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Feedback Redefined: Principles and Practice

Published on May 1, 2019in Journal of General Internal Medicine4.606
· DOI :10.1007/s11606-019-04874-2
Subha Ramani13
Estimated H-index: 13
(Brigham and Women's Hospital),
Karen D. Könings17
Estimated H-index: 17
(UM: Maastricht University)
+ 1 AuthorsC.P.M. van der Vleuten74
Estimated H-index: 74
(UM: Maastricht University)
Sources
Abstract
Feedback is defined as a regulatory mechanism where the effect of an action is fed back to modify and improve future action. In medical education, newer conceptualizations of feedback place the learner at the center of the feedback loop and emphasize learner engagement in the entire process. But, learners reject feedback if they doubt its credibility or it conflicts with their self-assessment. Therefore, attention has turned to sociocultural factors that influence feedback-seeking, acceptance, and incorporation into performance. Understanding and application of specific aspects of psychosocial theories could help in designing initiatives that enhance the effect of feedback on learning and growth. In the end, the quality and impact of feedback should be measured by its influence on recipient behavior change, professional growth, and quality of patient care and not the skills of the feedback provider. Our objective is to compare and contrast older and newer definitions of feedback, explore existing feedback models, and highlight principles of relevant psychosocial theories applicable to feedback initiatives. Finally, we aim to apply principles from patient safety initiatives to emphasize a safe and just culture within which feedback conversations occur so that weaknesses are as readily acknowledged and addressed as strengths.
  • References (69)
  • Citations (3)
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References69
Newest
#1Subha Ramani (Brigham and Women's Hospital)H-Index: 13
#2Karen D. Könings (UM: Maastricht University)H-Index: 17
Last. C.P.M. van der Vleuten (UM: Maastricht University)H-Index: 74
view all 4 authors...
AbstractFeedback in medical education has traditionally showcased techniques and skills of giving feedback, and models used in staff development have focused on feedback providers (teachers) not receivers (learners). More recent definitions have questioned this approach, arguing that the impact of feedback lies in learner acceptance and assimilation of feedback with improvement in practice and professional growth. Over the last decade, research findings have emphasized that feedback conversation...
11 CitationsSource
#1Rebecca Baines (Plymouth University)H-Index: 2
#2Sam Regan de Bere (Plymouth University)H-Index: 10
Last. Julian Archer (Plymouth University)H-Index: 17
view all 8 authors...
Patient feedback is considered integral to quality improvement and professional development. However, while popular across the educational continuum, evidence to support its efficacy in facilitating positive behaviour change in a postgraduate setting remains unclear. This review therefore aims to explore the evidence that supports, or refutes, the impact of patient feedback on the medical performance of qualified doctors. Electronic databases PubMed, EMBASE, Medline and PsycINFO were systematica...
5 CitationsSource
#1Joan Sargeant (Dal: Dalhousie University)H-Index: 31
#2Jocelyn Lockyer (U of C: University of Calgary)H-Index: 36
Last. Michelle Boudreau (Dal: Dalhousie University)H-Index: 3
view all 13 authors...
Purpose The authors previously developed and tested a reflective model for facilitating performance feedback for practice improvement, the R2C2 model. It consists of four phases: relationship building, exploring reactions, exploring content, and coaching. This research studied the use and effectiveness of the model across different residency programs and the factors that influenced its effectiveness and use. Method From July 2014–October 2016, case study methodology was used to study R2C2 model ...
15 CitationsSource
#1Elizabeth A. Rider (Harvard University)H-Index: 14
#2Mary Ann Gilligan (MCW: Medical College of Wisconsin)H-Index: 11
Last. William T. Branch (Emory University)H-Index: 28
view all 12 authors...
Background Changes in the organization of medical practice have impeded humanistic practice and resulted in widespread physician burnout and dissatisfaction.
7 CitationsSource
#1Subha Ramani (Harvard University)H-Index: 13
#2Karen D. KöningsH-Index: 17
Last. C.P.M. van der VleutenH-Index: 74
view all 5 authors...
PurposeTo explore resident and faculty perspectives on what constitutes feedback culture, their perceptions of how institutional feedback culture (including politeness concepts) might influence the quality and impact of feedback, feedback seeking, receptivity, and readiness to engage in bidirectiona
9 CitationsSource
#1Ara Tekian (UIC: University of Illinois at Chicago)H-Index: 16
#2Christopher Watling (UWO: University of Western Ontario)H-Index: 21
Last. John J. Norcini (Foundation for Advancement of International Medical Education and Research)H-Index: 45
view all 5 authors...
