Constructive feedback is an important exam preparation tool for improving your Clinical Competency Exam (CCE) performance. Learn why, plus how to ensure you’re getting the right kind of feedback to make a difference.

You are currently preparing to sit the RACGP Clinical Competency Exam (CCE). You are studying consistently and putting a lot of hours into your exam preparation, but you feel an underlying niggle that there’s more you should be doing or you feel unsure if you’re on the right track. You may also have failed this exam in the past and want to ensure it doesn’t happen again. So what do you do?

It’s time to get feedback on your performance. For written exams like the AKT/ MCQ and KFP, feedback tends to be in the form of correct or incorrect answers, which you can get from online questions banks, like those in our Dr MCQ and Dr KFP courses. Feedback in these forms is ideal when it not only tells you whether your answers are correct or incorrect, but also provides you with a model answer and resources or articles to help you address your knowledge gaps.

However, it’s more complex for the CCE, as the exam not only assesses your knowledge on the topic examined, but also other aspects of your performance such as your clinical reasoning skills, professionalism, ethical decision-making and communication skills. In addition, there is a personal aspect to this exam, unlike the written exams, which can make the exam more nerve-racking. That’s why receiving appropriate feedback is so important for the CCE.

What is feedback?

Whether we realise it or not, we are continually giving and receiving feedback, both explicitly through oral and written language, and implicitly through gestures and tone of voice. Feedback is any kind of information (e.g., comments, advice, praise) that someone gives you about your performance, skills or understanding, after the fact. It therefore provides an opportunity to improve in these different areas. For your CCE preparation, it can be helpful to perceive feedback as a formative assessment tool that ideally uses descriptive, constructive, and nonjudgmental language to enable you to improve your CCE performance over time.

Why feedback is important for CCE preparation

There’s a saying, ‘it’s difficult to know what you don’t know’. Hence, it’s important to have someone tell you what you may not know about your CCE performance, so you can change aspects of it and increase your potential for exam success.

However, not all feedback is equal. You need feedback that is of a sufficiently good and accurate quality to enable you to amend your performance accordingly.

What does good feedback look like? How does it differ from bad feedback?

Good, or more accurately constructive, feedback enables you to change or improve your performance effectively. It should be specific, tangible, transparent, actionable, personalised, consistent and timely. Good feedback:-

  • includes details about what, why and how you can improve
  • gives you clear direction about the behaviours or actions you need to address
  • is impartial and individualised to you and your performance
  • is given ‘in the moment,’ as soon after the performance or case as possible. The longer the delay, the more likely the feedback will deteriorate in quality and relevance to you
  • is linked to relevant goals and/or standards (e.g., the RACGP CCE Clinical Competency rubric)
  • provides supporting information to help illustrate the point
  • is a two-way conversation
  • uses questions (both open and closed) to check for understanding and achieve clarity
  • helps you build self-awareness, reinforcing positive habits and encouraging more of the performance that you want to see and do.

In summary, constructive feedback presents you with an opportunity to respond and take on board the information given so you can keep developing your skills, thereby maximising your chances of success in the actual CCE. It can also prevent your preparation going off track or becoming misaligned to the RACGP’s expectations, wasting valuable time, energy and effort.

Finally, it can help you build confidence, reduce anxiety and leave you feeling calm, collected and ready both mentally and emotionally to tackle the CCE.

‘Bad’ feedback is when:

  • you think, ‘What can I do with this?’ If it’s difficult to understand how you can improve your performance, then it likely is ‘bad’ or unconstructive feedback.
  • its vague, non-specific or global (e.g., ‘that was good! that was horrible! You need to change your style!’)
  • it’s difficult to know what practical steps you could take to change your performance.
  • it feels pointless. Putting the feedback into action will likely not pay off, perhaps because it’s something difficult to change, like your personality.
  • its de-motivating. This may be because the feedback is about something difficult to change or perhaps the person’s feedback delivery style was negative or demotivating.
  • it’s about you as a person, rather than about your performance.

