Implementation of multisource feedback for competency assessment in medical students during clinical clerkship: a scoping review protocol

Abstract

Introduction

Clinical clerkship is a critical transitional phase in which medical students develop core competencies through experiential learning. Workplace-based assessment, specifically multisource feedback (MSF), serves as a vital evaluative framework by triangulating perspectives from multiple stakeholders to mitigate bias. Although MSF is extensively validated and used among practising physicians and in postgraduate medical education, its application within undergraduate clinical clerkships remains underexplored. Medical students represent a distinct population with unique developmental needs, meaning that existing evidence from senior medical cohorts cannot be directly extrapolated to this context. The primary objective of this scoping review is to map the evidence on MSF implementation processes for assessing the clinical competencies of medical students during clinical clerkship while further identifying the instruments, rater types, outcomes and implementation factors reported in this setting.

Methods and analysis

This scoping review will be conducted following the Joanna Briggs Institute methodology and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. An initial search strategy was developed and piloted in PubMed. The comprehensive search will include MEDLINE (via PubMed), Scopus (Elsevier), Web of Science (Clarivate) and ERIC (via ProQuest), as well as Grey literature sources, including Google Scholar. All searches were conducted from database inception to 5 May 2026, and were restricted to studies published in English. All primary research designs, including quantitative, qualitative and mixed methods, will be eligible for inclusion in this study. Study selection and data extraction from full-text articles will be performed independently by two reviewers based on the inclusion criteria and a predetermined data extraction form. In the event of any discrepancies, these will be resolved through discussion with the third reviewer. The extracted data will be summarised and displayed in tabular or graphical form.

Ethics and dissemination

This study does not require ethical approval, as all data will be collected from the published literature. The findings will be submitted for publication to peer-reviewed journals.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• This scoping review will be conducted in accordance with the Joanna Briggs Institute methodology and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist to ensure transparency and reproducibility.

• At least two independent reviewers will be involved at each stage of study selection, data extraction and synthesis to minimise reviewer bias and enhance the reliability of the review process.

• A comprehensive multidatabase search strategy will be employed to capture a broad range of relevant evidence.

• Grey literature sources will be systematically searched to mitigate publication bias.

• A limitation of this scoping review is the exclusion of studies in languages other than English due to limited access to studies in other languages.

Introduction

Clinical clerkship is a crucial phase in medical education. It serves as a transitional stage from classroom-based learning to real-world clinical practice. Students are directly involved in patient interactions during this phase.¹ Real-world clinical encounters provide a foundation for understanding health states, illness trajectories and the professional identity of healthcare providers.² This experiential learning is essential for the mastery of core competencies, which represent fundamental accountability to the public by ensuring that graduates are clinically prepared to address societal health needs.³

To ensure the attainment of clinical competencies, workplace-based assessment (WBA) serves as a critical evaluative framework. A systematic review by Guraya⁴ emphasises that WBA facilitates positive educational outcomes when implemented alongside meaningful feedback and rigorous observer training. One prominent WBA tool that prioritises feedback is multisource feedback (MSF). MSF, also known as 360-degree feedback, is a systematic method for evaluating performance behaviour through structured questionnaires completed by various stakeholders.⁵ Furthermore, MSF effectively mitigates individual bias by aggregating assessments from multiple raters.⁶ This approach facilitates data triangulation, in which the strengths of diverse perspectives offset the inherent weaknesses of any single source. Consequently, such triangulation produces assessment outcomes that are more accurate, reliable and equitable than those derived from a single viewpoint.⁷

MSF is a widely adopted WBA tool with established utility in evaluating both clinical and non-clinical competencies of physicians.^{8 9} Systematic reviews consistently highlight its high educational value and capacity to drive practice change, especially when integrated with coaching.¹⁰ Beyond its feasibility and validity in specialised fields like surgery,¹¹ MSF demonstrates robust psychometric properties. Meta-analyses and evidence syntheses confirm the construct and criterion validity across domains such as professionalism, communication and interpersonal skills.^{12 13} Furthermore, a comprehensive ‘review of reviews’ confirms high reliability, typically achieving Cronbach’s alpha ≥0.90 and generalisability coefficients ≥0.80 with six to eight raters, reinforcing MSF as a rigorous instrument for performance evaluation in diverse clinical settings.¹⁴

Despite this substantial body of supportive evidence, the validation literature has important gaps. Stevens et al¹⁴ noted that evidence for content validity, consequential validity and response process validity remained limited, indicating that while MSF demonstrates strong psychometric properties and criterion-related validity, questions persist regarding the comprehensiveness of content coverage, the consequences of MSF implementation on learners and systems and the cognitive processes underlying rater responses. These findings collectively establish MSF as a psychometrically sound and educationally valuable tool for physician assessment while simultaneously highlighting areas requiring further empirical investigation to strengthen the overall validity argument supporting its use in medical education and professional development contexts. Beyond psychometric considerations, the effectiveness of WBA more broadly (and MSF in particular) is also contingent on the design quality and the context in which it is implemented.⁴ This suggests that even a well-validated instrument may contribute to suboptimal outcomes if the implementation context is not carefully considered.

