Annotation is a valuable tool to enhance learning and assessment in student essays.

Unlabelled: As a United Kingdom (UK) wide organisation, the Quality Assurance Agencies ensure that best standards in higher education are reached. Following an institutional audit within a UK University, it was recommended that annotation be introduced to promote good practice in the management and implementation of giving feedback to students on assessed work. Annotation is a handwritten comment or mark written directly onto the page of the students' script.

Methods: A review of current literature, policy and practice in relation to annotation. Random sample of student scripts analysed for versions of annotation such as content, difference, length, approach and clarity. Questionnaires distributed to staff (n=74) and students n=249), analysed using SPSS and thematic analysis.

Outcomes: For both staff and students, interpretations of annotation in terms of transparency of style and legibility were an issue. Both respondents agreed or strongly agreed that annotation enhances a student-centered approach to learning. For the student sample, there was an agreement or strong agreement that annotation helped inform the next assignment (82.2%). There was a recognition that annotation can convey a tone and the student survey indicated that the tone of some annotation undermines confidence. Findings show annotation is considered important by students but is different from other forms of feedback. Because annotation is written on the page it requires greater sensitivity towards students' work. Recommendations disseminate findings to develop health professional education.

Discussion: The annotator's presence can influence the student's interaction with their script causing them to evaluate their original writing differently. Ramage and Bean [Ramage, J.D., Bean, J.C., 1995. Writing Arguments, third ed. Allyn and Bacon, Needham Heights, MA.], use two different annotated versions of the same essay to model and contrast ''reading as a believer" and ''reading as a doubter" (cited in Wolfe [Wolfe, J.L., 2002. Marginal pedagogy: how annotated texts affects writing-from-source text. Written Communication 19 (2), 297-333.]). Multiple readings can be made of one text, but how the essay is read by the lecturer has the greater impact on the student. Annotation defies any stable definition precisely because it can be practiced in so many ways. It is vital that annotation is used and received appropriately so that negative effects of annotation are minimised and the positive effects emphasised. There are a number of ways of improving annotation, and good practice guidelines are offered in the conclusion to this paper.