews. The outcomes highlight limitations of visualizing and summarizing narrative feedback in a comprehensive assessment system. Future work will explore how to optimize the dashboards to meet reviewer needs. Ongoing advancements in large language models may facilitate these efforts. Opportunities to collaborate with other institutions to apply the model to an external context will also be sought.

Leveraging Narrative Feedback in Programmatic Assessment: The Potential of Automated Text Analysis to Support Coaching and Decision-Making in Programmatic Assessment.

Current assessment approaches increasingly use narratives to support learning, coaching and high-stakes decision-making. Interpretation of narratives, however, can be challenging and time-consuming, potentially resulting in suboptimal or inadequate use of assessment data. Support for learners, coaches as well as decision-makers in the use and interpretation of these narratives therefore seems essential. We explored the utility of automated text analysis techniques to support interpretation of narrative assessment data, collected across 926 clinical assessments of 80 trainees, in an International Medical Graduates' licensing program in Australia. We employed topic modelling and sentiment analysis techniques to automatically identify predominant feedback themes as well as the sentiment polarity of feedback messages. We furthermore sought to examine the associations between feedback polarity, numerical performance scores, and overall judgments about task performance. Topic modelling yielded three distinctive feedback themes: Medical Skills, Knowledge, and Communication & Professionalism. The volume of feedback varied across topics and clinical settings, but assessors used more words when providing feedback to trainees who did not meet competence standards. Although sentiment polarity and performance scores did not seem to correlate at the level of single assessments, findings showed a strong positive correlation between the average performance scores and the average algorithmically assigned sentiment polarity. This study shows that use of automated text analysis techniques can pave the way for a more efficient, structured, and meaningful learning, coaching, and assessment experience for learners, coaches and decision-makers alike. When used appropriately, these techniques may facilitate more meaningful and in-depth conversations about assessment data, by supporting stakeholders in interpretation of large amounts of feedback. Future research is vital to fully unlock the potential of automated text analysis, to support meaningful integration into educational practices.

Attitudes and Confidence in Communication Skills of Fourth-Year Medical Students After Online Small Group Discussion and Peer Role-Play: A Survey Study.

This study investigated the impact of online small group discussions and peer role-play on medical students' attitudes toward and confidence in communication skills. The study involved a 3-hour instructional design that integrated small group discussions and role-plays to enhance the communication abilities of fourth-year medical students. The data were obtained from students through a post-activity online survey. Likert scale responses were quantified as percentages. Students' narrative feedback on their learning achievements was subjected to content analysis. Codes and categories were agreed upon by investigators and reviewed by an external auditor. A total of 151 medical students responded to the survey, representing a 47.94% response rate. The majority strongly agreed that good communication skills help physicians obtain reliable information (94.00%) and that practicing questioning skills is essential (92.1%). Content analysis revealed that nearly half (48.34%) considered that the learning activities fostered positive attitudes toward communication. These attitudinal improvements included increased empathy and emotional care (37.75%), recognition of communication as a trainable skill (10.57%), and recognition of the necessity of communication skills for physicians (8.61%). Additionally, most students (75.5%) reported increased confidence in their communication skills. In alignment with transformative learning theory, online small group discussions combined with peer role-play may potentially enhance the attitudes and confidence of medical students in relation to communication skills.

Conceptualizing and Developing Competence in Newborn Medicine Among Military Pediatricians.

