Uncovering the unknown: A grounded theory study exploring the impact of self-awareness on the culture of feedback in residency education

Abstract

Aim: Self-assessment and reflection are essential for meaningful feedback. We aimed to explore whether the well-known Johari window model of self-awareness could guide feedback conversations between faculty and residents and enhance the institutional feedback culture.

Methods: We had previously explored perceptions of residents and faculty regarding sociocultural factors impacting feedback. We re-analyzed data targeting themes related to self-assessment, reflection, feedback seeking and acceptance, aiming to generate individual and institutional feedback strategies applicable to each quadrant of the window.

Results: We identified the following themes for each quadrant: (1) Behaviors known to self and others – Validating the known; (2) Behaviors unknown to self but known to others – Accepting the blind; (3) Behaviors known to self and unknown to others – Disclosure of hidden; and (4) Behaviors unknown to self and others – Uncovering the unknown. Normalizing self-disclosure of limitations, encouraging feedback seeking, training in nonjudgmental feedback and providing opportunities for longitudinal relationships could promote self-awareness, ultimately expanding the “open” quadrant of the Johari window.

Conclusions: The Johari window, a model of self-awareness in interpersonal communications, could provide a robust framework for individuals to improve their feedback conversations and institutions to design feedback initiatives that enhance its quality and impact.

Acknowledgements

We express our appreciation to all the residents and faculty who participated in this study and provided valuable insights on this topic.

Disclosure statement

The authors reports no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Glossary

Johari window: Is a psychological matrix developed by Joseph Luft and Harry Ingham in 1955, to enable awareness and understanding of own behaviors, feelings and motivation during interpersonal interactions (Luft 1969).

Luft J. 1969. Of human interaction. Palo Alto (CA): National Press Books. 76084008

Reflexivity in Qualitative Research: Qualitative researchers need to be aware of their biases and assumptions and acknowledge how their relationship to the research topic and participants can influence data collection, analysis and reporting. This concept is termed reflexivity.

Watt D. On becoming a qualitative researcher: the value of reflexivity. TQR. 2016;12: 82-101.

Notes on contributors

Dr. Subha Ramani, MBBS, MMEd, MPH, is the Director of the Scholars in Medical Education Track for the Internal Medicine Residency Program at Brigham and Women’s Hospital and Assistant Professor of Medicine at Harvard Medical School.

Dr. Karen Könings, PhD, is Associate Professor at the School of Health Professions Education, Maastricht University.

Dr. Karen Mann, PhD, (Late) was Professor Emeritus, Department of Medical Education, Faculty of Medicine at Dalhousie University, Halifax, Canada.

Dr. Cees van der Vleuten, PhD, is the Director of the School of Health Professions Education and Professor of Education, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University.

Additional information

Funding

This research was funded by the Department of Medicine CERS (Clinical Education Research Scholars) grant at the Brigham and Women’s Hospital.