FEEDBACK-DRIVEN SKILL ACQUISITION IN COMPETENCY BASED HEALTH PROFESSIONS EDUCATION: A NARRATIVE REVIEW WITH IMPLICATIONS FOR INDIAN COMPETENCY BASED MEDICAL EDUCATION

Abstract

Competency-based health professions education (CBHPE) has replaced time-based progression with measurable competencies, learner-centred advancement and authentic workplace-based assessment. Within this model, feedback has moved from an adjunct of summative evaluation to the principal mechanism through which skills are acquired, refined and certified. This narrative review synthesises literature on feedback-driven skill acquisition across undergraduate and postgraduate health professions education, with particular attention to the competency-based medical education (CBME) curriculum introduced in India by the National Medical Commission. It examines the theoretical foundations of feedback (skill acquisition models, educational theories and feedback frameworks), the integration of feedback into programmatic assessment, entrustable professional activities and coaching models, the evidence on learner outcomes, the role of digital and artificial intelligence (AI)-enabled tools, and the barriers that impede implementation. The literature indicates that feedback which is timely, specific, criterion-referenced, dialogic and longitudinal supports procedural skill acquisition, clinical reasoning, communication, professional identity formation and reflective practice, provided it is delivered within a relationship of trust and a psychologically safe climate. Persistent barriers include inadequate faculty development, time pressure, large student-to-faculty ratios, hierarchical culture, inconsistent documentation, limited infrastructure and the digital divide. Evidence linking specific feedback characteristics to long-term clinical performance and patient outcomes remains limited, and research from India is sparse. Priorities include faculty capacity building, culturally adapted feedback practices, rigorous validation of technology-enhanced feedback, implementation science and longitudinal outcome studies.