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Original research
Effect of face-to-face verbal feedback compared with no or alternative feedback on the objective workplace task performance of health professionals: a systematic review and meta-analysis
  1. Christina Elizabeth Johnson1,2,
  2. Mihiri P Weerasuria3,
  3. Jennifer L Keating4
  1. 1Monash Doctors Education, Monash Health; Faculty of Medicine, Nursing and Health Sciences, Monash University; Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
  2. 2Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
  3. 3Monash Health, Melbourne, Victoria, Australia
  4. 4Department of Physiotherapy, Monash University, Clayton, Victoria, Australia
  1. Correspondence to Dr Christina Elizabeth Johnson; christina.johnson{at}


Objective Verbal face-to-face feedback on clinical task performance is a fundamental component of health professions education. Experts argue that feedback is critical for performance improvement, but the evidence is limited. The aim of this systematic review was to investigate the effect of face-to-face verbal feedback from a health professional, compared with alternative or no feedback, on the objective workplace task performance of another health professional.

Design Systematic review and meta-analysis.

Methods We searched the full holdings of Ovid MEDLINE, CENTRAL, Embase, CINAHL and PsycINFO up to 1 February 2019 and searched references of included studies. Two authors independently undertook study selection, data extraction and quality appraisal. Studies were included if they were randomised controlled trials investigating the effect of feedback, in which health professionals were randomised to individual verbal face-to-face feedback compared with no feedback or alternative feedback and available as full-text publications in English. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach. For feedback compared with no feedback, outcome data from included studies were pooled using a random effects model.

Results In total, 26 trials met the inclusion criteria, involving 2307 participants. For the effect of verbal face-to-face feedback on performance compared with no feedback, when studies at high risk of bias were excluded, eight studies involving 392 health professionals were included in a meta-analysis: the standardised mean difference (SMD) was 0.7 (95% CI 0.37 to 1.03; p<0.001) in favour of feedback. The calculated SMD prediction interval was −0.06 to 1.46. For feedback compared with alternative feedback, studies could not be pooled due to substantial design and intervention heterogeneity. All included studies were summarised, and key factors likely to influence performance were identified including components within feedback interventions, instruction and practice opportunities.

Conclusions Verbal face-to-face feedback in the health professions may result in a moderate to large improvement in workplace task performance, compared with no feedback. However, the quality of evidence was low, primarily due to risk of bias and publication bias. Further research is needed. In particular, we found a lack of high-quality trials that clearly reported key components likely to influence performance.

Trial registration number CRD42017081796.

  • medical education & training
  • feedback
  • health professions education
  • formative feedback

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors CEJ and JLK designed the review; CEJ created the search strategy and undertook the literature searches; CEJ and MPW undertook study screening, data extraction and quality assessment with oversight from JLK; CEJ and JLK undertook data analysis and interpreted the findings; CEJ prepared the manuscript; and all authors contributed to the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Data access can be requested by contacting the corresponding author.

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