This post is the fourth in a five-part series drawing on Formative Assessment and Feedback in Medical Education: A Practical Guide, AMEE Guide No. 189. Each post will take a question medical educators are actively grappling with and work through what the research and the practice actually suggest.
The previous post in this series looked at what makes an assessment truly formative and why feedback doesn’t always stick. Now let’s focus on the educator, because getting formative assessment in medical education right is as much about role as method.
The research is clear: Effective formative assessment requires a fundamentally different orientation from educators compared to traditional evaluation. The shift doesn’t require a major overhaul of everything you do, but a change in how you position yourself relative to your students’ learning—from evaluator to facilitator.
This isn’t a critique of how educators have operated. It’s recognition that formative assessment, when it’s working properly, places different demands on everyone involved.
What the evaluator model leaves out
With traditional evaluation, the flow is simple: The instructor assesses and delivers a grade or some feedback. The feedback is essentially a wrap-up on performance that’s already finished. Formative assessment upends that flow, with the instructor guiding and the student actively setting goals and tracking their development. Feedback in this model isn’t a final word on what happened—it’s a prompt for what comes next.
Students don’t naturally make that switch on their own. Most have learned to treat grades as endpoints rather than starting points. Helping them engage differently with assessment—as an ongoing process rather than a series of events to complete—is part of what the facilitator role requires.
Showing students how to use feedback
One of the more practical things the facilitator role asks of you is demonstrating how to use feedback versus simply delivering it. The research shows that when you model for students what it looks like to take a piece of feedback, connect it to a learning goal, and apply it in the next attempt, they become much better at doing it themselves.
This kind of teaching focuses on the “how” of learning as well as the “what.” As a facilitator, you're making the improvement process visible, which is vital because many students don't know how to engage with feedback productively until they've seen it demonstrated.
Feedback should also be built as a cycle, not a one-time handoff. Students should revisit their goals, check their progress, and adjust, because the positive effects compound when this cycle recurs over time. That compounding doesn’t happen unless the structure supports it. When feedback is designed consistently at the program level, students are more likely to experience it as a true loop—one that builds in value over time rather than resetting with each new instructor.
Self-reflection is a clinical skill, not a nice-to-have
In a formative system, the instructor should create the right conditions for students to reflect on their own performance. This doesn’t mean simply adding a reflective exercise to the end of an assessment. Self-reflection is the mechanism through which students process and apply feedback. Skip it, and even strong feedback tends to fade.
Research shows structured self-reflection improves diagnostic accuracy and clinical reasoning directly—not as a side benefit, but as a result of students learning to slow down and probe their own thinking.
The operative word is “structured.” Asking students to reflect on their performance without scaffolding doesn’t work well. Research shows that self-assessment without clear standards or external feedback to anchor it tends to be unreliable. Students may over- or underestimate their own performance when they're working from personal judgment alone. Reflective journals, guided self-assessment forms, rubric-based post-OSCE reviews and annotated exemplars that show both stronger and weaker approaches give students a framework to move from vague impressions to useful analysis.
The way you structure your feedback conversations makes a difference, too. Asking a student what went well, where they felt most challenged and what they’d do differently next time draws out their thinking before you weigh in. That kind of dialogue builds the habit of self-evaluation, which students then carry into independent practice.
Of course, all of this works better in an environment that feels genuinely safe—where mistakes are expected, not penalized, and students feel comfortable being honest about where they're struggling.
The student’s role changes, too
The move to facilitator only works if the learner also shifts from passive recipient to actively invested in their own growth. To support that shift, you can establish clear expectations, create structured opportunities and make it known that engagement is expected, not optional. Over time, you are helping your students become “Master Adaptive Learners” who can continually reassess their own performance, seek feedback and adjust to changing demands.
Self-assessment is the most direct way to get there. When students regularly evaluate their own work against clear criteria—rubrics, structured frameworks, calibrated benchmarks—they get a clearer picture of where they stand and which improvement areas to prioritize. Students who do this consistently tend to perform better clinically, largely because they’re more effective at identifying and closing their own gaps.
One important caveat: Self-assessment is frequently unreliable (and can become an exercise in false confidence) without explicit standards and instructor feedback to anchor it. Facilitators can strengthen self‑assessment by explicitly encouraging feedback‑seeking, modeling a growth mindset about mistakes and repeatedly tying performance gaps to specific, achievable next steps.
What that means in practice
Becoming a more facilitative educator comes down to a few deliberate changes in how you structure student interactions. That means:
Making feedback the start of a conversation, not a closing statement, with a structured check-in afterward.
Asking before you tell. Let students assess their own performance before weighing in.
Bringing structured self-reflection tools into your assessment design (rubric-based reviews, reflective journals or post-encounter video review).
Giving students concrete criteria upfront. Sharing standards makes it possible for students to meet them.
Modeling what it looks like to receive and act on feedback. Showing is a form of teaching.
Students who set goals, track their progress and adjust their approach consistently outperform those who don’t. Your job as facilitator is to make these habits a normal part of how your students learn.
Looking to put data behind the facilitator role? Our Using NBME INSIGHTS to Support Student Success webinar shows how the INSIGHTS® dashboard—including NBME® Self-Assessment data—helps students identify patterns, prioritize key focus areas and turn assessment results into actionable steps for improvement.
Up next
The next post in this series turns to those delivering these assessments—examining what effective formative assessment in medical education asks of educators that traditional evaluation never has, and what it means to move from evaluator to coach. Sign up for our mailing list to make sure you don’t miss it.