What makes feedback effective?
Feedback is information about the gap between what someone did and the standard they are aiming for, given in a way that helps them close it. Done well, it is one of the strongest influences on learning. Done badly, through vague praise or personal criticism, it can do more harm than saying nothing.
- Timely: soon after the event, while both of you remember it.
- Specific: about what you saw or heard, not general impressions.
- About behaviour, not personality: describe actions the learner can change.
- Focused: one or two points that matter most, not a long list.
- Two-way: the learner reflects first and helps shape the plan.
- Private for anything critical: never in front of patients or the team.
You're a bit disorganised on the ward round. You need to be more on top of things.
On this morning's round, three of your patients' blood results were not ready, so we stopped to look them up and nearly missed a high potassium. What do you think would help you prepare? One option is to check results for your patients in the twenty minutes before the round.
The weak version labels the person, which tends to make people defensive and gives them nothing to act on. The strong version describes what happened, explains why it matters, invites the learner's view and offers a practical step.
What is Pendleton's feedback model?
Pendleton's rules come from work on teaching consultation skills by Pendleton and colleagues in the 1980s. They remain one of the most widely used feedback structures in UK medical, nursing and allied health education.
- Check the learner wants feedback now: Agree that this is a good moment, and clear up any questions of fact first.
- Learner: what went well?: Ask the learner what they think went well. Encourage specifics.
- Supervisor: what went well: Add your own specific observations of good practice.
- Learner: what could be improved?: Ask what they would do differently next time.
- Supervisor: what could be improved, and a plan: Add your suggestions, agree one or two actions and when you will review them.
Strengths and weaknesses of Pendleton
| Strengths | Weaknesses |
|---|---|
| Starts with the learner's own reflection | Can feel rigid or formulaic, especially for experienced learners |
| Safe and supportive for students and new starters | The positive stages can become repetitive |
| Easy to learn and to use consistently | The most important improvement can get lost at the end |
| Builds self-assessment skills over time | Learners who are anxious may struggle to name strengths |
To get the most from it, keep the stages short and make sure the key improvement point is clear and recorded. You do not need equal time on each stage.
Is the feedback sandwich a good idea?
The feedback sandwich puts criticism between two pieces of praise. It is common because it feels kind, but it often does not work. Learners can miss the key message, and over time they learn to distrust praise because they expect a but to follow.
Pendleton is sometimes confused with the sandwich, but it is different: the learner reflects first, and the conversation ends with a plan rather than with reassurance. A better principle is to be clear and kind. Give honest, specific praise when it is earned, and give improvement feedback directly with a practical next step.
Other feedback models and when to use them
No single model suits every situation. Choose the one that fits the setting, the time available and the learner.
| Model | How it works | Best for |
|---|---|---|
| Pendleton's rules | Learner then supervisor on what went well, then learner then supervisor on what to improve, then a plan | Students, new starters, structured debriefs |
| SET-GO (part of ALOBA) | What did you See, what Else, what do you Think, what Goal, any Offers | Observed consultations and communication skills |
| Ask, Tell, Ask | Ask how it went, tell one or two observations, ask what they will do next time | Two-minute feedback between tasks on a busy shift |
| R2C2 | Build the Relationship, explore Reaction, explore Content, Coach for change | Multi-source feedback, assessments, feedback that is hard to accept |
SET-GO and agenda-led feedback
SET-GO comes from the agenda-led, outcome-based analysis (ALOBA) approach developed by Kurtz, Silverman and Draper for communication skills teaching. It begins with what the learner wants help with and what was observed, before any judgement. Because it starts with description, it keeps feedback specific and less threatening, and it suits rehearsal of a better approach straight away.
Ask, Tell, Ask in two minutes
After a cannulation, for example: ask how the learner felt it went. Tell them one strength, such as explaining the procedure clearly, and one change, such as releasing the tourniquet before preparing the dressing. Then ask what they will do on the next one. The final question checks understanding and turns feedback into a plan.
R2C2 for harder conversations
R2C2, developed by Sargeant and colleagues, is designed for discussing performance data such as multi-source feedback. It gives time to explore the learner's emotional reaction before looking at the content, which matters when feedback is unexpected. It ends with coaching towards a specific, agreed change.
Where feedback fits in clinical supervision
Supervision means different things in UK healthcare. It can mean overseeing a learner to keep patients safe, guiding someone's education over months, or a protected reflective conversation for a qualified professional. Proctor's model describes three functions that good supervision balances: normative (standards and safety), formative (learning) and restorative (support and wellbeing).
Regulators set expectations for supervisors. The NMC Standards for student supervision and assessment separate the practice supervisor, practice assessor and academic assessor roles. The GMC requires named clinical and educational supervisors of doctors in training to be trained and recognised. HCPC and GPhC standards cover practice-based learning and supervision in their professions. In England, the A-EQUIP model underpins professional midwifery advocates and professional nurse advocates, who offer restorative supervision.
Set expectations at the first meeting
- Meet early, in private, with protected time.
- Ask about previous experience, confidence and any needs.
- Agree three to five specific objectives and what the learner may do without checking first.
- Explain that you will give regular, specific feedback and invite them to ask for it.
- Record a short learning agreement with midpoint and final review dates.
What should you do if a learner is struggling?
