Risky business: medical students’ feedback-seeking behaviours: a mixed methods study

ABSTRACT

There are differing views on how learners’ feedback-seeking behaviours (FSB) develop during training. With globalisation has come medical student migration and programme internationalisation. Western-derived educational practices may prove challenging for diverse learner populations. Exploring undergraduate activity using a model of FSB may give insight into how FSB evolves and the influence of situational factors, such as nationality and site of study. Our findings seek to inform medical school processes that support feedback literacy. Using a mixed methods approach, we collected questionnaire and interview data from final-year medical students in Ireland, Bahrain, and Malaysia. A validated questionnaire investigated relationships with FSB and goal orientation, leadership style preference, and perceived costs and benefits. Interviews with the same student population explored their FSB experiences in clinical practice, qualitatively, enriching this data. The data were integrated using the ‘following the thread’ technique. Three hundred and twenty-five of a total of 514 completed questionnaires and 57 interviews were analysed. Learning goal orientation (LGO), instrumental leadership and supportive leadership related positively to perceived feedback benefits (0.23, 0.2, and 0.31, respectively, p < 0.05). Perceived feedback benefits are related positively to feedback monitoring and inquiry (0.13 and 0.38, respectively, p < 0.05). The personal cost of feedback is unsupported in quantitative data, but was a strong theme in interviews, as was feedback avoidance, peer feedback, and unsupportive learning environment. No differences were observed across sub-groups based on gender, study site, or student nationality. Integrated analysis describes FSB: avoiding ‘unsafe’ feedback (first, do no harm) and overcoming barriers (beat the system) and goal-centred curation (shop around) to optimise benefits. Diverse medical students across three continents undertake FSB with careful navigation, as a valued but risky business, that is highly contextualised. Promoting a constructive FSB is complex. Overcoming outdated theory and practices on the wards remains a challenge to psychologically safe, learner-centred feedback.

Keywords:

• Feedback-seeking
• feedback
• mixed methods
• undergraduate feedback
• feedback literacy

Acknowledgments

We are very grateful to the medical students who contributed to this work and to Dr. Naji Alamuddin, RCI Bahrain, who kindly assisted with recruitment at XXXX Medical University. We thank Professor Pim Teunissen for permitting us to use his questionnaire. We thank Professors Jan Illing, Pim Teunissen, and David Sklar for their kind and constructive feedback which has greatly improved this manuscript.

Author contributions

MS conceptualised the study. MS, FB, and TP contributed to the study design. MS and TP performed the data collection. FB and MS performed statistical analysis. MS and TP undertook integrated data analysis. MS produced the first draft of the paper; all authors contributed to and refined this draft. All authors approved the final manuscript for submission.

Availability of data and materials

The datasets analysed in the study are available from the corresponding author on reasonable request.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported that there is no funding associated with the work featured in this article.