AbstractResearch indicates the importance and usefulness of feedback, yet with the shift of medical curricula toward competencies, feedback is not well understood in this context. This paper attempts to identify how feedback fits within a competency-based curriculum. After careful consideration of the literature, the following conclusions are drawn: (1) Because feedback is predicated on assessment, the assessment should be designed to optimize and prevent inaccuracies in feedback; (2) Giving qua...
7 CitationsSource
#1Robert G. Bing-YouH-Index: 16
#2Kalli VaraklisH-Index: 6
Last. Dina McKelvyH-Index: 2
view all 6 authors...
PurposeTo conduct an integrative review and analysis of the literature on the content of feedback to learners in medical education.MethodFollowing completion of a scoping review in 2016, the authors analyzed a subset of articles published through 2015 describing the analysis of feedback exchange con
15 CitationsSource
#1Anne Gaunt (Warw.: University of Warwick)H-Index: 2
#2Abhilasha PatelH-Index: 3
Last. Teresa Pawlikowska (RCSI: Royal College of Surgeons in Ireland)H-Index: 8
view all 6 authors...
Objectives Although trainees and trainers find feedback interactions beneficial, difficulties in giving and receiving feedback are reported. Few studies have explored what drives trainees to seek feedback. This study explores how workplace-based assessments (WBAs) influence the ways surgical trainees seek feedback and feedback interactions. Methods Utilising a template analysis approach, we conducted 10 focus groups with 42 surgical trainees from four regions across the UK. Data were independent...
8 CitationsSource
#1Subha Ramani (Brigham and Women's Hospital)H-Index: 13
#2Sarah E. Post (Brigham and Women's Hospital)H-Index: 1
Last. C.P.M. van der Vleuten (UM: Maastricht University)H-Index: 74
view all 6 authors...
ABSTRACTPhenomenon: Competency-based medical education requires ongoing performance-based feedback for professional growth. In several studies, medical trainees report that the quality of faculty feedback is inadequate. Sociocultural barriers to feedback exchanges are further amplified in graduate and postgraduate medical education settings, where trainees serve as frontline providers of patient care. Factors that affect institutional feedback culture, enhance feedback seeking, acceptance, and b...
27 CitationsSource
#1Joan SargeantH-Index: 31
#2Karen MannH-Index: 45
Last. Michelle BoudreauH-Index: 3
view all 7 authors...
ABSTRACT Background Feedback is increasingly seen as a collaborative conversation between supervisors and learners, where learners are actively and reflectively engaged with feedback and use it to improve. Based on this, and through earlier research, we developed an evidence- and theory-informed, 4-phase model for facilitating feedback and practice improvement—the R2C2 model (relationship, reaction, content, coaching). Objective Our goal was to explore the utility and acceptability of the R2C2 m...
15 CitationsSource
Cited By3
Newest
#1Christine Ossenberg (Griffith University)H-Index: 1
Last. Amanda Henderson (Princess Alexandra Hospital)H-Index: 28
view all 3 authors...
Introduction Current perspectives present feedback as a dynamic, dialogic process. It is widely accepted that feedback can have an impact on workplace performance, however, how dialogic feedback is enacted with the learner in authentic healthcare settings is less apparent. This paper seeks to describe the design and development of an implementation study to promote the learner voice in the feedback process and improve feedback encounters between learners and learning partners in healthcare setti...
Source
#1Christy Noble (Griffith University)H-Index: 8
Last. Elizabeth Molloy (University of Melbourne)H-Index: 22
view all 7 authors...
Feedback can improve students' learning and performance on clinical placements, yet students are often dissatisfied with the process. Attempts to improve feedback frequently focus on faculty development programs without addressing learners' capabilities to engage with feedback. For feedback to be effective, students need to understand its processes and to translate this into practice. Developing student feedback literacy may enhance feedback engagement and, therefore, learning outcomes. This qua...
7 CitationsSource
#1Serena Y. Kuang (Oakland University)
#2Suzan Kamel-ElSayed (Oakland University)H-Index: 1
Last. Deirdre Pitts (Oakland University)
view all 3 authors...
Mistakes in clinical practice may have life-or-death consequences for patients. Training in how to give and receive feedback has been emphasized in medical education for decades, yet medical practitioners continue to struggle with these practices. Giving feedback is difficult because it is not easy for a receiver to receive feedback. Current training programs lack an in-depth understanding of the causes of why receiving feedback is not easy. The purposes of this article are to (1) fill this gap ...
Source
#1Eric Young (University of Colorado Denver)
#2D. Michael Elnicki (University of Pittsburgh)H-Index: 19
Source