Encouraging residents to seek feedback

Figures & data

Table

Practice points

The feedback exchange model between clinical supervisors and learners has shifted to include the role of the learner in seeking and accepting feedback The feedback exchange process and resident feedback-seeking are influenced by multiple factors Both faculty and learner roles require attention Resident feedback-seeking activities appear to be dependent on four central factors: 1. learning/workplace culture/climate, 2. relationships, 3. purpose and quality of feedback, 4. emotional responses to feedback Further research is needed to determine how to reduce the tensions between faculty and learner perceptions of the feedback exchange process and how to encourage residents to take an active role in seeking feedback from their clinical supervisors

Figure 1. Model of interaction of themes influencing resident feedback-seeking behaviours.

Table 1  Quotes illustrating similarities and differences between perceptions of faculty (F) and residents (R) with respect to Influences upon residents’ feedback-seeking activities

Theme: Influences upon residents’ feedback-seeking	Subtheme	Agreement	Differences in perceptions leading to tensions
1. Culture/climate		R1: “I think there just needs to be a culture shift. Right?)… we are at a teaching institution. Teaching should be built into the job. And as part of teaching, you need to let people know how they are doing.”	R1: “I find too when you get kind of used to not getting feedback ever, you stop looking for it.”
		F2:” I think that if there was a culture of okay, at the end of the day today, I want to know one thing that I can improve on.”	F1: “but the residents in general don’t seem to grasp the fact that evaluation is very much their responsibility.”
	Safety	R2: “We don’t want to have our worst fears of inadequacy realized by anybody.”	R1:“there is the whole sense of safety too in evaluation, right? ….if you’re actually looking for informal feedback on how to be better, …… there's still that, I find, that desire to conquer that ITER and to do well “
		F1:” or whatever. I don’t know Don’t ask, don’t tell. Now, maybe some of them feel, “Geez, I don’t want to hear any bad news.	F2: “there are groups, in my experience, who are anxious to have very constructive feedback and don’t find that threatening … And other times where it would seem there is a real defensiveness about any kind of constructive feedback.”
	Time	F 1: “So for both the learner who is trying to get to their clinic, and for the teacher who is trying to get somewhere else, the time pressures are huge.”	R2:” the person that was evaluating me had spent very little time with me.”
		R1: “they have their own things to do, and they are too busy with their own stuff, or trying to deal with the rest of the residents, to deal with you.”	F1: “But the resident needs to bring that to your attention because if it's a busy clinic, you’re going to forget.”
	Structure	R1: “I’ve noticed that, residents on a service in their own specialty are more likely to look for feedback than people who are just trying to get in and get out. …… So I think there is a difference between whether there's an ownership to your own service or not.”
		F1: “I find with our core program trainees, it's easier because we have more of a longitudinal relationship with them.”
2. Relationships		R1: “I like the feedback that I get when I feel it's personalized and the person who I worked with really understood what I was doing, what I was trying to achieve, and how much time and effort I put into it.“	R2: “Like they honestly don’t care about the off-service residents that are just there for bodies.”
	Comfort	R1:“If you feel really comfortable with the staff then there's no hesitancy. If it's somebody that, I don't know, you're more intimidated by, there's less of an inclination to do that.”	R1: “I've never tried to seek out feedback because I feel I'd be this little puppy or this little kid going, “Did I do a good job? Are you watching me?” ……. And I just feel like that's not the type of person I want to be. You want to portray this confidence.”
		R1:”it seems that a lot of residents all get comfortable with the same couple of staff.”
		F2: “So it will be interesting from the resident's side to see how comfortable they feel and how approachable they feel that staff are as teachers for them to ask those kind of things.”	R2 “But in terms of meeting with that person who might be intimidating, …… , I'm not sure I'm any better at it 6 years later.”
3. Quality of Feedback
	Contact	F1: “You are working with a resident every single day. Then you have a better opportunity of seeing how they work and working with them and giving them some feedback”	R2: If I've gone and done 1,000 physical exams on patients, and my staff hadn't seen me do one of them, I don't think that their feedback is going to be helpful.
		F1:” it's much more difficult when you're just dropped in somewhere for that 4 week rotation …… something could easily get left behind.”	”
		R2: “it has to happen around a specific circumstance. It needs to be direct, timely.”
		R2:“I would say that probably 80% of the evaluations that I had in my rotating year were from staff that spent little time with me. And it's not useful.”
4. Emotional Response: a barrier		R1: “it's probably hard for him to tell me, and for me to take it at the time. I was completely mortified. But in retrospect, I was glad.”
		F2:“And so I thought, wow, she just totally took that as a personal attack. And I'm sure a lot of that is … I'm sure a lot of it was my method but also her sensitivity. And so I think both of those things could be worked on."
		F2: “And it's easy to give positive feedback. It's easier to kind of let the small negative things go.”
		R1: “To understand that it's a natural first response to feel really defensive … But just to kind of try to take it and process it and let it percolate for a couple of days or whatever it takes until you can seek out the wisdom.
		R 2. When you are constantly trying to meet a standard and you get told that you are not there, it stings

Note: Numbers represent the focus group, e.g., R1 is a resident in the resident focus group 1.