While the evidence base for MSF in graduate medical education (including residency and fellowship training) has been extensively developed, as demonstrated by the reviews described above, its application to medical students during clinical clerkship remains comparatively underexplored and less thoroughly synthesised. Existing reviews have primarily focused on residents and practising physicians,^{9 11–15} leaving a notable gap in evidence specific to the clerkship context. Medical students in clinical clerkship represent a distinct population, characterised by different developmental stages, supervisory relationships, clinical responsibilities and assessment needs compared with residents and preclinical students.^{16 17} Given these distinctions, findings from studies conducted in postgraduate or non-clinical settings cannot be uncritically extrapolated to the clerkship context, underscoring the need for a dedicated synthesis of the available evidence pertaining specifically to this population.

Several critical knowledge gaps regarding this population justify a focused scoping review on MSF for clerkship students. Among various evidence synthesis methods, a scoping review was selected as the most suitable approach because it allows for the systematic mapping of available evidence on a specific topic across diverse contexts.¹⁸ This method is particularly appropriate for several reasons. First, while MSF implementation processes have been documented in postgraduate and specialist physician settings,^{19 20} best practices for implementing MSF specifically within undergraduate clerkship contexts have not been systematically mapped. Second, which MSF instruments have been developed or adapted specifically for clerkship students and what competencies they target in this population remain unclear. Although emerging studies have begun to address this question,^21–23 a comprehensive synthesis of available instruments and their psychometric properties in clerkship settings is lacking. Third, the optimal selection and number of rater types for assessing clerkship students have not been well established, nor is there sufficient clarity on how different rater perspectives, such as self-ratings versus peer ratings, contribute unique or redundant information in this context.²⁴ Finally, although the impact of MSF on learning and professional development has been explored among practising physicians,^{25 26} evidence regarding its effect on student learning, professional development and clinical clerkship performance remains limited and requires dedicated synthesis.

Objectives

The primary objective of this scoping review is to map the available evidence on the implementation processes of MSF for assessing clinical competencies among medical students during clinical clerkships.

Methods and analysis

This scoping review followed the methodology of the Joanna Briggs Institute (JBI) and was further refined using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) framework to ensure rigour. The process encompassed several key stages: title and review questions, inclusion criteria, evidence screening and selection, data extraction, data analysis and results presentation.²⁷ The completed scoping review will be reported in accordance with the PRISMA-ScR checklist.²⁸ The protocol was registered in the Open Science Framework (registration DOI: 10.17605/OSF.IO/XNQY9). The study is scheduled to begin in mid-April 2026 and will end in December 2026.

Step 1: title and review questions

Following the population, concept and context mnemonic recommended for scoping reviews, the title of this review reflects its three core elements: the population (medical students during clinical clerkship), the concept (MSF for competency assessment) and the context (clinical clerkship settings). Accordingly, the primary review question is as follows: How has MSF been implemented for competency assessment among medical students during clinical clerkships, focusing on data collection procedures and feedback delivery processes? The secondary review questions are as follows:

1. What clinical competencies are assessed using MSF?

2. What are the MSF instruments used?

3. Who are the sources of feedback (raters) received by students?

4. What outcomes associated with MSF use have been reported in clinical clerkship (eg, student learning, professional development and stakeholder satisfaction)?

5. What are the identified challenges, barriers and facilitators of MSF implementation in clinical clerkship settings?

Step 2: inclusion criteria

Population

The review will consider studies involving medical students enrolled in their clinical clerkship or clinical training phase. Studies focusing exclusively on preclinical medical students, residents, interns, fellows or practising physicians will be excluded. Research involving multidisciplinary health professional students (eg, nursing, pharmacy or dentistry) will only be included if data for medical students can be disaggregated and extracted separately. Furthermore, studies that combine data for medical students and residents without providing distinct results for clerkship students will be excluded.

Concept

The core concept of interest is MSF, defined as the use of feedback from at least two different sources. To be eligible, MSF must be used for competency assessment, encompassing both formative and summative applications. Studies using MSF solely for the purpose of programme evaluation rather than individual student assessment will be excluded.

Context

This review will include studies conducted in any authentic clinical educational setting where medical students undertake rotations, including hospital-based and community-based settings. Studies will be excluded if they are situated in purely classroom-based environments or simulation-based settings that lack an authentic clinical workplace context.

Types of evidence sources

This scoping review will consider all primary research designs, including quantitative, qualitative and mixed-methods studies, to ensure a comprehensive synthesis of the available evidence. No restrictions will be placed on specific study methodologies, provided that they report original empirical data.

However, secondary sources, such as narrative reviews, commentaries and editorials, will be excluded. Systematic and scoping reviews will also be excluded from the formal analysis, although their reference lists may be screened for relevant primary studies. In addition, conference abstracts without available full texts and articles not published in English will be excluded. The search will encompass all relevant literature published until 5 May 2026.

