Feedback About Feedback

Feedback: In this qualitative study, investigators held focus groups and individual interviews with residents and faculty in the internal medicine department at Brigham and Women’s Hospital (Boston), looking into the “culture” of feedback.  Reviewers looked at transcripts and identified three major themes:  “normalizing constructive feedback to promote a culture of growth, overcoming the mental block to feedback seeking, and hierarchical culture impeding bidirectional feedback.”  Many barriers to honest constructive feedback were mentioned:  fear of damaging the relationship, fear of damaging the team dynamic, lack of comfort with giving feedback to a superior, fear of retaliation from the institution for giving negative feedback, fear of threatening the recipient’s self-esteem, and fear of threatening the reputation of the institution.  Lots of facilitators of useful feedback were also mentioned: normalizing weakness (e.g. superiors admitting their own limitations), attention to the language and tone of constructive feedback, and training in feedback delivery and feedback seeking.  Many physicians felt that longitudinal relationships made giving feedback easier, and that direct observation facilitated feedback, although some residents “saw the presence of a faculty observer as intrusive and a potential threat to autonomy.” — Laura Willett, MD

Ramani S, Könings KD, Mann KV, Pisarski EE, van der Vleuten CPM. About Politeness, Face, and Feedback: Exploring Resident and Faculty Perceptions of How Institutional Feedback Culture Influences Feedback Practices. Acad Med. 2018 Mar

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