Study 2: How Do International Medical Students Make Sense of Internal and External Feedback to Improve Their Dutch Communication Skills?

<B>Summary of the Study:</B><BR><BR>
This study explored how international medical students perceive and integrate <B>internal feedback</B> (self-reflection) and <B>external feedback</B> (from peers, teachers, and simulated patients) while learning <B>medical Dutch communication skills</B> through simulated patient consultations (SPCs).<BR>
• <B>Design:</B>Mixed-methods design (survey + semi-structured interviews).<BR>
• <B>Participants</B>: 16 third-year international medical students (3 male, 13 female; mean age = 23; all B2 Dutch CEFR level).<BR>
• <B>Procedure</B>: Six-session Medical Dutch course during which each session included briefing, SPC, and debriefing. Students received internal and external feedback systematically integrated into the course.<BR>
• <B>Instruments</B>:<BR>
o <I>Feedback perception survey</I> (8 items: preference, satisfaction, trustworthiness, progress facilitation).<BR>
o <I>Semi-structured interviews</I> (30–60 min, conducted online during COVID-19).<BR>
o <I>Thematic analysis</I> (Atlas.ti, data saturation reached at 16 interviews).<BR>
<B>Key Findings:</B><BR>
1. <B>Quantitative survey results:</B><BR>
o External feedback scored higher than internal feedback in <B>preference, satisfaction, and trustworthiness</B>.<BR>
o Both internal and external feedback were rated <B>equally effective</B> for facilitating learning progress.<BR>
2. <B>Qualitative themes (5):</B><BR>
o <B>Proactive engagement with feedback</B> – students actively sought feedback from teachers, peers, and simulated patients, valuing clarity and actionable advice.<BR>
o <B>Dialogue and discussion</B> – peer/teacher discussions broadened perspectives and deepened learning.<BR>
o <B>Self-reflection and progress tracking</B> – internal feedback supported personal growth, even though students sometimes felt overly self-critical.<BR>
o <B>Value from diverse perspectives</B> – combining feedback from different sources (medical accuracy, patient empathy, peer observation) enriched understanding.<BR>
o <B>Moment-specific and actionable feedback</B> – timely, targeted feedback was easier to apply immediately.<BR>
3. <B>Conclusion:</B><BR>
o External feedback was more trusted and satisfying, but internal feedback was critical for <B>self-regulated learning</B> and <B>growth</B>.<BR>
o Together, they formed a <B>complementary system</B>, fostering comprehensive communication skill development in L2 medical Dutch.<BR><BR>