How to use the Pendleton model of feedback in different pharmacy sectors: a practical guide

Effective feedback sits at the heart of professional growth. In healthcare, where learning is continuous and the stakes are high, the way we give and receive feedback directly shapes both individual performance and the quality of patient care. For pharmacists, feedback is more than a developmental tool — it is a mechanism for strengthening clinical judgement, supporting colleagues and contributing to safer, more responsive services.

Pharmacists encounter feedback in many forms: supervising trainees, supporting colleagues in practice, guiding independent prescribers, leading teams or contributing to multidisciplinary learning. While some roles make this expectation explicit, such as educators, line managers and designated prescribing practitioners, feedback is not limited to formal hierarchies. Education is a central pillar of post‑registration development, while every pharmacist — regardless of sector — will find themselves in situations where offering constructive guidance helps someone learn, refine a skill or make better decisions. In reality, feedback can be used any time there is an instructional relationship or a development opportunity.

Yet despite its value, feedback can feel uncomfortable. Many pharmacists worry about upsetting others, overstepping or navigating workplace cultures where open discussion is not always encouraged. These barriers are common, and they can make feedback feel daunting even when it is needed. Structured approaches, such as the Pendleton model, help reduce this discomfort by providing a clear, balanced way to frame conversations. They normalise feedback, make it easier to deliver and support reflective practice in a way that feels safe for both parties.

This article explores how healthcare professionals can apply the Pendleton model across academia, primary care, secondary care and public health, showing how a simple, structured framework can strengthen learning and embed continuous improvement into everyday practice.

The Pendleton model of feedback

The Pendleton model, developed by David Pendleton and colleagues in 1984^​1​, was initially designed for medical education but has since been adopted across numerous fields, including pharmacy.

The Pendleton model comprises four essential steps: 

1. Self-assessment — the recipient reflects on their own performance before receiving feedback;
2. Positive feedback — acknowledge specific strengths and successes to reinforce good practice;
3. Constructive feedback — offer suggestions for improvement that are clear and actionable;
4. Reflection on feedback — open a dialogue to discuss how the recipient feels about the feedback and what steps can be taken for further development.

The model emphasises collaborative feedback, placing equal importance on self-assessment, positive reinforcement, constructive critique and reflective discussion. This structured approach ensures that feedback is not only delivered in a way that encourages improvement but also helps the recipient develop a deeper self-awareness, which is a critical component of professional growth in healthcare^​1​.

A broad approach to giving feedback

Feedback should be adapted to the learner, the setting and the purpose of the interaction. The approach may differ depending on whether feedback is provided within an established learning relationship, such as between an educator and student, mentor and learner, clinical supervisor and junior doctor, or line manager and employee, or whether it is provided more informally and ad hoc during practice.

Where there is an established learning relationship, feedback can form part of an ongoing process of assessment, reflection and professional development. In contrast, ad hoc feedback may be shorter and focused on a specific behaviour or learning point identified during practice. Regardless of the context, an effective feedback approach should encourage reflection, recognise strengths and identify specific opportunities for improvement.

A broad four-stage approach can be used.

1. Self-assessment

Encourage the learner to reflect on their own performance before providing feedback. Open questions can gently guide the learner towards areas of strength or development that have been observed. For example:

• ‘How do you feel about the way you handled that consultation?’
• ‘How well do you think the patient understood the potential side effects?’
• ‘What part of the consultation did you find most difficult?’

This encourages self-awareness and allows the learner to take an active role in identifying their own learning needs.

2. Positive feedback

Acknowledge specific aspects of the learner’s performance that were effective. For example: ‘Your communication with the patient was clear and empathetic, which helped them feel comfortable discussing their treatment.’ Specific positive feedback reinforces good practice and helps the learner recognise behaviours they should continue.

3. Constructive feedback

Identify specific areas for development and provide practical suggestions for improvement. For example: ‘Next time, consider using more open-ended questions to check the patient’s understanding of their medication regimen.’ Feedback should focus on observable behaviours and provide the learner with a clear indication of how they could approach the situation differently.

4. Reflection and action planning

Invite the learner to respond to the feedback and consider how they might apply it in future practice. Questions such as ‘How do you feel about the feedback?’ or ‘What might you do differently next time?’ encourage the learner to take ownership of their development. Where appropriate, the discussion can conclude with an agreed action or learning goal.

Adapting feedback to different contexts

Although the same broad principles can be applied across healthcare settings, the emphasis of each stage should be adapted to the learner’s role, level of experience and context. The nature of the relationship between the person giving feedback and the learner is also important.

The Table below shows how each of the four steps in the Pendleton model can be applied in different situations.

Table: How to use the Pendleton model steps in different situations

By following this process, you not only help learners improve their clinical skills but also instil a habit of reflective practice, which benefits them throughout their careers.

