Use of the learning conversation improves instructor confidence in life support training: an open randomised controlled cross-over trial comparing teaching feedback mechanisms

Research output: Contribution to journalArticlepeer-review


  • Lydia J.l. Baldwin
  • Christopher Jones
  • Jonathan Hulme
  • Andrew Owen

Colleges, School and Institutes


Aims Feedback is vital for the effective delivery of skills-based education. We sought to compare the sandwich technique and learning conversation structured methods of feedback delivery in competency-based basic life support (BLS) training. Methods Open randomised crossover study undertaken between October 2014 and March 2015 at the University of Birmingham, United Kingdom. Six-hundred and forty healthcare students undertaking a European Resuscitation Council (ERC) BLS course were enrolled, each of whom was randomised to receive teaching using either the sandwich technique or the learning conversation. Fifty-eight instructors were randomised to initially teach using either the learning conversation or sandwich technique, prior to crossing-over and teaching with the alternative technique after a pre-defined time period. Outcome measures included skill acquisition as measured by an end-of-course competency assessment, instructors’ perception of teaching with each feedback technique and candidates’ perception of the feedback they were provided with. Results Scores assigned to use of the learning conversation by instructors were significantly more favourable than for the sandwich technique across all but two assessed domains relating to instructor perception of the feedback technique, including all skills-based domains. No difference was seen in either assessment pass rates (80.9% sandwich technique vs. 77.2% learning conversation; OR 1.2, 95% CI 0.85–1.84; p = 0.29) or any domain relating to candidates’ perception of their teaching technique. Conclusions & relevance This is the first direct comparison of two feedback techniques in clinical medical education using both quantitative and qualitative methodology. The learning conversation is preferred by instructors providing competency-based life support training and is perceived to favour skills acquisition.


Original languageEnglish
Pages (from-to)199-207
Early online date24 Aug 2015
Publication statusPublished - Nov 2015


  • Feedback, Sandwich technique, Learning conversation, Cardiopulmonary resuscitation (CPR), Basic life support (BLS), Resuscitation