Barriers and Facilitators to Effective Feedback: A Qualitative Analysis of Data From Multispecialty Resident Focus Groups

Abstract

Background Despite the importance of feedback, the literature suggests that there is inadequate feedback in graduate medical education. Objective We explored barriers and facilitators that residents in anesthesiology, emergency medicine, obstetrics and gynecology, and surgery experience with giving and receiving feedback during their clinical training. Methods Residents from 3 geographically diverse teaching institutions were recruited to participate in focus groups in 2012. Open-ended questions prompted residents to describe their experiences with giving and receiving feedback, and discuss facilitators and barriers. Data were transcribed and analyzed using the constant comparative method associated with a grounded theory approach. Results A total of 19 residents participated in 1 of 3 focus groups. Five major themes related to feedback were identified: teacher factors, learner factors, feedback process, feedback content, and educational context. Unapproachable attendings, time pressures due to clinical work, and discomfort with giving negative feedback were cited as major barriers in the feedback process. Learner engagement in the process was a major facilitator in the feedback process. Conclusions Residents provided insights for improving the feedback process based on their dual roles as teachers and learners. Time pressures in the learning environment may be mitigated by efforts to improve the quality of teacher-learner relationships. Forms for collecting written feedback should be augmented by faculty development to ensure meaningful use. Efforts to improve residents' comfort with giving feedback and encouraging learners to engage in the feedback process may foster an environment conducive to increasing feedback.

Feedback: Cultivating a Positive Culture

“…8 Resident observation of colleague behaviors is already ubiquitous within training programs: to not capture it is a missed opportunity, for both improving learner performance and feedback culture. The illumination by Reddy et al 9 of some of the barriers that hinder resident engagement in feedback should not discourage us, but rather empower us to overcome them. While peer-to-peer feedback is only one component of a comprehensive feedback program, nurturing its success may have downstream benefits on the feedback culture.…”

Milestone Implementation’s Impact on Narrative Comments and Perception of Feedback for Internal Medicine Residents: a Mixed Methods Study

“…10 As programs become more familiar with milestones, additional faculty development is required to improve the content and delivery of verbal and written feedback. 6,24 One area for improvement, suggested by our findings, is the need for faculty to reinforce residents' areas of strength via specific comments supported by examples.…”

“…[20][21][22] Our analysis of narrative comments supports resident perception, as the majority of commentary consisted of vague statements about resident strengths and are the type of comments that are known to not be valued as feedback. 6,15,23 This likely contributes to the low rating of usefulness of verbal feedback and narrative comments. In regard to the content of comments, our work supports the use of analysis by competencies, as narrative comments covered all of the ACGME competencies.…”

“…2,3 Residents perceive receiving little feedback on clinical skills and report the majority of feedback received is vague and not beneficial to development. [4][5][6] It is unclear if resident perception correlates with the actual quality of feedback content. 4 While multiple interventions to improve faculty feedback have been published, application is often limited due to time and resource constraints.…”

Does formal workplace based assessment add value to informal feedback?

“…The description given by students of the WBA process suggests three stages -immediate feedback, then a discussion in which feedback is summarised and strategies suggested, and finally receipt of the written feedback. The feedback discussion was linked by students to the requirement for formal assessment and although this qualitative data cannot prove that students in a similar clinical placement without the requirement for written feedback would get less feedback in total, the large quantity of feedback described here contrasts with the usual student and graduate complaint of insufficient feedback (J. M. M. van de Ridder et al 2008;Reddy et al 2015). In this study, the verbal feedback also appears to be aligned with the written feedback which in turn is aligned with the formal consultation skills curriculum (Lefroy et al 2011;Lefroy et al 2014) which we consider to increase its educational value.…”