How to use the Pendleton model in academia

In academia, pharmacists often take on the role of educators, mentoring undergraduate pharmacy students, postgraduate learners and colleagues. Pharmacist lecturers also contribute to the education of other health professionals, including medical students, nurses and those undertaking non-medical prescribing training. The importance of feedback in this context cannot be overstated, as it shapes the development of learners across all levels, equipping them with the knowledge, skills and professional attitudes needed for success. According to Sheldon and Slavin et al, effective feedback is a cornerstone of clinical education^​2​, while the Pendleton Model offers a structured yet flexible approach to feedback that is crucial in helping learners progress.

How to use the Pendleton model in primary care

In primary care, pharmacists are vital members of multidisciplinary teams, working alongside doctors, nurses and other healthcare professionals. Feedback is particularly important in this setting, as it can strengthen team dynamics and improve patient care. Through collaborative feedback, pharmacists help ensure that care is patient-centred and evidence-based, fostering positive interactions within the healthcare team^​3​.

1. Self-assessment

After patient consultations, ask your colleagues to reflect on their performance: ‘How do you think the patient responded to the medication adjustments you recommended?’^​3​

2. Positive feedback

Acknowledge successes within the team. For instance: ‘You did an excellent job explaining the potential side effects to the patient, helping them make an informed decision about their treatment.’^​4​

3. Constructive feedback

Provide specific suggestions for improvement: ‘Next time, it might be helpful to discuss the patient’s lifestyle factors in more depth before suggesting changes to their treatment plan.’^​1​

4. Reflection on feedback

Open a discussion about the feedback. For example: ‘What are your thoughts on this? Is there anything we could do differently in future consultations to improve patient engagement?’

Feedback in primary care is about improving not just individual performance but also team collaboration, ultimately leading to better patient outcomes^​3​.

How to use the Pendleton model in secondary care (i.e. hospital settings)

In hospital settings, pharmacists often work with complex cases, where feedback is essential for enhancing clinical decision-making and ensuring high standards of care. Feedback in this setting can be pivotal in ensuring that patients receive optimal treatment, particularly in multidisciplinary teams where collaboration is essential^​5​.

1. Self-assessment

After clinical rounds or reviewing patient cases, pharmacists can identify natural opportunities to provide informal feedback to colleagues, particularly when they do not have a formal supervisory role. For example, they could ask, colleagues to reflect on the treatment plan: ‘What do you think of the current medication therapy? Are there adjustments we need to consider?’ This encourages reflection and discussion around clinical decision-making^​1​.

2. Positive feedback

Recognise strengths in clinical decision-making: ‘Your adjustment to the antibiotic dosage, based on renal function, was appropriate and well-informed.’^​5​

3. Constructive feedback

Offer specific suggestions for improvement: ‘It might be beneficial to double-check the patient’s home medications to avoid potential drug interactions.’^​4​

4. Reflection on feedback

Engage in a reflective dialogue with your colleagues: ‘What are your thoughts on this approach? Are there other aspects of the patient’s care we should revisit?’

Feedback in secondary care not only enhances clinical decision-making but also improves team coordination, ensuring that each patient receives the best possible care^​5​.

How to use the Pendleton model in public health

In public health, pharmacists may work on large-scale projects, policy initiatives and community outreach, where feedback is less focused on individual patient interactions and more strategic in nature. It may consider the effectiveness of programmes, population needs, service outcomes and the wider impact of decisions. This is also relevant for pharmacists in senior or policy-focused roles, where feedback may focus on organisational priorities, implementation and system-level outcomes. The Pendleton model can support constructive dialogue in these contexts by encouraging reflection on what is working well, identifying areas for improvement and ensuring that initiatives remain responsive to community needs.

1. Self-assessment

In public health campaigns or outreach programs, ask team members to reflect on the overall strategy: ‘How do you think our community outreach was received? What areas could be improved?’

2. Positive feedback

Highlight successful aspects of the initiative: ‘Your engagement with local leaders was crucial in the success of the immunisation campaign.’^​3​

3. Constructive feedback

Offer suggestions for improvement: ‘We could refine the messaging to make it more culturally relevant, ensuring it resonates with diverse community groups.’^​5​

4. Reflection on feedback

Encourage team members to reflect on the feedback and suggest improvements: ‘Do you feel the current approach is effective? What could we do differently moving forward?’

In public health, feedback plays a vital role in refining strategies and ensuring that interventions are aligned with community needs.

Conclusion

The Pendleton model of feedback offers a clear, structured approach that is applicable across various pharmacy practice settings, including academia, primary care, secondary care and public health. By promoting self-reflection, encouraging constructive dialogue and fostering a collaborative learning environment, this model helps professionals improve both their individual performance and the quality of patient care. The Pendleton model can be a useful catalyst for continuous learning and professional development. Healthcare leaders can use this approach to foster a culture of excellence, encourage reflective practice and enhance team performance across disciplines.