Competence in neonatal care is especially important for military pediatricians because military pediatricians can be asked to serve in remote duty locations with limited resources. We sought to understand how this competence is defined, developed, and assessed by military pediatric training programs. After Institutional Review Board approval was obtained, we interviewed educators and recent graduates from every pediatric military training program to construct a shared definition of competence. We then used Kern's Six Steps for curriculum development to understand how competence is taught and assessed. Participants felt that competence for military pediatricians in the neonatal setting meant that learners should be able to provide a full spectrum of newborn care in any military setting. Participants confirmed that this competence was particularly important for military pediatricians because of the possibility of remote duty locations. Participants felt that specific knowledge, skills, and attitudes supported competence. Knowledge domains include distinguishing normal newborns from abnormal newborns, managing normal newborn care, managing common newborn abnormalities, and creating a safe escalation plan for complicated or uncommon newborn abnormalities. Specific skills that support competence are newborn resuscitation, delivery of effective ventilation, and neonatal circumcision. Specific attitudes that support competence are, understanding the personal limits of knowledge and understanding the resources for escalation of care. Educators use a variety of modalities to teach toward competence, including the structured curricula, bedside teaching, and simulation. According to participants, the assessment of learners occurs primarily through narrative assessment and feedback but would ideally occur through direct observation. Competence in the neonatal setting is particularly important for military pediatricians. Essential skills undergo differential assessment and current assessment methods differ from ideal assessment methods. Future work should focus on how these facets can support a unified curriculum in newborn medicine.

Impact of a feedback strategy in a series of communication‐focused patient care simulations

AbstractIntroductionPatient care simulations (PCS) and objective structured clinical examinations (OSCE) allow pharmacy students to practice communication. Feedback can help improve communication, but the impact over time is not well understood.ObjectiveThis study investigated the impact of a feedback strategy on pharmacy students' communication skills over three PCS. It also evaluated the alignment between students' self‐scoring and faculty scoring.MethodsPharmacy students participated in three sessions (PCS1, OSCE, and PCS3) that were focused on the affective domain. Individualized numerical and narrative feedback was provided to students on their performance after PCS1. Students' communication was scored by faculty graders out of an 18‐point validated rubric. Students self‐scored their communication with the same rubric. Faculty and student scores were compared using a linear mixed effects model, and an intraclass correlation coefficient was used to measure agreement.ResultsIn PCS1, 82 students scored an average of 15.41 ± 2.14 for faculty scores and 16.06 ± 1.55 for self‐graded scores (0.36, p < 0.001). In the OSCE, 81 students had an average of 15.93 ± 1.86 for faculty scores and 16.45 ± 1.35 for self‐graded scores (0.1, p = 0.18). In PCS3, 74 students scored an average of 15.22 ± 2.15 for faculty scores and 16.25 ± 1.44 for self‐graded scores (0.14, p = 0.08). A correlation between faculty and student scores was seen for PCS1. Over the three sessions, no significant differences were found between student self‐graded scores (p = 0.08), but faculty scores did differ, with the OSCE having higher scores than PCS3 (p < 0.01). Many students with faculty‐graded scores greater than 1 standard deviation below the mean scored themselves higher than faculty did.ConclusionFeedback after PCS1 did not significantly improve scores. Students with low faculty‐graded scores frequently scored themselves higher indicating low self‐awareness.

Interprofessional Curriculum Delivery: Experience of a Primary Care Education Program.

Few post-graduate training programs offer a comprehensive curriculum that includes structured clinical experiences to teach interprofessional care. To address this need, the United States Department of Veterans Affairs, Office of Academic Affiliations funded the Centers of Excellence in Primary Care Education (CoEPCE) from 2011-2019 to provide interprofessional curricula for health profession trainees (HPTs), including physician residents, nurse practitioner residents, pharmacy residents, and psychology residents. We examined changes over time in curricular domains, system impacts, and program practices based on HPT survey data and the qualitative evaluation of narrative feedback. An annual survey was administered to participants. Indirect standardized ratios were calculated for interprofessional professional education (IPE) program domains, system impacts, and program practices. Qualitative responses were coded based on curricular domains and key program components. The study cohort included 369 HPTs. Site and profession standardized indirect ratios across all professions indicated improvements in curricular domains, system impacts, and program practices, with significant differences observed for associated health HPTs as compared to other HPTs for performance improvement. Qualitative data indicated that profession was associated with differences in perceptions of the curriculum. Although improvements occurred over time, our findings support the need for the thoughtful consideration of profession-specific identity characteristics when designing interprofessional curricula.

