"Well I Failed, but I Have No Idea Why"…: Experiences of Feedback After High-Stakes Summative Specialist Medical Examination in Ophthalmology.

Objective: Medical specialist trainees report dissatisfaction with both the usefulness and timing of feedback provided following summative examinations. This study aimed to explore ophthalmology trainee and supervisor experiences of feedback following final summative examination (the Royal Australian and New Zealand College of Ophthalmologists Advanced Clinical Examination (RACE)).

Methods: Semi-structured interviews were undertaken with ophthalmology trainees who had recently sat RACE (2017-2021) (n = 19) and supervising ophthalmologists who support trainees to prepare for RACE (n = 10). Interview data were thematically analyzed.

Results: Two themes were identified. Inadequate feedback related to trainee experiences receiving feedback relating to examination performance that was insufficient and unhelpful in identifying gaps in learning, explaining the reasons for failure and supporting preparation for resitting. Inability to contextualize feedback encompassed trainee and supervisor concerns regarding the inability to review examination manuscripts after sitting the examination, the absence of marking criteria, rubrics and model answers to understand the passing standard and the lack of opportunity to discuss performance with examiners.

Conclusions: Detailed, individualized task-level and process-level feedback on examination performance is needed for all trainees. Opportunities to view examination manuscripts, marking criteria and model answers, as well as speak with examiners, would improve transparency of the assessment process, enhance feedback and improve trainee success.