Teaching & Learning in HPE

What?

At first glance, the Teaching-and-Learning module felt familiar. I teach regularly, supervise registrars, and often present on health information systems. The brief for Assignment 2 seemed manageable: analyse one of my own teaching sessions through the lens of learning theory and suggest improvements. I chose a session I had facilitated with MBChB II students on the Burden of Disease. It was interactive and well-received, and I had used various digital tools including Mentimeter, live dashboards, and ChatGPT. I expected to tidy up the session report and submit it with confidence.

However, once I began reflecting more deeply, I started to notice a few cracks. The teaching strategies and theories of learning I had drawn on were hefty in their cognitive load. The learning outcomes were focused on critical appraisal, but the assessment relied on multiple-choice questions. The digital tools, while engaging for some, excluded others who had to share devices or simply observe. Nicol’s work on internal feedback made me reconsider how the session was structured. I began to see that it had been overly teacher-led, and that opportunities for peer engagement and comparison had been missed. What started as a confident submission turned into a more uncomfortable process of re-evaluation.

During the online forum discussions, I explored how Nicol’s model could connect my interests in Design Science Research and feedback theory. His ideas about internal comparison and artefact development mirrored the learning journey in DSR. But I also realised we are not doing enough to explicitly build feedback literacy into these spaces. It was encouraging to see peers engage with this thread and extend the discussion to include emotional responses to feedback and student well-being. That exchange reminded me that reflection and feedback are not just cognitive activities. They are also emotional, and our teaching needs to acknowledge that.

Although I had started both assignments with confidence, the written feedback showed that I had overestimated the clarity and coherence of my arguments. For Assignment 1, I was commended for structure and relevance, but reminded that many claims leaned too heavily on single sources. This highlighted the importance of stronger synthesis. For Assignment 2, the feedback recognised the depth of analysis and personal insight, but pointed out that I had assumed reader familiarity with learning theory. I was also reminded to pay closer attention to presentation and formatting. Across both assignments and the peer discussions, a pattern emerged: I tend to lead with theory before ensuring accessibility. The feedback was constructive and encouraging, but it also pointed out some blind spots in how I communicate ideas, both in teaching and in writing.

So what?

That discomfort turned out to be productive. Students enjoyed the digital elements, but what stayed with them were the narratives I introduced during the session. When I asked what would happen to a 12-year-old girl whose only parent had suffered a stroke, it sparked a noticeable shift in their engagement. It was a turning point that made the Burden of Disease feel personal and immediate. An "aha" moment.

The module made me reflect on three key areas:

• Constructive alignment: While the session objectives encouraged application of knowledge, the assessment focused on recall. There was a clear misalignment between what was taught and what was measured.

• Feedback literacy: The feedback loop remained one-directional. By centring myself as the sole provider of feedback, I unintentionally limited opportunities for students to develop their own evaluative judgement.

• Equity in access: The session assumed all students had access to both laptops and smartphones. In practice, this was not the case. Some watched while others worked, which meant that experiential learning was not equally available to all.
  
  

Although I felt a bit deflated at first, the analysis sharpened my sense of purpose. If the goal is to foster deeper learning, then I need to be more deliberate in how sessions are designed, delivered, and assessed.

The peer feedback on my forum post reinforced the emotional weight that students carry in responding to feedback, especially in high-stakes or reflective assignments. One peer drew a connection between Nicol’s model and mental health in healthcare students, which really stayed with me. It reminded me that internal feedback is not just about comparing knowledge or performance. It’s also tied up in students’ sense of self. That has broadened my thinking on how feedback practices can either support or strain learner well-being.

The written feedback I received from both assignments prompted a deeper awareness of how my assumptions as a teacher and writer shape learning design and academic communication. While I had worked to align teaching strategies with outcomes, I hadn’t always made the theoretical foundations clear or accessible. This was noted in Assignment 2, where I was encouraged to define learning theories more explicitly. It was a useful reminder not to assume shared knowledge. The same theme emerged in my forum engagement. While the ideas landed well, I realised I often lead with theory before checking whether it’s digestible to my audience. I’m now more aware that feedback, whether written, verbal, or embedded in design, is not only about guidance. It is a shared reflective space where both giver and receiver are actively learning.

Now what?

Reflecting on this experience, I’ve started making a few practical shifts in how I approach my teaching.

• Reframe the structure: In future, I plan to use a flipped classroom approach. Theory and concepts will be shared in advance using short, accessible video material. This will free up classroom time for sense-making and discussion. I’d like to try a Fishbowl format, where students are invited to connect core ideas with their own experiences of health and illness.

• Revise assessment: I will replace the current multiple-choice quiz with a more authentic task. Students will write a short BoD brief aimed at a district health manager. This better aligns with the intended outcomes and gives them a chance to apply what they’ve learned in a meaningful way.

• Reimagine feedback: I plan to introduce a simple peer review process, where students annotate each other’s work using a clear rubric. They will then revise their briefs before submitting the final version. I see my role shifting from primary evaluator to facilitator of useful, iterative feedback.

• Prioritise equity: All activities will need to pass what I’ve started calling the “single-device test.” If a task can’t be completed using just a smartphone, I will provide a low-tech alternative. I’ll also ensure printed resources are available for those with unreliable connectivity.

• Professional development: I’ve added a SMART goal to my development plan to run a short workshop on feedback practices with colleagues. I also want to shadow others who manage to facilitate well without leaning heavily on digital tools. This feels like a useful way to balance my own digital tendencies with more inclusive, grounded approaches.

This reflection has challenged some of the assumptions I held about what effective teaching looks like. I’m reminded that learning is not something I deliver—it’s something I create the conditions for. Technology has a role to play, but it’s no substitute for alignment, access, and a space where students feel able to make sense of their learning.

I’d like to explore the possibility of developing a short paper or blog post that integrates Nicol’s feedback cycle with teaching in Design Science Research. There’s a gap here that feels worth exploring, especially in postgraduate health professions education. The forum discussion gave me a helpful nudge, and I might reach out to a few peers to take this further. It’s a way to build something scholarly out of practice, while continuing to think more deeply about feedback, not only as a process of improvement, but as something students experience and carry with them.

The feedback from both assignments and the online discussions has also reminded me to be more intentional about how I explain theory. I sometimes assume shared understanding, but that’s not always the case. Going forward, I want to introduce key ideas more clearly and give students more support in navigating feedback. I’ve added this to my development plan and will keep an eye out for moments where I can put it into practice.

Supporting sources

Biggs, J. (2012). What the student does: teaching for enhanced learning.

Carless, D. & Boud, D. (2018). The development of student feedback literacy.

Dawson, P. et al. (2021). Authentic feedback: supporting learners to engage…

Nicol, D. (2021). The power of internal feedback: exploiting natural comparison processes.

Rolfe, G., Freshwater, D. & Jasper, M. (2001). Critical Reflection for Nursing and the Helping Professions.