Case of Application of Essay-type Evaluation and Feedback Using Artificial Intelligence for Liberal Arts Education: Focusing on the basic liberal arts course ‘Understanding Sustainable Development Goals’

The purpose of this study is to reveal the results of cases where artificial intelligence descriptive evaluation and feedback systems were applied in large-scale online liberal arts lectures at universities. For this purpose, we investigated and analyzed the results and satisfaction of descriptive evaluations conducted by students in the online liberal arts course ‘Understanding Sustainable Development’ taken by 2,600 students at University A. As a research method, frequency analysis and trajectory analysis were conducted to confirm changes in student participation rates, and factor analysis was used to cluster and compare students' narrative evaluation response trends. As a result of the analysis, first, more than 60% of the students who took the ‘Understanding Sustainable Development’ course participated even after the 14th week, and more than 70% of the students participated more than 10 times. Second, the students' evaluation scores showed a similar score range in the first week, but the range of scores increased as the 14th week progressed. In addition, there was a group whose score difference reversed around the 7th week, the midpoint of a semester's lectures, so it was possible to identify both the period and the group in which the students' learning needs to be carefully managed. Third, when looking at students' satisfaction with AI quizzes, 86.6% responded positively regarding their active participation in AI-based quizzes, and 83.1% responded positively regarding the usefulness of AI-based quizzes. Meanwhile, the degree of motivation and expansion of AI-based quizzes into other liberal arts classes was relatively low at positive rates of 52.6% and 61.5%, respectively, but was much higher than the negative rates of 19.6% and 11.8%. Through these results, this study confirmed that the artificial intelligence-based narrative evaluation feedback system that provides feedback to individual students has implications in terms of student learning management and quality management of liberal arts courses. In order to improve learners' learning fidelity and increase their academic retention rate in large-scale online liberal arts lectures in the future, interest in and improvement of the evaluation feedback system is essential, and its use can be expanded to other classes that require descriptive evaluation.

Use the right words: evaluating the effect of word choice and word count on quality of narrative feedback in ophthalmology competency-based medical education assessments

Background: The purpose of this study was to investigate the effect of word choice on the quality of narrative feedback in ophthalmology resident trainee assessments following the introduction of competency-based medical education at Queen’s University. Methods: Assessment data from July 2017-December 2020 were retrieved from ElentraTM (Integrated Teaching and Learning Platform) and anonymized. Written feedback was assigned a Quality of Assessment for Learning (QuAL) score out of five based on this previously validated rubric. The correlation between QuAL score and specific coaching words was determined using a Spearman’s Rho analysis. Independent samples t-tests were used to compare the QuAL score when a specific word was used, and when it was absent. Results: A total of 1997 individual assessments were used in this analysis. The number of times the identified coaching words were used within a comment was significantly and positively associated with the total QuAL score, with the exception of “next time” (rho=0.039, p=0.082), “read” (rho = 0.036, p = 0.112), “read more” (rho = -0.025, p = 0.256) and “review” (rho = -0.017, p = 0.440). The strongest correlations were for “continue” (rho = 0.182, p < 0.001), “try(ing)” (rho = 0.113, p < 0.001) and “next step” (rho = 0.103, p < 0.001). The mean value of the QuAL score increased when coaching words were used vs. not used with the largest mean difference of 1.44 (p < 0.001) for “reflect”. A clear positive relationship was demonstrated between word count and QuAL score (rho = .556, p < 0.001). Conclusions: The use of certain coaching words in written comments may improve the quality of feedback.

Evaluating the Quality of Narrative Feedback for Entrustable Professional Activities in a Surgery Residency Program.

