By: Emily Nuttall, Pharm.D., MBA and Ashlyn Aguiniga, Pharm.D., BCACP, CDCES
As a pharmacy student on clinical rotations, I took feedback personally. Negative feedback would linger over me like a dark cloud, growing larger with every critique, awaiting any one piece of advice to spill over and erupt into a complete downpour. As a high achieving student, I sought approval in the form of “Excellent work!”, and I began to doubt myself when preceptors modified my SOAP notes and suggested alternative phrasing in patient interviews.
How many of our students feel this way today? How can we evoke change in their perspectives: from uncertainty to motivation and from vulnerability to self-compassion? Feedback is intended to pave a pathway to success, but learners must understand how to process the critiques before they can make improvements.
What do we know about feedback?
Feedback is a type of formative assessment that is generally ongoing and focused on specific skills and behaviors, rather than summative assessments which tend to be more structured and focus on global performance. Integrating feedback promotes personal growth and development.1 High-quality feedback is both specific and actionable. Imagine reading an evaluation stating, “Dr. Smith can’t teach.” Based on this comment, what changes would you make to your lecture materials? Imagine instead the student wrote, “Dr. Smith’s lecture slides are too busy and distract from what he is saying.” Now, because the feedback was both specific and actionable, you may be able to reduce text on your slides to improve concept delivery.
Well-developed feedback identifies individual strengths and areas for improvement. It may also include reflective questions and provide opportunities for further discussion among the feedback provider and receiver. For pharmacy students, feedback is a key component to applying medical knowledge and strengthening clinical skills. For pharmacy educators, feedback is essential for continued development of effective teaching methods and evidence of student growth. The Accreditation Council for Pharmacy Education (ACPE) mandates College of Pharmacy faculty members “provide timely, formative performance feedback to students in both didactic and experiential education courses”.2 There are many resources describing methods for providing effective feedback, including The American Society of Health-System Pharmacists Preceptor’s Handbook for Pharmacists,3 and The Effective Pharmacy Preceptor1 which focus on methods like the Sandwich Method, Pendleton’s Four-step Model, and Situation-Behavior-Impact. Despite advances in feedback models and heavy emphasis on feedback in pharmacy curricula, there is not a widely accepted approach for teaching students how to process feedback.
One of the earliest formal feedback models identified four stages of feedback processing: perception, acceptance, desire to respond, intended response. Over the years, research progressed to the development of the Feedback Propensity Scale, the broad-concept Feedback Orientation Construct, and the situation-specific Feedback Environment Scale. In an effort to further expand on these ideas, the Feedback Orientation Scale was established as a validated tool for identifying individual differences in the feedback process.4
How can we teach students to process feedback effectively?
Ultimately, effective feedback processing surrounds the individual’s attitudes and actions. In exploring this topic, I discovered a Harvard Business Review article published in 2022 describing the 6 Ps of processing feedback. Although intended for business-minded individuals, this stepwise method could lay the groundwork for teaching pharmacy students how best to evaluate and utilize feedback.5
| The 6 Ps of Processing Feedback | |
| Poise | Approach with neutrality and grace, listen to understand |
| Process | Make space for and investigate causes of feelings |
| Positionality | Reflect on feedback provider’s motive, position, and intent |
| Percolate | Use a decision tree for structure and consistency |
| Proceed | Implement small changes over time |
| Perspective | Seek continual feedback from those you respect and trust |
Pharmacy students could utilize the 6 Ps in a variety of settings, such as Introductory and Advanced Pharmacy Practice Experiences, objective structured clinical exams, or even in their personal lives. Let’s review an example of what this process may look like in pharmacy training.
| The 6 Ps of Processing Feedback in Action APPE preceptor provides student AA feedback that patient work-ups are insufficient. See how AA applies the 6 Ps below. | |
| Poise | AA clarifies the feedback to ensure understanding and does not immediately accept or reject the feedback |
| Process | AA sets aside time to reflect on the feedback and investigate the resulting feelings |
| Positionality | AA acknowledges the preceptor’s goals to provide high-quality patient care and prepare AA to succeed in a clinical setting |
| Percolate | AA uses a decision tree to identify 1) AA trusts the preceptor’s motives, and 2) the feedback aligns with AA’s goals of becoming a clinical pharmacist |
| Proceed | Moving forward, AA dedicates more time for patient workups |
| Perspective | The following week, AA seeks feedback on improvements |
Implementing a stepwise method like this may mitigate student uncertainties and frustrations and foster growth and motivation across the next generation of pharmacists.
What strategies have you implemented as a faculty member, preceptor, or student to effectively process feedback?
References:
- Soric MM, Schneider SR, Wisneski SS. The Effective Pharmacy Preceptor. Am J Pharm Educ. 2017.
- Accreditation Council for Pharmacy Education: Accreditation Standards and Key Elements for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree. American Council for Pharmacy Education; 2025. https://www.acpe-accredit.org/pdf/ACPEStandards2025.pdf
- Cuellar LM, Ginsburg DB. Preceptor’s Handbook for Pharmacists, Fourth Edition. Am J Pharm Educ. 2019.
- Linderbaum BA, Levy PE. The Development and Validation of the Feedback Orientation Scale. J Manage. 2010;36(6):1372-1405.
- Conaway C. The Right Way to Process Feedback. Harv Bus Rev. 2022.
Author Bio(s):
Emily Nuttall is a PGY-2 Ambulatory Care Pharmacy Resident at JPS Health Network and an Adjunct Assistant Professor at the University of North Texas Health Science Center College of Pharmacy. Her educational interests include academia, ambulatory care, and geriatrics. In her free time, she enjoys traveling with her husband.
Ashlyn Aguiniga is an Assistant Professor of Pharmacotherapy at the University of North Texas Health Science Center College of Pharmacy and an Ambulatory Care Pharmacist at HSC Health Family Medicine Clinic. Her educational scholarship interests include classroom innovations, critical thinking, and teaching skills in the affective domain. In her free time, she enjoys spending quality time with her husband, daughter, and dogs as well as trying new restaurants in the Dallas-Fort Worth area and beyond.
Pulses is a scholarly blog supported by a team of pharmacy education scholars.
Pulses 
Hello Emily and Ashlyn,
Thank you for your thoughtful article on how students process feedback! Building on your insights, I am particularly interested in exploring how inherent power imbalances within the context of faculty feedback influence student outcomes. Specifically, I wonder what feedback practices can be implemented to mitigate the effects of these power dynamics, ensuring that feedback serves as a tool for growth rather than a source of stress or inequity.
Best!
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