• Some of the methods of providing formative feedback, particularly simulation and clinical experience can provide opportunities for peer support or inter-professional support and feedback. 
• Simulation and role play enables immediate feedback, which can be difficult in a clinical setting with a patient present.  
• Formative feedback on clinical skills can facilitate student development in practice, assist reflection ‘on action’ in addition to providing opportunities to see how assessments work in practice.  

• Time and staffing are some of the biggest challenges when considering ways to provide formative feedback opportunities within busy clinical settings.  
• Consistency of feedback can be difficult when there are multiple placements or groups. 
• Many students are fearful of ‘role play’. It requires a skillful facilitator to ensure all students can feel comfortable engaging with the process.  
• Additional challenges are provided in the pros and cons list. 

• If using simulation, try to make it as realistic as possible.  
• Provide all students with a part to play in simulations or role play. Active observer status can increase participation and learning.  
• The use of actors within role play scenarios or previous students can help provide more realistic scenarios for role play. 
• Prepare students with a ‘pre-brief’, to set the scene and objectives of the session. 
• Remind students about confidentiality within the learning environment and any other ground rules.  
• Ensure time for debriefing and considering the learning points from the sessions are included when timetabling. 
• Provide training for practice educators, to empower them to provide high quality feedback to learners and help improve consistency.  

The benefits of work-based learning have been highlighted in a document by the Royal College of Physicians (RCP, 2018). The document contains many examples of how feedback can be provided in the workplace.  

Simulation is seen as a ‘safe’ space for learning (Gordon and McGonigle, 2018). It enables learners to make mistakes, discuss the mistakes, how to improve, the consequences and impact of errors in relation to clinical outcomes, thus developing critical reasoning skills (Mason Barber and Schuessler 2018; RCP, 2018). A wide range of scenarios can be facilitated through simulation, the environment can be controlled and feedback instantaneous. Within a simulated setting, if a student needs advice or support, this can be provided before resuming the simulation.

Learning points can be discussed during the simulated scenario, if necessary, providing instant feedback, an opportunity to change behaviours and the possibility of repetition (Bosse et al, 2015; Palaganas et al, 2016; RCP, 2018). Simulation can be used to provide formative feedback to students in the HEI setting or clinical placement. The use of more experienced student peers working with less experienced students could also add to the value of the simulation experience. More experienced peers can develop skills for providing effective feedback, whilst less experienced students gain valuable knowledge and advice from students who have been in that situation more recently.  

Role play provides students to explore challenging situations and develop skills to assist them in clinical practice.  It also enables students to explore behaviours, communication and reactions, whilst interacting with others (Bradshaw and Hultquist, 2017).

It is important to remember that role play scenarios can also be used via the virtual learning environment (VLE), providing synchronous and asynchronous opportunities for students to develop skills and give/receive formative feedback. Virtual learning and virtual reality simulation can help develop a range of skills and decision making. Gordon (2017) highlights a method for debriefing following virtual simulation exercises using videoconferencing, to develop understanding and help promote deeper learning. They recommend no more than ten students on any conference call, to provide all students with an opportunity to learn and interact.  

Bosse, H.M., Mohr, J., Buss, B., Krautter, M., Weyrich, P., Herzog, W., Jünger, J. & Nikendei, C. 2015, "The benefit of repetitive skills training and frequency of expert feedback in the early acquisition of procedural skills", BMC Medical Education, vol. 15, no. 1, pp. 22-22. 

Bradshaw, M. and Hultquist, B. (2017) Innovative teaching strategies in nursing, 7th Ed. Burlington; Jones & Bartlett Learning.  

CETL (2010) Feedback Opportunities. A training resource for healthcare professionals. Available at:  http://cetl.org.uk/learning/feedback_opportunities/player.html (Accessed 26 February 2019) 

Gordon, R.M. 2017, "Debriefing Virtual Simulation Using an Online Conferencing Platform: Lessons Learned", Clinical Simulation in Nursing, vol. 13, no. 12, pp. 668-674. 

Gordon, R.M., McGonigle, D. & eBook Nursing Collection – Worldwide 2018, Virtual simulation in nursing education, 1st edn, Springer Publishing Company, LLC, New York, NY. 

Junod Perron, N., Louis-Simonet, M., Cerutti, B., Pfarrwaller, E., Sommer, J. & Nendaz, M. 2016, "The quality of feedback during formative OSCEs depends on the tutors' profile", BMC Medical Education, vol. 16, no. 1, pp. 293-8. 

Mason Barber, L.A. & Schuessler, J.B. 2018, "Standardized Patient Simulation for a Graduate Nursing Program", The Journal for Nurse Practitioners, vol. 14, no. 1, pp. e5-e11. 

Palaganas, J.C., Fey, M. & Simon, R. 2016, "Structured Debriefing in Simulation-Based Education", AACN Advanced Critical Care, vol. 27, no. 1, pp. 78-85. 

RCP (2018) ‘Never too busy to learn: How the modern team can learn together in the busy workplace.’ Royal College of Physicians 

Available at: https://www.rcplondon.ac.uk/projects/outputs/never-too-busy-learn-how-modern-team-can-learn-together-busy-workplace (Accessed 26 February 2019) 

Solheim, E., Plathe, H.S. & Eide, H. 2017, "Nursing students' evaluation of a new feedback and reflection tool for use in high-fidelity simulation – Formative assessment of clinical skills. A descriptive quantitative research design", Nurse Education in Practice, vol. 27, pp. 114-120.