We assessed the quality of narrative feedback given to surgical residents during the first five years of Competency-Based Medical Education (CBME) implementation. CBME requires ongoing formative assessments and feedback on learners' performance. We conducted a retrospective cross-sectional study using assessments of Entrustable Professional Activities (EPAs) in the Surgical Foundations curriculum at Queen's University from 2017-2022. Two raters independently evaluated quality of narrative feedback using the Quality of Assessment of Learning (QuAL) Score (0-5). A total of 3,900 EPA assessments were completed over 5 years. Fifty-seven percent (2229/3900) of assessments had narrative feedback documented with a mean QuAL score of 2.16±1.49. Of these, 1614 (72.4%) provided evidence about the resident's performance, 951 (42.7%) provided suggestions for improvement, and 499/2229 (22.4%) connected suggestions to the evidence. There was no meaningful change in narrative feedback quality over time (r=0.067, P=0.002). Variables associated with lower quality of narrative feedback include: Attending role (2.04±1.48) compared to medical student (3.13±1.12, P<0.001) and clinical fellow (2.47±1.54, P<0.001), concordant specialties between the assessor and learner (2.06±1.50 vs. 2.21±1.49, P=0.025), completion of the assessment one month or more after the encounter versus one week (1.85±1.48 vs. 2.23±1.49, P<0.001), and resident entrustment versus not entrusted to perform the assessed EPA (2.13±1.45 vs. 2.35±1.66; P=0.008). The quality of narrative feedback was similar for assessments completed under direct and indirect observation (2.18±1.47 vs. 2.06±1.54; P=0.153). Just over half of the EPA assessments of surgery residents contained narrative feedback with overall fair quality. There was no meaningful change in the quality of feedback over 5 years. These findings prompt future research and faculty development.

Brief online acceptance and commitment therapy for adults with type 1 diabetes: a pilot study.

Recognizing the pivotal role of psychosocial factors in triggering and maintaining Type 1 Diabetes Mellitus (T1DM), the integration of psychoeducational and psychotherapeutic interventions is associated with comprehensive management of the disease. This study aimed to evaluate the impact of a four-week online individual Acceptance and Commitment Therapy (ACT) intervention in mitigating diabetes-associated stress, fostering diabetes acceptance, enhancing the patient-doctor relationship, and promoting psychological flexibility in adults diagnosed with T1DM. Employing a single-arm trial design with mixed methodology, thirteen participants (Mage = 39.04, SDage =13.74) engaged in the intervention and completed self-report measures before and after the intervention. Quantitative analysis with the Wilcoxon signed-rank test indicated a statistically significant difference in diabetes-associated stress, diabetes acceptance, and psychological flexibility pre- and post-intervention. Notably, stress levels and psychological inflexibility diminished, while psychological flexibility and diabetes acceptance improved. However, the patient-doctor relationship did not exhibit a significant change. Furthermore, narrative feedback obtained from participants reflected overall satisfaction with the intervention. These preliminary findings contribute to the expanding body of literature supporting the affirmative influence of ACT interventions on individuals with T1DM.

Making narrative feedback meaningful.

Narrative written feedback given to students by faculty often fails to identify areas for improvement and recommended actions to lead to this improvement. When these elements are missing, it is challenging for students to improve and for medical schools to use narrative feedback in promotion decisions, to guide coaching plans and to pass on meaningful information to residency programs. Large-group faculty development has improved narrative written feedback, but less is known about individualised faculty development to supplement large-group sessions. To fill this gap, we built a curriculum with general and individualised faculty development to improve narrative written feedback from Internal Medicine faculty to clerkship students. We used Kern's steps to build a curriculum with general and individualised one-on-one faculty development to improve the problem of inadequate narrative written feedback. We used a novel narrative feedback rubric for pre and post-intervention faculty scores. Through general and individualised one-on-one faculty development with peer comparison scores, we were able to improve narrative written feedback from 3.7/6 to 4.6/6, for an increase of 23%. We found our faculty development program effective in improving feedback and was easy to implement. Our rubric was easy to use, and faculty were receptive to feedback in one-on-one meetings. We plan to extend this work locally to other divisions/departments and into graduate medical education; it should also be easily extended to other medical disciplines or health professions.

