Resident impression management within feedback conversations: A qualitative study

Abstract

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.

An act of performance: Exploring residents’ decision‐making processes to seek help

“…He described that performance arises in two contexts: in the frontstage where ‘some aspects of the activity are expressively accentuated and other aspects, which might discredit the fostered impression, are suppressed’, 46 whereas in the backstage ‘the suppressed facts make an appearance’ 46 . Previous research on feedback conversations suggested how residents wanted to create a front stage performance to display confidence to supervisors 47 . While our results underline this finding, we also provide insights into the interplay between the frontstage and backstage.…”

More than meets the eye: The impact of imposter syndrome on feedback receptivity

“…By admitting our own limitations as educators, learners can better avoid the drive towards perfectionism and better accept that feedback is critical for growth. This would align with one participant's statement that they were more likely to incorporate feedback from an educator who demonstrates vulnerability than a ‘talking head or textbook walking around’ 3 . Additionally, imposter syndrome thrives in cultures where asking for help and identifying knowledge gaps are treated as a weakness 4 .…”

“…This would align with one participant's statement that they were more likely to incorporate feedback from an educator who demonstrates vulnerability than a 'talking head or textbook walking around'. 3 Additionally, imposter syndrome thrives in cultures where asking for help and identifying knowledge gaps are treated as a weakness. 4 Therefore, we should normalise identifying knowledge gaps and encourage learners to focus on their growth as opposed to merely the achievement of goals.…”

“…This requires the learner to be actively engaged in receiving and incorporating the feedback in order to best operationalise the changes. In ‘Resident impression management within feedback conversations: a qualitative study’, Huffman et al explore the tension between learners’ guarding of external impressions and their desire to grow and improve their skills 3 . The authors describe the impact of the perceived linkage between assessment of learning and assessment for learning upon feedback receptivity by the learner.…”

From Crisis to Growth: A Guiding, Pragmatic Model During a Global Pandemic

“…In residents receiving formative feedback, a growth mindset (contrasted with a fixed mindset) was associated with a focus on professional development, asking more questions, and looking for opportunities for growth. 16 A growth mindset has been associated with positive effects on the brain's neural network. 9 For institutional leaders, modeling a growth mindset 9,17 includes modeling transparency and self-compassion and an empathic response to patients and team members.…”