Step 3: the search strategy

A comprehensive literature search will be performed using the following electronic databases: MEDLINE (via PubMed), Scopus (Elsevier), Web of Science (Clarivate) and ERIC (via ProQuest). Grey literature will be searched using Google Scholar, screening the top 100 results ranked by relevance for feasibility.²⁹ A preliminary search will be performed in PubMed to develop the search strategy using keywords and Boolean operators. To refine the search strategy, this initial phase will involve scrutinising text words in titles/abstracts and index terms of retrieved articles. The optimised strategy will then be systematically applied to all included databases, with search strategies adapted to database-specific parameters to ensure comprehensive literature identification. The detailed line-by-line search strategy for all databases and additional sources, including exact search terms, limits and yields, is provided in online supplemental file 1. All search strategies will be developed by SS and YS and subsequently reviewed by OE, and executed with technical assistance from an academic research librarian.

Step 4: evidence screening and selection

All retrieved literature will be incorporated into Rayyan (https://rayyan.ai/), and any duplicate records will be deleted. The study selection will follow a two-step screening process, consisting of title and abstract screening, followed by a full-text review. In both steps, two independent reviewers (SS and CBP) will screen the articles against the eligibility criteria. Any disagreements will be discussed, and if no consensus can be reached a third reviewer (YS) will be consulted.

Step 5: data extraction

Relevant data will be extracted from all included studies in the scoping review by two independent reviewers (SS and CBP). A structured data recording form developed by the reviewers will be used, and the information will be recorded on Microsoft Excel. Discrepancies in extracted data will be resolved through discussion, with arbitration by a third reviewer if necessary. If data are unclear or missing, the study authors will be contacted via email (up to two contact attempts). Pilot testing of the data extraction form will be conducted on 5–10 included studies, with refinements made as needed.

A standardised data extraction form was developed by the research team and piloted on a sample of included studies prior to full implementation. The following data will be extracted from each study.

General study characteristics will be extracted for all included studies, comprising: author(s), year of publication, title, country, study design, study aims and objectives, study setting (eg, hospital, primary care, specialty rotation), study duration, sample size and student characteristics (year of study and clerkship rotation).

To address the primary review question regarding MSF implementation, data will be extracted on data collection procedures and feedback delivery processes, including format, timing and the involvement of a facilitator.

For the secondary review questions, data extraction was categorised as follows:

1. Competencies assessed: Identification of specific competency domains evaluated, such as professionalism, communication and clinical skills. To provide a structured analysis of competency, the competencies assessed through MSF across included studies will be systematically extracted and mapped against established core medical education competency frameworks (eg, Canadian Medical Education Directives for Specialists (CanMEDS) roles, Accreditation Council for Graduate Medical Education (ACGME) core competencies or national medical graduate competency standards).

2. Instruments used: Instrument names (if applicable), number of items, response scales (eg, Likert scale) and specific domains or subscales.

3. Rater sources: Rater types (eg, physicians, residents, nurses, allied health professionals, peers, patients and self-assessment) and the number of raters per student.

4. Outcomes: Reported student outcomes (eg, learning, performance changes, feedback-seeking behaviour and professional development) and stakeholder satisfaction.

5. Challenges, barriers or limitations encountered during MSF implementation, as well as facilitators and success factors identified by the authors.

Finally, key findings, including the authors’ primary conclusions and recommendations, were extracted to capture overarching insights relevant to the study’s broader implications.

Step 6: data analysis

Data will be synthesised using narrative and descriptive summaries consistent with scoping review methodology.²⁷ A narrative summary will be conducted to address each research question by identifying patterns, categories and conceptual relationships across studies, highlighting areas of convergence and divergence and identifying evidence gaps. Furthermore, by comparing the extracted assessed competencies against established competency frameworks, the narrative synthesis will systematically identify core competency domains (eg, learner autonomy or self-directed learning) that remain unaddressed or under-represented in the evaluated MSF tools. Descriptive statistics will be used to summarise quantitative data, including frequency counts and percentages for categorical variables (eg, study designs, rater types, competencies assessed), as well as ranges and means for continuous variables (eg, number of raters, sample sizes).

Step 7: presentation of the results

Data extracted from the included literature will be visually presented in graphs or tables to provide a concise overview of the findings. This presentation of the results will be structured into two main sections. First, the selection process will be detailed using a PRISMA flow diagram to illustrate the results of the search strategy and the study inclusion process. Second, the key information relevant to the objectives of the review will be mapped using diagrammatic, tabular or descriptive formats. Although these approaches are prespecified in this protocol, they may be further refined during the review stage to better reflect the specific nature of the included evidence.

Ethics and dissemination

This study does not require ethical approval, as all data will be collected from the published literature. The findings of the scoping review will be disseminated through professional networks, conference presentations, and publication in a scientific journal.