Emotion as reflexive practice: A new discourse for feedback practice and research

Abstract

Introduction: Like medicine and health care, feedback is a practice imbued with emotions: saturated with feelings relevant to one's identity and status within a given context. Often this emotional dimension of feedback is cast as an impediment to be ignored or managed. Such a perspective can be detrimental to feedback practices as emotions are fundamentally entwined with learning. In this critical review, we ask: What are the discourses of emotion in the feedback literature and what 'work' do they do? Methods: We conducted a critical literature review of emotion and feedback in the three top journals of the field: Academic Medicine, Medical Education and Advances in Health Sciences Education. Analysis was informed by a Foucauldian critical discourse approach and involved identifying discourses of emotion and interpreting how they shape feedback practices.Findings: Of 32 papers, four overlapping discourses of emotion were identified.Emotion as physiological casts emotion as internal, biological, ever-present, immutable and often problematic. Emotion as skill positions emotion as internal, mainly cognitive and amenable to regulation. A discourse of emotion as reflexive practice infers a social and interpersonal understanding of emotions, whereas emotion as socio-cultural discourse extends the reflexive practice discourse seeing emotion as circulating within learning environments as a political force.Discussion: Drawing on scholarship within the sociology of emotions, we suggest the merits of studying emotion as inevitable (not pathological), as potentially paralysing and motivating and as situated within (and often reinforcing) a hierarchical social health care landscape. For future feedback research, we suggest shifting towards recognising the discourse-theory-practice connection with emotion in health professional education drawing from reflexive and socio-cultural discourses of emotion. | INTRODUCTIONIdeally, students of health professions develop capabilities to critically evaluate and act on the feedback information they receive from academic staff, clinical educators, peers and patients. This is central to developing as professionals and lifelong learners. Like medicine and health care more broadly, feedback is a practice imbued with emotion: saturated with feelings relevant to one's sense of self and one's status

How creative enquiry can help educators develop learners' person‐centredness

“…Unanimously across all the papers we have studied, humanising the learner, clinician or patient were also held up as important. For example, human failure might be thought about as inevitable (and therefore a shared experience) rather than as an individual trait 8 . Then, when senior clinicians choose to model humility and appropriate vulnerability, this allows others to engage and is a core part of establishing psychological safety, creating a powerful learning space for team working 9 .…”

“…Secondly, the ambiguity of the creative text allows for exploration of emotions typically seen as undesirable—of shame, guilt and thoughts often left lingering in the shadows. Doing so enables emotions which are usually ineffable and often pathologised (as discussed by Ajjawi, Olson and McNaughton 8 ) to be explored, and existing beliefs to be questioned (noted as key to the process of transformative learning by Van Schalkwyk et al 11 ). Finally, the otherness of the languages of the arts in the healthcare professional discipline may further support development of new perspectives, in a similar way to immersion in an unfamiliar context, for example, the clinical environment, 11 and, in combining both of these new spaces, may be additionally potent for transformative learning (e.g.…”

Expanding the discourse on emotion in health professions education

“…Medicine is philosophically framed as a partnership "that is respectful of, and responsive to, individual patient preferences, needs and values." 1 The shift to person-centred care was revolutionary, 2 eschewing the doctor-knows-best model of care to one acknowledging that "patients know best how well their health providers are meeting their needs." 3 Modern curricular frameworks formalised the shift from paternalism to person-centredness, expanding conceptualisations of physician competence to include the advocacy, collaboration and communication skills essential for centring care around patients' needs and goals.…”

“…The discussion of the impacts of emotion on learning, as well as on curricular, assessment, and evaluation processes in health professions education (HPE), remains small. Ajjawi et al's critical review on emotion in the feedback setting helps address this gap 1 . The authors explore scholarly discourses around emotion's role in feedback, describing four main types of discussion.…”

“…Ajjawi et al's critical review on emotion in the feedback setting helps address this gap. 1 The authors explore scholarly discourses around emotion's role in feedback, describing four main types of discussion. The dominant discourses revolve around emotion as a physiologic response to be mitigated and as a primarily cognitive skill to be regulated.…”