Virtual Reality Relaxation for Mental Health Service Users with Complex Care Needs: a Pilot Study in Residential Care Homes and Supported Accommodation

AbstractVirtual reality (VR) relaxation is a promising, novel intervention for service users with a range of mental health conditions and has potential wellbeing benefits such as promoting relaxation and reducing stress and anxiety. Less is known about the implementation of VR relaxation for service users in complex care mental health services. This study aimed to investigate implementation of a single session of VR relaxation for service users in residential care homes and supported accommodation, who were supported by a South London community team. Participants could explore relaxing, natural environments in VR. Pre- and post-VR visual analogue scales of mood, immersiveness, helpfulness, narrative feedback and clinician reflections were recorded. Participants (N = 20) had psychotic disorders and other serious mental health conditions. Post-VR, there were significant increases in relaxation (large effect), happiness and connectedness to nature (both medium effects), and decreases in anxiety and sadness (both medium effects). Stress was low at baseline and there was no significant effect post-VR. Helpfulness and immersion scores were high (both &gt; 8). Participants reported the intervention was very relaxing, exciting, uplifting and were enthusiastic about engaging in more VR relaxation and further psychological interventions, including therapy and other digital interventions. Participants reported finding a session facilitator helpful. Technical issues were minor and resolved by the facilitator. Findings indicate scope to widen access to VR relaxation within complex care services. More facilitators could offer multiple sessions to larger, more diverse groups of service users. Future research with more robust methodologies is needed to test effectiveness and longer-term impact.

Assessment in Undergraduate Competency-Based Medical Education: A Systematic Review.

Studies that have methodically compiled the body of research on the competency-based medical education (CBME) assessment procedure and pinpointed knowledge gaps about the structure of the assessment process are few. Thus, the goals of the study were to create a model assessment framework for competency-based medical education that would be applicable in the Indian setting as well as to thoroughly examine the competency-based medical education assessment framework. PubMed, MEDLINE (Ovid), EMBASE (Ovid), Scopus, Web of Science, and Google Scholar were the databases that were searched. The search parameters were restricted to English language publications about competency-based education and assessment methods, which were published between January 2006 and December 2020. A descriptive overview of the included research (in tabular form) served as the foundation for the data synthesis. Databases provided 732 records; out of which 36 fulfilled the inclusion and exclusion criteria. Thirty-six studies comprised a mix of randomized controlled trials, focus group interviews, and questionnaire studies, including cross-sectional studies, qualitative studies (03), mixed-method studies, etc. The papers were published in 10 different journals. The greatest number was published in BMC Medical Education (18). The average quality score for included studies was 62.53% (range: 35.71-83.33%). Most authors are from the UK (07), followed by the USA (05). The included studies were grouped into seven categories based on their dominant focus: moving away from a behavioristic approach to a constructive approach of assessment (01 studies), formative assessment (FA) and feedback (10 studies), the hurdles in the implementation of feedback (04 studies), utilization of computer or online based formative test with automated feedback (05 studies), video feedback (02 studies), e-learning platforms for formative assessment (04 studies), studies related to workplace-based assessment (WBA)/mini-clinical evaluation exercise (mini-CEX)/direct observation of procedural skills (DOPS) (10 studies). Various constructivist techniques, such as concept maps, portfolios, and rubrics, can be used for assessments. Self-regulated learning, peer feedback, online formative assessment, an online computer-based formative test with automated feedback, the use of a computerized web-based objective structured clinical examination (OSCE) evaluation system, and the use of narrative feedback instead of numerical scores in mini-CEX are all ways to increase student involvement in the design and implementation of the formative assessment.