Receiving feedback

Sometimes it can be difficult to listen to feedback, as we may take it personally, like an insult about us or our performance. It can be particularly hard after a case where you thought you performed well but your colleague has a lot to say about how to improve! Here are some tips for receiving feedback:

  • Listen to the feedback given. This includes not interrupting. Hear the person out, and listen to what they are saying, not what you assume they will say. You can absorb more information if you are concentrating on listening and understanding rather than being defensive and focusing on your response.
  • Be aware of your responses. Your body language and tone of voice often speak louder than words. Try to avoid putting up barriers. If you look distracted and bored, that sends a negative message as well. Attentiveness, on the other hand, indicates that you value what someone has to say and puts both of you at ease.
  • Be open. This means being receptive to new ideas and different opinions. Often, there is more than one way of doing something and others may have a completely different viewpoint on a given topic. You may learn something worthwhile.
  • Understand the message. Make sure you understand what is being said to you, especially before responding to the feedback. Ask questions for clarification. Listen actively by repeating key points so that you know you have interpreted the feedback correctly. In a group environment, ask for others’ feedback before responding (for more on studying effectively in a group, view our blog). As well, when possible, be explicit as to what kind of feedback you are seeking before your performance, so you are not taken by surprise.
  • Reflect and decide what to do. Assess the value of the feedback, the consequences of using it or ignoring it, and then decide what to do because of it. Your response is your choice. If you disagree with the feedback, consider asking for a second opinion.
  • Follow up. There are many ways to follow up on feedback. Sometimes, your follow-up will simply involve implementing the suggestions given to you. In other situations, you might want to set up another meeting to discuss the feedback further.

Where to receive feedback

A conducive environment for giving and receiving feedback is also important, such as the time allowed, location (format) and timing.

Time – this includes adequate time allowed to ask questions or clarify the feedback received, and time to prepare questions ahead of time where possible. It’s not conducive to good feedback if one or more people are in a rush.

Location – it is important to consider where feedback will be given/received. Zoom or telephone will be a different experience to face-to-face (e.g., facial expressions and body language may be easier to interpret face-to-face). A quiet, private location is best.

Timing – if possible, consider the timing of giving/receiving feedback. For example, at the end of a long session or when one or both people are tired or in a negative mood will not be the best time.

When should you receive feedback for the CCE?

When to receive feedback can be as important as what or why. The simple answer is: the earlier the better! However, feedback is best given when the receiver is receptive to the feedback, has the energy to do something with it, and there is sufficient time prior to the exam to implement the changes recommended.

When is too early?

Timing of feedback received is important to ensure you make the most of it. Feedback received too early will likely not be implemented or put to good use because the receiver is not ready for it. For example, if you receive feedback six months before the CCE but you haven’t fully started preparing for the exam, you’re unlikely to take as much notice or treat it with the respect and urgency it deserves.

When is too late?

Feedback received too late is unhelpful because the receiver will lack sufficient time to implement and practice the changes recommended, leading to increased anxiety and/or loss of confidence. ‘Too late’ depends partly on the type and size of the change recommended by the feedback. For example, while mock exams give you great insights into your likely CCE performance, doing one the day before the CCE will more likely be a waste of effort and increase anxiety as there is limited time to implement any feedback received.

So what should you do?

Practice testing and completing cases with study partners is the best technique to prepare for the CCE and you will want to continue practicing the week prior to the exam. Therefore, tailor the feedback to be received to your needs and its timing prior to the CCE. For example, ask those who you will receive feedback from to concentrate on what you do well (positive aspects of your performance so you know what to continue doing for the exam) and what you can realistically change or practice in the time between then and the exam (e.g., small aspects of your performance such as practising looking at the camera rather than the screen when on Zoom).

How to put feedback into practice

So, what should you do once you receive feedback? Here are some ideas and strategies for putting your feedback into action:

  • Listen to your feedback! Many people ignore or discount feedback received, missing an opportunity to improve their performance. However, remember it’s very difficult to improve or change what you don’t know or understand about yourself and your performance. Ignoring your feedback will make it difficult to improve.
  • What issues is the feedback highlighting? Your feedback will tell you what you do well and where you can improve.  
  • What solution(s) or changes does the feedback propose? Your feedback may also include advice on how to improve. It’s important to try and implement the changes suggested, which can be invaluable. Sometimes you may need to read between the lines. For example, if you’re told your structure is weak, this should make you think about how to improve your performance structure in future, not just why it wasn’t good enough last time.
  • Write the specific feedback down on paper, post-it notes or cue cards as actionable behaviours or scripts that you want to do or use during CCE practice cases. Put them somewhere you can see them or refer to easily when practising cases. 
  • When giving and receiving feedback in study groups, set expectations early on, ideally when the group is first formed. Agree as a group to give constructive feedback, such as timely/in the moment with descriptions of behaviours so the receiver knows what they are doing well and what they need to change (with suggestions for how).

Both positive and negative performance feedback is useful (e.g., behaviours others have suggested you either do more or less of). A good balance of positive and negative feedback will enable you to improve your performance across the variety of competencies you will be assessed on, enabling you to work on both your strengths and weaknesses for CCE success.

All our CCE exam preparation courses and mock exams include individualised feedback to help you improve. Check them out here.