Fostering a Feedback Mindset: A Qualitative Exploration of Medical Students’ Feedback Experiences With Longitudinal Coaches

Bakke, Brian; Sheu, Leslie; Hauer, Karen E.

doi:10.1097/acm.0000000000003012

Cited by 28 publications

(23 citation statements)

References 49 publications

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“…Creating structures for learning, mentoring and assessment which support the development of a growth mindset will be important for fostering a growth mindset and authentic performances that support effective conversations. This includes providing longitudinal coaching relationships and using competency frameworks to guide learner development 36‐39 …”

Section: Discussionmentioning

confidence: 99%

Resident impression management within feedback conversations: A qualitative study

et al. 2020

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Introduction Medical education is moving to conceptualise feedback as a bidirectional learning conversation. Within this conversation, learners experience a tension between assessment and feedback. That perceived tension affects learners’ outward performances. In this study, we aimed to characterise residents’ experiences with this tension and its effect on learner authenticity within feedback conversations. Methods In this constructivist grounded theory study, the authors were informed by Goffman's theory of impression management. During data analysis, Dweck's theory of mindset was adopted. The authors conducted semi‐structured interviews with 15 internal medicine residents. Data collection and analysis were conducted iteratively, using constant comparison to identify themes coinciding with impression management and mindset, ultimately developing a theoretical model to help explain residents’ responses to tensions within feedback conversations. Results Residents constantly felt ‘scrutinized’, and this affected their engagement in feedback conversations. They staged a performance within those conversations, linked to their underlying mindset: growth or fixed. Growth mindset was characterised by a focus on development as a physician and was associated with asking questions and seeking opportunities for growth. Fixed mindset was characterised by a focus on achieving a favourable evaluation and was associated with a hesitation to ask questions when faced with uncertainty and admit opportunities for growth, because they were concerned about impression management. Context influenced mindset and impression management. Residents adopted a fixed mindset and managed impressions when they perceived the permanence or consequences of evaluations within feedback. Residents adopted a growth mindset when they trusted the supervisor. Discussion Residents assess the context of feedback conversations, altering the authenticity of their behaviours. Context, including the perceptions of formal assessment and relationships with supervisors, affected residents’ mindset and impression management. Providing space for relationship‐building and clarifying the purpose and structure of assessment may be helpful in supporting effective learning conversations in graduate medical education.

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Section: Discussionmentioning

confidence: 99%

Resident impression management within feedback conversations: A qualitative study

et al. 2020

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“…Thus, teaching may serve its own important and separate role in increasing knowledge while requiring far less vulnerability, possibly improving psychological safety. Psychological safety is critical for high-functioning clinical teams, fostering relationship-building and allowing learners to “focus on learning in the present moment without considering the consequences for their image in the eyes of others [ 14 ].” Residents frequently have difficulty identifying feedback in clinical environments for factors including the relationship between a learner and supervisor, the learner’s mindset, and the culture of feedback in the learning environment [ 5 , 6 ], which tie into psychological safety.…”

Section: Discussionmentioning

confidence: 99%

“…Although residents and faculty agree on the importance of feedback [ 5 , 6 ], they often disagree on the frequency of feedback in clinical scenarios [ 7 ]. We previously conducted a national survey of internal medicine residents demonstrating that residents may have difficulty identifying feedback in the context of teaching [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Medical residents and attending physicians’ perceptions of feedback and teaching in the United States: a qualitative study

Matthiesen

Kelly

Dzara

et al. 2022

J Educ Eval Health Prof

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Purpose: Residents and attendings agree on the importance of feedback to resident education. However, while faculty report providing frequent feedback, residents often do not perceive receiving it, particularly in the context of teaching. Given the nuanced differences between feedback and teaching, we aimed to explore resident and attending perceptions of feedback and teaching in the clinical setting. Methods: We conducted a qualitative study of internal medicine residents and attendings from December 2018 through March 2019 at a large US academic medical center (Massachusetts General Hospital) to investigate perceptions of feedback in the inpatient clinical setting. Residents and faculty were recruited to participate in focus groups. Data were analyzed using thematic analysis to explore perspectives and barriers to feedback provision and identification. Results: Five focus groups included 33 total participants in 3 attending (n=20) and 2 resident (n=13) groups. Thematic analysis of focus group transcripts identified 7 themes which organized into three thematic categories: (1) disentangling feedback and teaching, (2) delivering high-quality feedback, and (3) experiencing feedback in the group setting. Residents and attendings highlighted important themes in discriminating feedback from teaching. They indicated that while feedback is reactive in response to an action or behavior, teaching is proactive and oriented toward future endeavors. Conclusion: Confusion between the critical concepts of teaching and feedback may be minimized by allowing them to each have their intended impact, either in response to prior events or aimed toward those yet to take place.

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“…4 Our respondents also highlighted the importance of trusted mentors for contextualizing any feedback. 15,16 Educators should be aware that providing retrospective feedback has the potential to trigger a strong emotional reaction. 17 Finally, we noted that residents expressed less interest in institutional metrics, and their faculty acknowledged this lower level of interest without great concern.…”

Section: Discussionmentioning

confidence: 99%

Trainee and Program Director Perspectives on Meaningful Patient Attribution and Clinical Outcomes Data

Rosenbluth

Tong

Montes

et al. 2020

Journal of Graduate Medical Education

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Background The Accreditation Council for Graduate Medical Education specifies that trainees must receive clinical outcomes and quality benchmark data at specific levels related to institutional patient populations. Program directors (PDs) are challenged to identify meaningful data and provide them in formats acceptable to trainees. Objective We sought to understand what types of patients, data/metrics, and data delivery systems trainees and PDs prefer for supplying trainees with clinical outcomes data. Methods Trainees (n = 21) and PDs (n = 12) from multiple specialties participated in focus groups during academic year 2017–2018. They described key themes for providing clinical outcomes data to trainees. Results Trainees and PDs differed in how they identified patients for clinical outcomes data for trainees. Trainees were interested in encounters where they felt a sense of responsibility or had autonomy/independent decision-making opportunities, continuity, or learned something new; PDs used broader criteria including all patients cared for by their trainees. Both groups thought trainees should be given trainee-level metrics and consistently highlighted the importance of comparison to peers and/or benchmarks. Both groups found value in “push” and “pull” data systems, although trainees wanted both, while PDs wanted one or the other. Both groups agreed that trainees should review data with specific faculty. Trainees expressed concern about being judged based on their patients' clinical outcomes. Conclusions Trainee and PD perspectives on which patients they would like outcomes data for differed, but they overlapped for types of metrics, formats, and review processes for the data.

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Fostering a Feedback Mindset: A Qualitative Exploration of Medical Students’ Feedback Experiences With Longitudinal Coaches

Cited by 28 publications

References 49 publications

Resident impression management within feedback conversations: A qualitative study

Resident impression management within feedback conversations: A qualitative study

Medical residents and attending physicians’ perceptions of feedback and teaching in the United States: a qualitative study

Trainee and Program Director Perspectives on Meaningful Patient Attribution and Clinical Outcomes Data

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