Only When They Seek: Exploring Supervisor and Resident Perspectives and Positions on Upward Feedback

Abstract

Introduction:Verbal feedback from trainees to supervisors is rare in medical education, although valuable for improvement in teaching skills. Research has mostly examined narrative comments on resident evaluations of their supervisors. This study aimed to explore supervisors' and residents' beliefs and experiences with upward feedback, along with recommendations to initiate and facilitate effective conversations.Methods:Using 60-minute focus group discussions, a previous study explored opinions of internal medicine residents and clinical supervisors at the Brigham and Women's Hospital regarding the impact of institutional culture on feedback conversations. For this study, we conducted a thematic analysis of the transcribed, anonymous data to identify key concepts pertaining only to verbal upward feedback, through the theoretical lens of Positioning theory.Results:Twenty-two supervisors and 29 residents participated in three and five focus groups, respectively. Identified themes were mapped to three research questions regarding (1) existing beliefs (lack of impact, risks to giving supervisors feedback, need for preparation and reflection), (2) experiences (nonspecific language, avoidance of upward feedback, bypassing the supervisor), and (3) recommended approaches (setting clear expectations, seeking specific feedback, emphasizing interest in growth).Discussion:Study participants appeared to assume learner–teacher positions during feedback conversations, resulting in residents' concerns of adverse consequences, beliefs that supervisors will neither accept feedback nor change their behaviors, and avoidance of constructive upward feedback. Residents suggested that emphasis on mutual professional growth and regular feedback seeking by supervisors could encourage them to take on the role of feedback providers. Their recommendations could be a valuable starting point for faculty development initiatives on upward feedback.

Residents’ and supervisors’ experiences when using a feedback-model in post-graduate medical education

“…Feedback in the other direction, up-ward feedback, from residents to supervisors, is often challenging and less researched [ 8 ]. Here, the residents need to understand their own role as mediators of feedback, have a language to provide it and work in a learning environment where feedback is requested [ 9 , 10 ].…”

The Technological Society and the Social Organization of Continuing Professional Development Interventions

“…Roy et al 5 focus on design issues in their exploration of content relationships among components of a multisource feedback program. Ramani et al 6 take us on a qualitative exploration of feedback at the individual level involving a reversal of the feedback flow—from residents to clinical supervisors. Three other articles in this Issue concern online continuing professional development (CPD).…”