Struggling learners usually have a mix of reasons: knowledge or skills gaps, health problems, personal stress, cultural adjustment or problems in the learning environment. Early, honest, supportive action works far better than waiting for the final assessment.
- Gather facts: Collect specific, dated examples from named observers, not rumour.
- Meet privately: Describe the concerns factually, listen to the learner's account and explore causes, including health and personal factors.
- Agree a plan: Set specific objectives, the support offered, how progress will be measured and a review date.
- Involve the right people: Inform the link lecturer, practice education facilitator, educational lead or training programme director as your local process requires. Refer to occupational health if health may be a factor.
- Document and review: Keep a factual shared record. If concerns persist or patient safety is at risk, follow the formal process without delay.
Met with student. Some concerns about attitude. Told to improve.
Meeting 14 May, 30 minutes. Concerns: arrived after handover on 3, 6 and 10 May; one medicines round on 10 May finished 40 minutes late. Student's account: change in childcare. Agreed: student to phone the ward by 7.15 am if delayed; review options with university student support; one supervised medicines round each shift this week. Review 21 May. Link lecturer informed.
Case study: when expectations were never set
Priya is an occupational therapist supervising Daniel, a final-year student on a stroke unit. Covering a vacancy, she has only had brief chats with him. In week three a nurse reports that Daniel took a patient into the kitchen for an assessment without checking the patient's swallowing plan. The midpoint review is in two days.
Priya realises they never had a proper first meeting. She meets Daniel privately, describes what was reported and asks for his account. He explains that on his last placement he ran kitchen assessments alone and assumed the same applied. He was unsure where swallowing plans were kept but did not want to look incapable by asking.
Priya acknowledges her part in the confusion. They agree that Daniel will not run functional assessments alone until signed off, they will review the unit's swallowing documentation together, and they will meet twice a week. After an observed session the next day she uses Pendleton's model; Daniel identifies for himself that he now checks the plan first. Priya records the plan and tells the university link tutor, as the placement process requires.
Building your supervision and feedback skills
Pick one model and use it deliberately for a few weeks, then ask learners how it felt. Ask a colleague to sit in on a feedback conversation and give you feedback in return. Record your reflections, as supervision and teaching make strong evidence for appraisal and revalidation.
Our course Clinical Supervision and Giving Feedback works through these models with worked conversations and guidance on learners in difficulty. Teaching Skills for Healthcare Professionals covers planning and delivering teaching, and Leadership and Team Working in the NHS looks at feedback and development across a whole team.
Frequently asked questions
What are Pendleton's rules of feedback?
Pendleton's rules are a structured order for feedback. After checking the learner is ready, the learner says what went well, the supervisor adds what went well, the learner says what could be improved, and the supervisor adds suggestions and agrees an action plan. The learner always reflects before the supervisor comments.
What is the difference between Pendleton and the feedback sandwich?
The feedback sandwich puts criticism between two pieces of praise, delivered by the supervisor. Pendleton starts with the learner's own reflection at each stage and ends with an agreed plan rather than reassurance. Pendleton is a two-way conversation; the sandwich is a one-way message that can hide the main point.
What are the criticisms of Pendleton's model?
It can feel rigid and formulaic, especially for experienced learners. The positive stages can become repetitive, anxious learners may struggle to name strengths, and the most important improvement point can get lost at the end. Keeping stages brief and stating the key action clearly helps.
What does SET-GO stand for?
SET-GO stands for: what did you See, what Else did you see, what do you Think, what Goal are we trying to achieve, and any Offers of how to get there. It is part of the agenda-led, outcome-based analysis approach used in communication skills teaching, and starts with description rather than judgement.
What is the R2C2 feedback model?
R2C2 is a four-phase model for feedback conversations about performance data such as multi-source feedback. You build the Relationship, explore the learner's Reaction, explore their understanding of the Content, and Coach for change with a specific plan. It is useful when feedback is unexpected or difficult to accept.
How do you give feedback to a student nurse who is struggling?
Meet privately, describe specific dated observations, and ask for their account. Explore possible causes, including health and personal factors. Agree clear objectives, support and a review date, record the plan, and involve the practice assessor and academic assessor or link lecturer as local policy requires. Act early rather than waiting for the final assessment.
What are the three functions of clinical supervision?
Proctor's model describes normative, formative and restorative functions. Normative covers standards, accountability and safe practice. Formative covers learning and skill development. Restorative covers support and the emotional impact of the work. Good supervision includes all three, with the balance depending on the supervisee and the situation.
Related courses
Clinical Supervision and Giving Feedback
This course explains the different kinds of supervision used in UK healthcare, how to set up a supervisory relationship that works, and how to give…
Teaching Skills for Healthcare Professionals
This practical course teaches you how to plan and deliver effective teaching in clinical settings, from a formal session to five minutes at the…
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This course explains what leadership means for every healthcare professional, not only managers, and teaches practical skills for leading a shift or…
Sources and further reading
- Standards for student supervision and assessment. Nursing and Midwifery Council.
- Promoting excellence: standards for medical education and training. General Medical Council.
- Standards of education and training. Health and Care Professions Council.
- Standards for the initial education and training of pharmacists. General Pharmaceutical Council.
- A-EQUIP: a model of clinical midwifery supervision. NHS England.
- Professional Standards for medical, dental and veterinary educators. Academy of Medical Educators.
Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.
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