["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.", '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.', "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."] Is annotation a valuable tool to enhance learning and assessment in student essays?